Enhancing Patient-Oncologist Communication

描述（由申请人提供）：当患者和医生面临着从对抗一种可能治愈的疾病到意识到传统疗法不再有效的转变时，关于癌症治疗的交流对他们来说是一种挑战。患者经常面临强烈的恐惧和损失，导致比治疗期间任何其他时间更大的情感需求。因为肿瘤学家也在努力应对这种转变，他们经常（但无意中）阻止患者透露情感担忧，从而错过了有效沟通的机会，导致患者更大的焦虑。不幸的是，没有容易传播的教育干预措施来帮助肿瘤学家克服这些挑战。我们提出一项随机对照试验，测试基于交互式CD-ROM的干预的有效性，使用肿瘤学家自己记录的接触反馈来改善他们的沟通。在这项为期五年的两个地点（杜克大学和匹兹堡大学）研究的基线上，我们将录音记录400次门诊会面，肿瘤学家（n=50）和晚期癌症患者（n=200）讨论向姑息治疗的过渡。这些数字化的录音将被编码，以供肿瘤学家引出患者的担忧，并对情感内容做出反应。

DESCRIPTION (provided by applicant): Communication about cancer treatment challenges patients and physicians as they face the transition from fighting a potentially curable disease to realizing that conventional therapies are no longer effective. Patients often confront intense fear and loss, leading to greater emotional needs than at any other time during treatment. Because oncologists also struggle with this transition, they frequently, yet inadvertently, discourage patients from disclosing emotional concerns and thus miss opportunities to communicate effectively, resulting in greater patient anxiety. Unfortunately, no easily disseminable educational interventions exist to help oncologists overcome these challenges. We propose a randomized, controlled trial testing the efficacy of an interactive CD-ROM based intervention using feedback from the oncologists' own recorded encounters to improve their communication. At baseline of this five-year, two site (Duke and the University of Pittsburgh) study, we will audio record 400 outpatient encounters between oncologists (n=50) and patients with advanced cancer (n=200) as they discuss the transition to palliative care. These digitized recordings will be coded for the oncologists eliciting patients' concerns and responding to emotional content. After baseline assessment, we will randomly assign the oncologists to intervention and control arms. The intervention oncologists each will receive a personalized user-friendly CD-ROM that contains their coded conversations, packaged with related educational material. A technical advisor will encourage and facilitate their use of materials. The control group will not receive the CD-ROM or any other support. Three months later, we will conduct the post-intervention assessment by recording another 400 clinic visits between these same oncologists (intervention and control) and a new sample of patients to measure the intervention impact. Primary outcomes will be the communication behaviors emphasized in the intervention, such as responding to empathic opportunities and eliciting patient concerns. This project will expand the field of oncologist-patient communication by identifying key communication skills that may assist patients through difficult transitions and by creating an easily disseminable intervention to help oncologists implement these skills.