Effective communication between physician and patient is the foundation of quality medical care. In the oncology setting, physician-patient communication is particularly important because oncologists discuss difficult issues with patients. These conversations typically include discussing prognosis, ensuring patient and family understand the prominent risks and side-effects of treatments, assessing and responding to psychological distress, managing the transition of care from a curative to palliative goal, and working to accept the dying process. Research suggests that oncologists, particularly newly trained oncologists, receive little training in how to communicate effectively about such issues. As a result, patients have unmet informational and emotional needs and their adaptation across the course of care is influenced by the interaction with and support they receive from the clinician. Over the course of the last decade, interventions to improve communication skill and efficacy have been developed and tested in RCTs, and have proven efficacy in altering physician communication. The establishment of programs of advanced communication skills training at Comprehensive Cancer Centers is a key training need for oncology nationally. This application responds to this need with a careful examination of an educational program piloted at Memorial Sloan-Kettering Cancer Center. The overall goal of this proposal is to develop a Communication Skills Education Program for Oncology. This program will be supported through three cores: an Education Core, a Faculty Development and Training Core, and an Evaluation Core.
The specific aims of this proposal are:
Aim 1 : To implement through an Education Core a communication training curriculum for Comprehensive Cancer Centers to improve the ability of medical, surgical, and pediatric fellows and junior faculty to communicate with patients and families effectively about complex oncological issues;
Aim 2 : To support this communication training curriculum through a Faculty Development and Training Core. This training core will maintain a faculty development program for attending physicians and will offer continuing training and feedback to facilitators to better teach communication skills;
Aim 3 : To assess through an Evaluation Core the outcomes of these programs on fellows and junior faculty through examination at several levels including: self-assessment, performance in standardized patient assessments, performance in clinical encounters, and patient reported outcomes. In this proposal, we will demonstrate the efficacy of a 7-module educational program on 264 participants and evaluate its effectiveness through the use of the Kirkpatrick's triangle of evaluation strategies from level 1, reaction of learners, to level 2, self-efficacy of learning and skill uptake via standardized patient assessments, to level 3, transfer of skills into the clinic, and finally at level 4, patient outcome in response to the consultation for 896 patients assessed. We hypothesize that dose of training will directly impact skill uptake, will explore the proportion of variance in skill uptake attributable to facilitator competence and assess the change pre to post training in patient's perception of the quality of the clinician's communication.
This specialized R25 cancer education program for oncologists will develop and trial a comprehensive communication skills training curriculum aimed at improving the ability of medical, surgical and radiation oncology faculty and fellows to communicate with patients and families effectively about complex oncological issues.
|Kissane, David W; Bylund, Carma L; Banerjee, Smita C et al. (2012) Communication skills training for oncology professionals. J Clin Oncol 30:1242-7|