Oncologist Communication Skills Intervention Assessment

描述(由申请人提供)：医生的沟通技巧是提供高质量姑息治疗的基础。最近的研究表明，根据专家程序员的评估，旨在改善沟通的教育干预可以改变医生的行为。然而，到目前为止，还没有研究检验专家编码员注意到的交流行为的变化是否也被患者和家人注意到或重视。科学知识的这一差距是理解提高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。在前期工作中，我们为医学肿瘤学研究员设计、实施和评估了一项为期4天的密集沟通技能干预，称为OncoTalk(美国国家癌症研究所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过渡到临终关怀(即将护理目标从抗癌治疗转移到生活质量)，但几乎没有得到实证研究。我们利用Oncotalk前后标准化的患者会面来衡量沟通技能的获得，这些会面被录音，并使用基于内容的编码系统进行分析。这些OncoTalk前后的音频文件提供了一个独特的研究机会，以检验医生沟通技能改进的重要性。在这一修订中，我们先征求患者和家人对过渡对话的看法，然后向他们展示一对随机顺序的单一医生在Oncotalk之前和之后的标准化患者会面。然后，我们将让受试者选择哪种遭遇代表了更有效的医生沟通，最后要求受试者解释他们选择的原因。这项建议的具体目标是：1.确定和描述医生在讨论过渡到姑息治疗时的关键沟通技能，这些技能受到患者和家庭照顾者的重视。2.使用专家编码系统，比较患者和家庭照顾者对Oncotalk前后关于过渡的对话的评价。3.确定和描述医生在过渡到姑息治疗方面的关键技能，患者认为这些技能在OncoTalk后有所改善。以经验为基础的沟通技能培训有可能改善患者的预后，包括减少痛苦、提高依从性和减少临床医生的倦怠。这项建议将开发一种新的方法来评估医生沟通的变化，绕过现有评级标准和以患者为中心的话语分析的限制，并为未来整合专家、患者和家庭观点并改善患者结果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.