The majority (95 percent) of lung cancer patients report experiencing lung cancer stigma from their family, friends, and medical providers, with 48 percent specifically reporting experiencing stigma from their medical providers. This stigma has negative effects on patients' psychological well-being as well as their medical outcomes. This perceived stigma may be exacerbated within the context of clinical consultations in which physicians routinely probe about patients' smoking behaviors. As such, empathic communication between patients and physicians during these clinical encounters may be critical to reduce patient's perceived stigma and thus improve the patient-physician relationship. This, in turn, may lead patients to report less psychological distress, be more honest with their physicians, and accept their physicians' advice and assistance to quit smoking. Despite the need for an intervention to improve these interactions, there is little research to examine ways that patients' perceived stigma could be reduced. The goals of this study are to: 1) describe empathic communication between oncologists and lung cancer patients during a clinical consultation of a newly diagnosed patient and 2) examine the association between oncologists' empathic communication and patients' perceived stigma, satisfaction with communication, psychological distress, intent to quit smoking, and acceptance of physicians' advice and assistance to quit smoking. To meet these goals, 55 lung cancer patients' clinical consultations with their physicians will be audio recorded. After their consultation, patients will fill out a bref questionnaire that includes questions about their perceived stigma, satisfaction with communication, and psychological distress. They will also participate in a brief (15-20 minute) interview asking about their perceptions of stigma within their clinical consultation. Analyses wil be two-fold and will focus both on how empathic communication occurs between physicians and patients (e.g., how many missed opportunities, degree of empathic communication, ways they respond to patients' anxieties, guilt, fear, etc.) as well as examine if empathic communication is associated with patients' decreased stigma, decreased psychological distress, and improved satisfaction with communication and adherence to referral for a Tobacco Cessation Program. It is expected that these results will provide preliminary evidence for the development of a communication intervention to improve empathic communication within potentially stigmatizing interactions.

Public Health Relevance

The proposed study is relevant to public health in that it addresses an at-risk group of cancer patients, current smokers diagnosed with lung cancer, by reducing their perceived stigma. Research indicates perceived stigma has negative effects on patients' psychological distress, accuracy of communication with physicians, and possibly their adherence to smoking cessation programs. The proposed study will address this public health concern by examining a potential mechanism (empathic physician communication) to decrease perceived stigma and, in turn, improve patients' psychological distress, satisfaction with physicians' communication, and adherence to referral to a Tobacco Cessation Program. Thus, this study is aligned with the NCI's long-term goal of reducing the negative effects of stigma on patient outcomes.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Social Psychology, Personality and Interpersonal Processes Study Section (SPIP)
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Kobrin, Sarah
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Sloan-Kettering Institute for Cancer Research
New York
United States
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Hamann, Heidi A; Shen, Megan J; Thomas, Anna J et al. (2018) Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI). Stigma Health 3:195-203
Riley, Kristen E; Ulrich, Michael R; Hamann, Heidi A et al. (2017) Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA J Ethics 19:475-485
Shen, Megan Johnson; Hamann, Heidi A; Thomas, Anna J et al. (2016) Association between patient-provider communication and lung cancer stigma. Support Care Cancer 24:2093-2099