Communication Skills Education Program for Oncology

描述(申请人提供)：医患之间的有效沟通是优质医疗的基础。在肿瘤学的背景下，医患沟通尤其重要，因为肿瘤学家与患者讨论困难的问题。这些对话通常包括讨论预后，确保患者和家人了解治疗的突出风险和副作用，评估和应对心理痛苦，管理从治愈目标到姑息目标的护理过渡，以及努力接受死亡过程。研究表明，肿瘤学家，特别是新培训的肿瘤学家，几乎没有接受过关于如何就此类问题进行有效沟通的培训。因此，患者有未得到满足的信息和情感需求，他们在整个护理过程中的适应受到与临床医生的互动和支持的影响。在过去的十年中，为了提高沟通技巧和效率的干预措施已经被开发出来，并在随机对照试验中进行了测试，并被证明在改变医生沟通方面是有效的。在综合癌症中心建立高级沟通技能培训计划是全国肿瘤学的关键培训需求。此应用程序通过仔细检查在纪念斯隆-凯特琳癌症中心试行的一个教育项目来回应这一需求。 这项提案的总体目标是为肿瘤学制定一个沟通技能教育计划。该计划将通过三个核心提供支持：教育核心、教师发展和培训核心以及评估核心。这项建议的具体目标是：目标1：通过教育核心为综合癌症中心实施沟通培训课程，以提高内科、外科和儿科研究员和初级教员就复杂的肿瘤学问题与患者和家人有效沟通的能力；目标2：通过学院发展和培训核心支持这一沟通培训课程。该培训核心将维持针对主治医生的教师发展计划，并将向辅导员提供持续培训和反馈，以更好地教授沟通技能；目标3：通过评估核心，通过几个级别的考试，评估这些计划对研究员和初级教师的结果，包括：自我评估、标准化患者评估的表现、临床接触的表现和患者报告的结果。 在这项提案中，我们将在264名参与者中展示7模块教育计划的有效性，并通过使用柯克帕特里克三角评估策略来评估其有效性，评估策略从级别1，学习者的反应，到级别2，通过标准化的患者评估，学习和技能获取的自我效能，到级别3，将技能转移到临床，最后在级别4，对896名患者的咨询做出回应，评估患者结果。我们假设培训的剂量将直接影响技能吸收，将探索可归因于促进者能力的技能吸收的差异比例，并评估培训前后患者对临床医生沟通质量的感知的变化。 公共卫生相关性：这一针对肿瘤学家的专业R25癌症教育计划将开发和试验一项全面的沟通技能培训课程，旨在提高内科、外科和放射肿瘤学教职员工与患者和家人就复杂的肿瘤学问题进行有效沟通的能力。

DESCRIPTION (provided by applicant): Effective communication between physician and patient is the foundation of quality medical care. In the oncology setting, physician-patient communication is particularly important because oncologists discuss difficult issues with patients. These conversations typically include discussing prognosis, ensuring patient and family understand the prominent risks and side-effects of treatments, assessing and responding to psychological distress, managing the transition of care from a curative to palliative goal, and working to accept the dying process. Research suggests that oncologists, particularly newly trained oncologists, receive little training in how to communicate effectively about such issues. As a result, patients have unmet informational and emotional needs and their adaptation across the course of care is influenced by the interaction with and support they receive from the clinician. Over the course of the last decade, interventions to improve communication skill and efficacy have been developed and tested in RCTs, and have proven efficacy in altering physician communication. The establishment of programs of advanced communication skills training at Comprehensive Cancer Centers is a key training need for oncology nationally. This application responds to this need with a careful examination of an educational program piloted at Memorial Sloan-Kettering Cancer Center. The overall goal of this proposal is to develop a Communication Skills Education Program for Oncology. This program will be supported through three cores: an Education Core, a Faculty Development and Training Core, and an Evaluation Core. The specific aims of this proposal are: Aim 1: To implement through an Education Core a communication training curriculum for Comprehensive Cancer Centers to improve the ability of medical, surgical, and pediatric fellows and junior faculty to communicate with patients and families effectively about complex oncological issues; Aim 2: To support this communication training curriculum through a Faculty Development and Training Core. This training core will maintain a faculty development program for attending physicians and will offer continuing training and feedback to facilitators to better teach communication skills; Aim 3: To assess through an Evaluation Core the outcomes of these programs on fellows and junior faculty through examination at several levels including: self-assessment, performance in standardized patient assessments, performance in clinical encounters, and patient reported outcomes. In this proposal, we will demonstrate the efficacy of a 7-module educational program on 264 participants and evaluate its effectiveness through the use of the Kirkpatrick's triangle of evaluation strategies from level 1, reaction of learners, to level 2, self-efficacy of learning and skill uptake via standardized patient assessments, to level 3, transfer of skills into the clinic, and finally at level 4, patient outcome in response to the consultation for 896 patients assessed. We hypothesize that dose of training will directly impact skill uptake, will explore the proportion of variance in skill uptake attributable to facilitator competence and assess the change pre to post training in patient's perception of the quality of the clinician's communication. PUBLIC HEALTH RELEVANCE: This specialized R25 cancer education program for oncologists will develop and trial a comprehensive communication skills training curriculum aimed at improving the ability of medical, surgical and radiation oncology faculty and fellows to communicate with patients and families effectively about complex oncological issues.