Empathic Physician Communication and Stigma in Lung Cancer Patients

 大多数（95%）的肺癌患者报告说他们的家人，朋友和医疗服务提供者经历了肺癌的耻辱，其中48%的人特别报告说他们的医疗服务提供者经历了耻辱。这种耻辱感对患者的心理健康及其医疗结果产生负面影响。在临床咨询的背景下，医生经常调查患者的吸烟行为，这种感知到的耻辱感可能会加剧。因此，在这些临床遭遇期间，患者和医生之间的共情沟通对于减少患者感知的耻辱感并从而改善医患关系可能是至关重要的。反过来，这可能会导致患者报告更少的心理困扰，对医生更诚实，并接受医生的建议和帮助戒烟。尽管需要干预措施来改善这些互动，但很少有研究来研究如何减少患者感知的耻辱感。本研究的目的是：1）描述肿瘤医生和肺癌患者在一个新诊断的患者的临床咨询过程中的共情沟通，2）检查肿瘤医生的共情沟通与患者感知的耻辱，沟通满意度，心理困扰，戒烟的意图，并接受医生的建议和帮助戒烟之间的关系。为了实现这些目标，55名肺癌患者与医生的临床咨询将被录音。咨询后，患者将填写一份bref问卷，其中包括关于他们感知的耻辱感，沟通满意度和心理困扰的问题。他们还将参加一个简短的（15-20分钟）采访，询问他们在临床咨询中对污名的看法。分析将是双重的，将集中在医生和患者之间如何发生移情沟通（例如，错过了多少机会，共情沟通的程度，他们对病人焦虑、内疚、恐惧的反应方式等）以及检查移情沟通是否与患者减少耻辱感、减少心理困扰、提高沟通满意度和坚持戒烟计划有关。预计这些结果将提供初步证据的沟通干预，以改善潜在的污名化的相互作用内的共情沟通的发展。

 DESCRIPTION (provided by applicant): The majority (95 percent) of lung cancer patients report experiencing lung cancer stigma from their family, friends, and medical providers, with 48 percent specifically reporting experiencing stigma from their medical providers. This stigma has negative effects on patients' psychological well-being as well as their medical outcomes. This perceived stigma may be exacerbated within the context of clinical consultations in which physicians routinely probe about patients' smoking behaviors. As such, empathic communication between patients and physicians during these clinical encounters may be critical to reduce patient's perceived stigma and thus improve the patient-physician relationship. This, in turn, may lead patients to report less psychological distress, be more honest with their physicians, and accept their physicians' advice and assistance to quit smoking. Despite the need for an intervention to improve these interactions, there is little research to examine ways that patients' perceived stigma could be reduced. The goals of this study are to: 1) describe empathic communication between oncologists and lung cancer patients during a clinical consultation of a newly diagnosed patient and 2) examine the association between oncologists' empathic communication and patients' perceived stigma, satisfaction with communication, psychological distress, intent to quit smoking, and acceptance of physicians' advice and assistance to quit smoking. To meet these goals, 55 lung cancer patients' clinical consultations with their physicians will be audio recorded. After their consultation, patients will fill out a bref questionnaire that includes questions about their perceived stigma, satisfaction with communication, and psychological distress. They will also participate in a brief (15-20 minute) interview asking about their perceptions of stigma within their clinical consultation. Analyses wil be two-fold and will focus both on how empathic communication occurs between physicians and patients (e.g., how many missed opportunities, degree of empathic communication, ways they respond to patients' anxieties, guilt, fear, etc.) as well as examine if empathic communication is associated with patients' decreased stigma, decreased psychological distress, and improved satisfaction with communication and adherence to referral for a Tobacco Cessation Program. It is expected that these results will provide preliminary evidence for the development of a communication intervention to improve empathic communication within potentially stigmatizing interactions.