Communication in Oncologist Patient Encounters: A Patient Intervention

描述（申请人提供）：晚期癌症患者遭受身体和精神上的痛苦。癌症患者会产生焦虑和抑郁，从而导致功能受损和健康状况恶化。肿瘤医生可以减轻患者的情感担忧，研究表明，患者希望他们的肿瘤医生关注他们的情感需求。然而，患者的情感问题往往被忽略。在SCOPE试验（肿瘤医生与患者交流研究）中，我们观察了51名肿瘤医生和270名晚期癌症患者之间的398次门诊就诊，发现患者仅在37%的就诊中表达了情感，医生仅对27%的这些提示做出了共情反应。作为回应，我们创造了一种创新的CD- ROM干预来训练医生认识和回应病人的担忧。采用随机对照设计，我们发现接受干预的肿瘤学家对患者情感表达的共情陈述作出反应的可能性是其两倍以上。然而，改善医生的行为只是解决方案的一部分。在这一竞争性更新中，我们提出了一项基于网络干预的随机对照试验，该干预训练患者向肿瘤医生表达情感，请求支持，并克服障碍以满足他们的情感需求。我们假设这种方法将对患者激活的仅信息方法具有累加效应。我们将从两个研究地点（杜克大学和匹兹堡大学）招募50名肿瘤学家、50名中级医疗服务提供者和400名晚期癌症患者。在2x2因子设计中，我们将患者随机分配到四组之一：对照组（标准互联网接入）；CHESS（一个已建立的认知导向的癌症信息网站）；COPE（互动式、量身定制的沟通培训，并回顾患者自己的诊所遭遇）；和国际象棋+应付。我们将录音记录三次门诊就诊（基线和两次后续就诊），让患者接触干预措施，并在就诊后对患者进行调查。我们的结果是患者在访问中表达的情感关注和对情感支持的请求，以及访问后患者的影响。该项目旨在创造一种易于传播的干预手段，帮助癌症患者获得情感支持。

DESCRIPTION (provided by applicant): Patients with advanced cancer suffer from physical and emotional distress. Living with cancer generates anxiety and depression that can lead to impaired function and worse health outcomes. Oncologists can alleviate patients' emotional concerns, and research shows that patients want their oncologists to attend to their emotional needs. However, patients' emotional concerns are frequently missed. In the SCOPE Trial (Study of Communication in Oncologist Patient Encounters), we observed 398 clinic visits between 51 oncologists and 270 advanced cancer patients and found that patients expressed emotion in only 37% of visits, and physicians responded empathically to only 27% of these cues. In response, we created an innovative CD- ROM intervention to train physicians to recognize and respond to patient concerns. Using a randomized, controlled design, we found that oncologists receiving the intervention were more than twice as likely to respond to patient expressions of emotion with empathic statements. Yet, improving physician behavior can only be part of the solution. In this competing renewal, we propose a randomized, controlled trial of a web- based intervention that trains patients to express emotion to their oncologists, request support, and overcome barriers to having their emotional needs met. We hypothesize that this approach will have additive effect over information only approaches to patient activation. We will enroll 50 oncologists, 50 mid-level providers and 400 advanced cancer patients from our two study sites (Duke and the University of Pittsburgh). In a 2x2 factorial design, we will randomly assign patients into one of four arms: Control (standard internet access); CHESS (an established, cognitively oriented cancer information website); COPE (interactive, tailored communication training with review of patients' own clinic encounters); and CHESS+COPE. We will audio- record three clinic encounters (baseline and two subsequent visits), expose patients to the intervention, and conduct post-visit patient surveys. Our outcomes are patient expressions of emotional concerns and requests for emotional support in the visit, and post-visit patient affect. This project aims to create an easily disseminable intervention to help cancer patients receive emotional support.