Empathic Communication Skills Training to Reduce Lung Cancer Stigma

项目摘要 几乎所有（95%）被诊断患有肺癌的患者都报告说感觉到了耻辱，定义为一种感觉， 自我和他人对肺癌诊断的负面评价和贬低的内化。 先前的研究表明，48%的肺癌患者在临床就诊时经历过耻辱感。 与他们的肿瘤护理提供者（OCP），这可能是潜在的触发和/或加剧OCP的 常规评估吸烟史。知觉耻辱感对患者的心理健康有负面影响- 以及他们的医疗结果。促进移情沟通似乎是一种潜在的 有效干预目标是帮助减少患者在临床就诊中对污名的感知;然而， 不存在专注于向OCP教授移情沟通的正式培训。为了满足这一关键需求， 我们开发了一个移情沟通技巧（ECS）培训，重点是沟通的挑战 OCP与肺癌患者讨论吸烟行为和吸烟史的内在原因。基础上 从先前的R21（R21 CA 202793）中获得了有利的发现，我们的目标是进行ECS培训的国家试验， 通过消除对肺癌患者的污名化，促进改善对肺癌患者的医疗和心理社会护理 与OCP的互动我们将在16个肺癌治疗中心进行一项随机分组试验， 在160名OCP（胸）中比较ECS培训（干预组）和候补对照组（WLC） 肿瘤医生和高级实践提供者）和960名肺癌患者（每名临床医生6名患者）。 ECS培训将远程提供，包括所有教学和体验培训材料， 是为试点试验而开发的。为了增加我们试验的真实世界的普遍性，我们将利用两个 社区肿瘤学实践的国家网络，护理连续卓越中心， 我们的肺癌患者倡导合作伙伴，Go2肺癌基金会和 社区医疗结果（ECHO）网站肺癌护理，由美国癌症协会支持 ECHO中心。本研究的目的是：（1）评估ECS培训对OCP主要结局的影响 （沟通和移情技能吸收）和次要结果（培训评估-相关性，新奇， 明确性、自我效能、与患者沟通的态度）;（2）评价ECS的影响 培训与WLC对患者报告的主要结局（肺癌污名）和次要结局的比较 （感知的临床医生同理心，沟通满意度，心理困扰，社会孤立，以及 患者的临床经验）。此外，接受戒烟转诊（目前 （3）研究预防吸烟者复吸的方法;及 OCP和患者结局的调节者。我们的中心假设是，ECS培训将证明 在临床医生的移情技能和自我效能的摄取显着改善，并将优于WLC上级 关于患者报告的耻辱、临床医生同情、满意度和整体体验的测量。

PROJECT SUMMARY Nearly all (95%) patients diagnosed with lung cancer report perceiving stigma, defined as a perception and internalization of negative appraisal and devaluation by self and others attributable to a lung cancer diagnosis. Prior research indicates that 48% of patients with lung cancer experience stigma during clinical encounters with their oncology care providers (OCPs), which may be potentially triggered and/or exacerbated by OCPs’ routine assessment of smoking history. Perceived stigma has negative effects on patients’ psychological well- being as well as their medical outcomes. Promoting empathic communication appears to be a potentially effective intervention target to help reduce patients’ perceptions of stigma within clinical encounters; however, no formal trainings exist that focus on teaching empathic communication to OCPs. To address this key need, we developed an Empathic Communication Skills (ECS) training focusing on the communication challenges inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients. Building upon favorable findings from a prior R21 (R21CA202793), our goal is to conduct a national trial of ECS training to facilitate improvements in the medical and psychosocial care of lung cancer patients through de-stigmatizing interactions with OCPs. We will conduct a cluster randomized trial at 16 lung cancer care delivery sites, comparing ECS training (intervention group) with a Waitlist Control Group (WLC) among 160 OCPs (thoracic oncology physicians and advance practice providers) and 960 lung cancer patients (6 patients per clinician). The ECS training will be offered remotely and include all the didactic and experiential training materials that were developed for the pilot trial. To increase the real-world generalizability of our trial, we will leverage two national networks of community oncology practices, the Care Continuum Centers of Excellence coordinated by our lung cancer patient advocacy partner, the Go2 Foundation for Lung Cancer and the Extension for Community Healthcare Outcomes (ECHO) sites for lung cancer care, supported by an American Cancer Society ECHO Hub. The aims of this study are (1) to evaluate the impact of the ECS training on OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (training appraisal – relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); (2) to evaluate the impact of the ECS training vs. WLC on patients’ reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with communication, psychological distress, social isolation, and patients’ experience of clinical encounter). Additionally, acceptance of referral to tobacco cessation (for current smokers) and relapse prevention (for former smokers) will be explored; and (3) to examine potential moderators of OCP and patient outcomes. Our central hypothesis is that the ECS training will demonstrate significant improvements in clinicians’ uptake of empathic skills and self-efficacy and will be superior to WLC with regards to patient reported measures of stigma, clinician empathy, satisfaction, and overall experience.