Oncologist Communication Skills Intervention Assessment

描述（由申请人提供）：医师沟通技巧是提供高质量姑息治疗的基础。最近的研究表明，旨在改善沟通的教育干预措施可以改变医生的行为，由专家编码器评估。然而，到目前为止，还没有研究检查专家编码器注意到的沟通行为的变化是否也被患者和家庭成员注意到或重视。科学知识的这种差距是理解改善医生沟通技能如何影响癌症患者姑息治疗结果的关键障碍。在初步工作中，我们设计、实施并评估了针对内科肿瘤学研究员的为期4.5天的强化沟通技能干预，名为“Oncotalk”（NCI R25 92055）.7我们在Oncotalk中教授的基本沟通任务之一是从抗癌治疗到临终关怀的过渡，这一点几乎没有得到实证研究（即将护理目标从抗癌治疗转向生活质量）。我们使用Oncotalk前后标准化的患者接触来测量沟通技能的获得，这些患者接触使用基于内容的编码系统进行录音和分析。这些前后Oncotalk音频文件提供了一个独特的研究机会，以检查改善医生沟通技能的意义。在这次修订中，我们引出了患者和家属对过渡对话的看法，然后以随机顺序向他们展示了一位医生在Oncotalk前后的标准化患者遭遇。然后，我们将要求受试者选择哪种接触代表更有效的医生沟通，最后要求受试者解释他们选择的原因。该提案的具体目标是：1.识别和描述医生沟通技巧的关键素质，在讨论过渡到姑息治疗，病人和家庭照顾者的价值。2.比较患者和家庭护理人员对Oncotalk前后关于专家编码系统的过渡对话的评价。3.识别并描述Oncotalk后患者认为改善的关于过渡到姑息治疗的医生沟通技能的关键品质。基于经验的沟通技巧培训有可能改善患者的预后，包括减少痛苦，提高依从性，减少临床医生的倦怠。该提案将开发一种新的方法来评估医生沟通的变化，以规避现有的以患者为中心的评级量表和话语分析的局限性，并为未来整合专家，患者和家庭观点并改善患者结局的沟通技能干预提供基础。

DESCRIPTION (provided by applicant): Physician communication skills are fundamental to providing high quality palliative care. Recent studies demonstrate that educational interventions designed to improve communication can change physician behavior, as assessed by expert coders. However, to date no studies have examined whether the changes in communication behaviors noticed by expert coders are also noticed or valued by patients and family members. This gap in scientific knowledge is a critical barrier to understanding how improving physician communication skills influences palliative care outcomes for patients with cancer. In preliminary work, we have designed, implemented, and evaluated an intensive 4.5 day communication skills intervention for Medical Oncology fellows, called `Oncotalk'(NCI R25 92055).7 One of the essential communication tasks we teach in Oncotalk that has received little empirical study is Transitions from anticancer therapy to end-of-life care (i.e. shifting goals of care from anticancer treatment to quality of life). We measured communication skill acquisition using pre- and post-Oncotalk standardized patient encounters that were audiotaped and analyzed using a content-based coding system. These pre- and post-Oncotalk audiofiles provide a unique research opportunity to examine the significance of improvements in physician communication skills. In this revision, we elicit patient and family views about transitions conversations before presenting them with pairs of pre- and post-Oncotalk standardized patient encounters from a single physician in random order. We will then ask subjects to choose which encounter represents more effective physician communication, and finally ask subjects to explain the reasons for their choice. The specific aims of this proposal are: 1. To identify and describe key qualities of physician communication skills in discussing transitions to palliative care that are valued by patients and family caregivers. 2. To compare patient and family caregiver evaluations of pre- and post-Oncotalk conversations about transitions with an expert coding system. 3. To identify and describe key qualities of physician communication skills about transitions to palliative care that patients perceive as improved after Oncotalk. Empirically based training in communication skills has the potential to improve patient outcomes, including decreased suffering, improved adherence, and reduced clinician burnout. This proposal will develop a novel method of assessing changes in physician communication that circumvents limitations of existing rating scales and utterance analyses that is patient-centered, and provide a basis for future communication skills interventions that integrate expert, patient, and family perspectives and improve patient outcomes.