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.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
O'Mara, Ann M
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Tulsky, James A; Arnold, Robert M; Alexander, Stewart C et al. (2011) Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med 155:593-601
Pollak, Kathryn I; Arnold, Robert; Alexander, Stewart C et al. (2010) Do patient attributes predict oncologist empathic responses and patient perceptions of empathy? Support Care Cancer 18:1405-11
Rodriguez, Keri L; Bayliss, Nichole; Alexander, Stewart C et al. (2010) How oncologists and their patients with advanced cancer communicate about health-related quality of life. Psychooncology 19:490-9
Pollak, Kathryn I; Alexander, Stewart C; Grambow, Steven C et al. (2010) Oncologist patient-centered communication with patients with advanced cancer: exploring whether race or socioeconomic status matter. Palliat Med 24:96-8
Casarett, David; Pickard, Amy; Fishman, Jessica M et al. (2010) Can metaphors and analogies improve communication with seriously ill patients? J Palliat Med 13:255-60
Kennifer, Sarah L; Alexander, Stewart C; Pollak, Kathryn I et al. (2009) Negative emotions in cancer care: do oncologists'responses depend on severity and type of emotion? Patient Educ Couns 76:51-6
Borrero, Sonya; Nikolajski, Cara; Rodriguez, Keri L et al. (2009) "Everything I know I learned from my mother...Or not": perspectives of African-American and white women on decisions about tubal sterilization. J Gen Intern Med 24:312-9
Skinner, Celette Sugg; Pollak, Kathryn I; Farrell, David et al. (2009) Use of and reactions to a tailored CD-ROM designed to enhance oncologist-patient communication: the SCOPE trial intervention. Patient Educ Couns 77:90-6
Pollak, Kathryn I; Alexander, Stewart C; Ostbye, Truls et al. (2009) Primary care physicians'discussions of weight-related topics with overweight and obese adolescents: results from the Teen CHAT Pilot study. J Adolesc Health 45:205-7
Robinson, Tracy M; Alexander, Stewart C; Hays, Margie et al. (2008) Patient-oncologist communication in advanced cancer: predictors of patient perception of prognosis. Support Care Cancer 16:1049-57

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