Empathic Communication Skills Training to Reduce Lung Cancer Stigma

同理心沟通技巧培训可减少肺癌耻辱感

基本信息

批准号：
10682462
负责人：
Smita Banerjee
金额：
$ 71.47万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-09 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10682462
关键词：
Address American Cancer Society Attitude Cancer Patient Client satisfaction Clinical Clinical Nursing Clinical Trials Cluster randomized trial Communication Communities Community Clinical Oncology Program Community Healthcare Community Networks Comprehensive Cancer Center Consent Continuity of Patient Care Control Groups Counseling Diagnosis Disclosure Distress Educational process of instructing Effectiveness Emotions Empathy Evaluation Family Foundations Friends Funding General Population Goals Guilt Health Health Personnel Hour Intervention Lung Malignant neoplasm of lung Measures Medical Medical History Nurse Practitioners Nurses Oncology Outcome Participant Patient Care Patient Outcomes Assessments Patient advocacy Patient-Focused Outcomes Patients Perception Personal Satisfaction Physician Assistants Physicians Pilot Projects Provider Psychosocial Assessment and Care Pulmonology Regrets Reporting Research Self Efficacy Services Shame Site Smoke Smoker Smoking Smoking Behavior Smoking History Social isolation Symptoms Thoracic Oncology Thoracic Surgical Procedures Tobacco Use Cessation Training Training Activity Waiting Lists Well in self advocacy organizations arm cancer care cancer diagnosis care delivery site care outcomes care providers care systems clinical encounter clinically relevant effective intervention empowerment experience former smoker group intervention health assessment help-seeking behavior improved multi-site trial patient-clinician communication pilot test pilot trial primary care provider primary outcome psychological distress psychological outcomes public health relevance relapse prevention response routine provider satisfaction secondary outcome skills skills training social stigma stem treatment as usual uptake

项目摘要

PROJECT SUMMARY Nearly all (95%) patients diagnosed with lung cancer report perceiving stigma, defined as a perception and internalization of negative appraisal and devaluation by self and others attributable to a lung cancer diagnosis. Prior research indicates that 48% of patients with lung cancer experience stigma during clinical encounters with their oncology care providers (OCPs), which may be potentially triggered and/or exacerbated by OCPs’ routine assessment of smoking history. Perceived stigma has negative effects on patients’ psychological well- being as well as their medical outcomes. Promoting empathic communication appears to be a potentially effective intervention target to help reduce patients’ perceptions of stigma within clinical encounters; however, no formal trainings exist that focus on teaching empathic communication to OCPs. To address this key need, we developed an Empathic Communication Skills (ECS) training focusing on the communication challenges inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients. Building upon favorable findings from a prior R21 (R21CA202793), our goal is to conduct a national trial of ECS training to facilitate improvements in the medical and psychosocial care of lung cancer patients through de-stigmatizing interactions with OCPs. We will conduct a cluster randomized trial at 16 lung cancer care delivery sites, comparing ECS training (intervention group) with a Waitlist Control Group (WLC) among 160 OCPs (thoracic oncology physicians and advance practice providers) and 960 lung cancer patients (6 patients per clinician). The ECS training will be offered remotely and include all the didactic and experiential training materials that were developed for the pilot trial. To increase the real-world generalizability of our trial, we will leverage two national networks of community oncology practices, the Care Continuum Centers of Excellence coordinated by our lung cancer patient advocacy partner, the Go2 Foundation for Lung Cancer and the Extension for Community Healthcare Outcomes (ECHO) sites for lung cancer care, supported by an American Cancer Society ECHO Hub. The aims of this study are (1) to evaluate the impact of the ECS training on OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (training appraisal – relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); (2) to evaluate the impact of the ECS training vs. WLC on patients’ reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with communication, psychological distress, social isolation, and patients’ experience of clinical encounter). Additionally, acceptance of referral to tobacco cessation (for current smokers) and relapse prevention (for former smokers) will be explored; and (3) to examine potential moderators of OCP and patient outcomes. Our central hypothesis is that the ECS training will demonstrate significant improvements in clinicians’ uptake of empathic skills and self-efficacy and will be superior to WLC with regards to patient reported measures of stigma, clinician empathy, satisfaction, and overall experience.

项目概要几乎所有（95%）被诊断患有肺癌的患者都表示感受到耻辱，定义为一种看法和由于肺癌诊断而导致的自我和他人的负面评价和贬低的内化。先前的研究表明，48% 的肺癌患者在临床就诊时经历过耻辱与其肿瘤护理提供者 (OCP) 的接触，这可能会因 OCP 的吸烟史的常规评估对患者的心理健康有负面影响。促进同理心沟通似乎是一种潜在的治疗效果。然而，有效的干预目标有助于减少患者在临床遭遇中的耻辱感；没有专门针对 OCP 进行同理心沟通的正式培训来满足这一关键需求。我们开发了移情沟通技巧（ECS）培训，重点关注沟通挑战 OCP 与肺癌患者讨论吸烟行为和病史的固有内容。根据之前的 R21 (R21CA202793) 的有利结果，我们的目标是进行 ECS 培训全国试验通过去污名化促进肺癌患者的医疗和社会心理护理的改善我们将在 16 个肺癌护理中心进行整群随机试验，将 ECS 培训（干预组）与 160 名 OCP（胸部肿瘤科医生和高级实践提供者）和 960 名肺癌患者（每位临床医生 6 名患者）。 ECS 培训将远程提供，包括所有教学和体验培训材料为了提高我们的试验在现实世界中的普遍性，我们将利用两个。全国社区肿瘤学实践网络、卓越护理连续体中心的协调我们的肺癌患者倡导合作伙伴 Go2 肺癌基金会和 Extension for 由美国癌症协会支持的肺癌护理社区医疗保健成果 (ECHO) 网站 ECHO 中心。本研究的目的是 (1) 评估 ECS 培训对 OCP 主要结果的影响。（沟通和共情技能的掌握）和次要结果（培训评估——相关性、新颖性、清晰度；自我效能感、与患者沟通的态度）；（2）评估 ECS 的影响培训与 WLC 关于患者报告的主要结果（肺癌耻辱）和次要结果的比较（感知到的临床医生同理心、沟通满意度、心理困扰、社会孤立和患者的临床经历）。将探索预防复吸（针对前吸烟者）的方法；(3) 检查潜力；我们的中心假设是 ECS 培训将证明 OCP 和患者结果的调节因素。人群对同理心技能和自我效能的接受度显着提高，并且将优于 WLC 关于患者报告的耻辱感、临床医生同理心、满意度和整体体验的衡量标准。