Preparation for survivorship beyond primary cancer treatment is vital so that each patient understands their ongoing care plan. Our proposal is to introduce a new clinical consultation that focuses deliberately on survivorship, promotes knowledge about long term and late effects of anti-cancer treatment and discusses the health promotion and lifestyle risk reduction approaches for future wellbeing. Such consultations are not current standard practice. This is a radical shift in clinical practice and gives each patient a document termed "Treatment Summary and Future Care Plan." Our study involves a Communication Skills Training (CST) intervention to train clinicians in the use of this new survivorship consultation. The excellent survival rates for Hodgkin's and Diffuse Large B-cell Lymphoma create an ideal study population. In a four-site, randomized controlled trial, we will compare this CST-based consultation by 18 clinicians with an attention-time control intervention by 18 clinicians who discuss diet and exercise. Our primary outcomes will be change in patient's knowledge about survivorship and adherence to health recommendations, while secondary outcomes will include satisfaction with care, perception of alliance with their clinician, decreased cancer worry and improved quality of life over time. We will also examine the uptake and utilization by clinicians of the strategies, tasks and skills taught in the CST workshop. At baseline, we will establish current patterns of communication by recording 2 patients per clinician to enable us to later control for site variations in practice. In our RCT, we will randomize by site to protect against contamination effects and will examine outcomes for 288 patients, eight nested within each clinician. These patients will be followed longitudinally for 12 months with outcome questionnaires. Patients in our control arm will receive matched timing of consultations, which will follow a structured manual that standardizes the focus on diet and exercise. We will monitor for contamination effects by recording consultations in intervention and control arms once chemotherapy is concluded, at the key new survivorship consultation and again three months later. Our study will explore the moderators and mediators of change in the use of health information to build up the patient's understanding of their survivorship care plan and of cancer survivorship as a prototype of the common- sense model of illness representation and behavioral self-regulation. We anticipate that more empathic communication will support the integration of greater knowledge and adherence to recommended health- promotion behaviors, leading to reduced worry, improved quality of life and better utilization of health care resources over time.
With effective anti-cancer treatments, cancer survivorship is a status affecting more and more millions, but without medicine having the approach to inform and guide these patients in their adaptation to this new state, with its myriad risks of long term and late effects, fear of recurrence, reduced quality of life and neglect of health promotion and wellness. This communication skills training intervention for lymphoma survivorship will establish the efficacy of a model that is readily generalizable to all cancers and will enormously enrich the health care of our nation through its dedicated focus on survivorship issues in a new clinical consultation.