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。与癌症生活在一起会产生焦虑和抑郁，这可能会导致功能受损和更糟糕的健康结果。肿瘤学家可以缓解患者的情绪担忧，研究表明，患者希望他们的肿瘤学家照顾他们的情绪需求。然而，患者的情感关切经常被遗漏。在SCOPE试验(肿瘤学家患者接触中的沟通研究)中，我们观察了51名肿瘤学家和270名晚期癌症患者之间的398次临床访问，发现只有37%的患者表达了情感，医生只对这些暗示中的27%做出了同理心的反应。作为回应，我们创建了一种创新的CD-ROM干预方法，以培训医生识别和回应患者的关切。使用随机对照设计，我们发现接受干预的肿瘤学家用移情陈述回应患者情绪表达的可能性是对照组的两倍以上。然而，改善医生的行为只能是解决方案的一部分。在这个相互竞争的更新中，我们建议进行一项基于网络的干预的随机对照试验，培训患者向他们的肿瘤学家表达情感，请求支持，并克服障碍，使他们的情感需求得到满足。我们假设，这种方法将对患者激活的纯信息方法产生附加效应。我们将从我们的两个研究地点(杜克大学和匹兹堡大学)招募50名肿瘤学家、50名中级提供者和400名晚期癌症患者。在2x2析因设计中，我们将患者随机分配到四个臂中的一个：对照组(标准互联网接入)；国际象棋(一个已建立的、面向认知的癌症信息网站)；COPE(互动的、量身定制的沟通培训，回顾患者自己的临床遭遇)；以及国际象棋+COPE。我们将对三次门诊会面(基线和随后的两次访问)进行录音，让患者接受干预，并进行访问后的患者调查。我们的结果是患者在访问中表达了情感关注和请求情感支持，以及访问后的患者情绪。该项目旨在创建一种易于传播的干预措施，帮助癌症患者获得情感支持。公共卫生相关性：许多晚期癌症患者在情绪上遭受痛苦，可能会导致焦虑、抑郁，甚至降低存活率。研究表明，当患者与医生讨论他们的担忧时，他们会感觉更好，结果也更好。这项研究将测试一项针对癌症患者的网络教育计划，以帮助他们与医生讨论他们的情感问题，并请求他们的支持。如果成功，我们将开发出一种癌症患者易于获得的工具，将加强他们与肿瘤医生的沟通，并提高他们的生活质量。

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. PUBLIC HEALTH RELEVANCE: Many patients with late stage cancer suffer emotionally in ways that can lead to anxiety, depression, and even decreased survival. Research suggests that when patients discuss their concerns with their doctors, they feel better and have better outcomes. This study will test a web-based educational program for patients with cancer to help them discuss their emotional concerns with their doctors and request their support. If successful, we will have developed a tool that is easily accessible to cancer patients, will enhance their communication with their oncologists, and improve their quality of life.