Empathic communication skills training to reduce lung cancer stigma in Nigeria

项目摘要 肺癌是全世界男性和女性癌症相关死亡的主要原因，并且大约 其中70%的死亡发生在低收入和中等收入国家（LMIC）。在撒哈拉以南非洲的研究 (SSA)不幸的是，肺癌在2015 - 2018年成为男性第三大最常见的癌症。 特征为晚期表现（3期和4期），75%的患者仅在 晚期在阻止寻求肺癌治疗的许多因素中，有一个是耻辱， 特别是在医疗接触中预期的肺癌耻辱。我们之前的国家癌症研究所资助的癌症耻辱 一项研究开发了一种患者报告的肺癌污名测量方法（肺癌污名量表-LCSI） 并证明在与肿瘤护理提供者（OCP）接触期间经历的耻辱感有助于 延迟症状表现和肺癌治疗的开始。减轻感知的一种方法 肺癌患者所经历的污名是医疗过程中移情沟通的实施， 探访我们最近在Memorial开发了同理心沟通技巧（ECS）培训模块 Sloan Kettering癌症中心在美国ECS培训模块侧重于解决沟通问题 OCP与肺癌患者讨论吸烟行为和吸烟史的固有挑战， 这是一种很有希望的方法来减少肺癌的耻辱感。使用ECS培训的初步研究 在改善OCP之间的沟通和提高患者满意度方面取得了令人鼓舞的成果。的 目前的提案旨在研究尼日利亚患者的肺癌耻辱感，并调整ECS用于 尼日利亚癌症护理机构。这项研究的目的是（a）适应文化和区域的相关性， 患者报告的肺癌污名和共情沟通技能测量工具（N-ECS） 通过评估污名的性质和频率，对治疗肺癌患者的OCP进行培训 尼日利亚肺癌患者的经验，和（B）检查的可行性和可接受性， 在尼日利亚治疗肺癌患者的OCP中进行N-ECS培训。对于目标1，研究者将 调整LCSI和ECS培训模块，以包括肺癌特异性临床小插曲和其他 培训材料（触发视频），使用以患者为中心的反馈， 来自尼日利亚伊巴丹大学学院医院和奥巴费米的20名肺癌患者代表 尼日利亚伊费岛，阿沃洛沃大学教学医院综合大楼。至于目的2，当局会从 同一医院参加2小时的N-ECS培训，并完成培训评估和 自我效能为了客观测量技能吸收，参与者将完成标准化患者 由来自MPI实验室的盲态工作人员编码的评估（SPA）。该研究还力求建立能力， 计划通过开发N-ECS，在尼日利亚进行多水平临床试验，以减轻肺癌的耻辱感， 基于美国高质量的循证ECS培训的成功。

Project Summary Lung cancer is the leading cause of cancer-related deaths in men and women worldwide, and approximately 70% of these deaths occur in low- and middle-income countries (LMICs). Prior research in sub-Saharan Africa (SSA) indicates that lung cancer became the 3rd most common cancer in men in 2015-2018, unfortunately characterized by late stage presentation (Stages 3 and 4) with 75% patients seeking medical care only at advanced stages. Among the many factors that deter seeking medical treatment for lung cancer is stigma, particularly anticipated lung cancer stigma during medical encounters. Our prior NCI-funded cancer stigma work has developed a patient-reported measure of lung cancer stigma (Lung Cancer Stigma Inventory – LCSI) and demonstrated that stigma experienced during encounters with oncology care providers (OCPs) contributes to delays in symptom presentation and initiation of treatment in lung cancer. One way to mitigate perceived stigma experienced by patients with lung cancer is enactment of empathic communication during medical visits. We have recently developed an Empathic Communication Skills (ECS) training module at Memorial Sloan Kettering Cancer Center in the USA. The ECS training module focuses on addressing communication challenges inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients and represents a promising approach to reduce lung cancer stigma. Preliminary studies using the ECS training have shown encouraging results in improving communication among OCPs and improving patient satisfaction. The current proposal is designed to examine lung cancer stigma in patients in Nigeria and adapt the ECS for use in Nigerian cancer care settings. The aims of the study are (a) to adapt for cultural and regional relevance a patient-reported tool for measurement of lung cancer stigma and an empathic communication skills (N-ECS) training for use with OCPs who treat patients with lung cancer by assessing the nature and frequency of stigma experiences by patients with lung cancer in Nigeria, and (b) to examine the feasibility and acceptability of the N-ECS training among OCPs who treat patients with lung cancer in Nigeria. For Aim 1, study investigators will adapt the LCSI and the ECS training module to include lung cancer-specific clinical vignettes and other training materials (trigger videos) that portray stigmatizing interactions using patient-centered feedback from 20 lung cancer patient representatives from University College Hospital, Ibadan, Nigeria and Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. For Aim 2, 25 OCPs will be recruited from the same hospitals to participate in the 2-hour N-ECS training, and complete measures of training evaluation and self-efficacy. For objective measurement of skill uptake, participants will complete standardized patient assessments (SPAs) coded by blinded staff from the MPIs’ labs. The study also seeks to build capacity for a planned multi-level clinical trial to mitigate lung cancer stigma in Nigeria by developing the N-ECS, building upon the success of high-quality, evidence-based ECS training in the USA.