The majority (95%) of lung cancer patients report experiencing lung cancer stigma from their family, friends, and medical providers, with 48% specifically reporting experiencing stigma from their medical providers. Stigma has negative effects on patients? psychological well-being as well as their medical outcomes. Stigma may be exacerbated within the context of clinical consultations in which physicians routinely probe about patients? smoking history and current smoking status. Empathic communication during these clinical encounters may reduce perceived stigma and improve other patient outcomes. The goals of this study are to: 1) To adapt a communication skills training module focusing on empathic physician communication; 2) examine the feasibility and acceptability of the empathic physician communication skills training intervention for thoracic oncologists; and 3) pilot test the effect of the adapted empathic physician communication skills training intervention on patient-reported stigma (primary), physician empathy, satisfaction with communication, psychological distress, and chart audit of patient acceptance of referral to psychosocial and/or tobacco cessation support services. To meet these goals, we will adapt an existing empathic physician communication skills training module developed by MSK?s Communication Skills Training and Research Lab to meet the specific smoking and stigma-related communication issues experienced by physicians treating patients with lung cancer. Next, we will determine thoracic oncology physicians? (n=30) rate of completion of the training, training module evaluation as well as pre- and post-changes in empathic communication skill uptake with video-recorded and coded standardized patient encounters. To estimate the potential benefit of the empathic communication skills module on patient reported outcomes, six patients (with smoking history) per participating physician (3 patients before the physician has completed the training and 3 patients after the training) will complete measures of perceived lung cancer stigma, perceived empathy, satisfaction with communication, and psychological distress. Additionally, electronic medical records will be examined pre- and post-training to examine rates of accepted referrals to the Tobacco Treatment Program and other psychosocial services. It is expected that these pilot test findings will provide evidence for the feasibility, acceptability and promise of a communication skills training intervention to improve physicians? empathic communication and thereby reduce stigma experienced by patients with lung cancer.
PUBLIC HEALTH RELEVANCE: 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 examine a potential mechanism (empathic communication) to decrease perceived stigma and, ultimately, reduce patients' psychological distress, and improve satisfaction with physicians' communication skills, increase perceptions of empathic communication, and increase adherence to referral to psychosocial services and/or 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.
