Communication about cancer treatment challenges patients and physicians as they face the transition from fighting a potentially curable disease to realizing that conventional therapies are no longer effective. Patients often confront intense fear and loss, leading to greater emotional needs than at any other time during treatment. Because oncologists also struggle with this transition, they frequently, yet inadvertently, discourage patients from disclosing emotional concerns and thus miss opportunities to communicate effectively, resulting in greater patient anxiety. Unfortunately, no easily disseminable educational interventions exist to help oncologists overcome these challenges. We propose a randomized, controlled trial testing the efficacy of an interactive CD-ROM based intervention using feedback from the oncologists' own recorded encounters to improve their communication. At baseline of this five-year, two site (Duke and the University of Pittsburgh) study, we will audio record 400 outpatient encounters between oncologists (n=50) and patients with advanced cancer (n=200) as they discuss the transition to palliative care. These digitized recordings will be coded for the oncologists eliciting patients' concerns and responding to emotional content. ? After baseline assessment, we will randomly assign the oncologists to intervention and control arms. The intervention oncologists each will receive a personalized user-friendly CD-ROM that contains their coded conversations, packaged with related educational material. A technical advisor will encourage and facilitate their use of materials. The control group will not receive the CD-ROM or any other support. Three months later, we will conduct the post-intervention assessment by recording another 400 clinic visits between these same oncologists (intervention and control) and a new sample of patients to measure the intervention impact. Primary outcomes will be the communication behaviors emphasized in the intervention, such as responding to empathic opportunities and eliciting patient concerns. This project will expand the field of oncologist-patient communication by identifying key communication skills that may assist patients through difficult transitions and by creating an easily disseminable intervention to help oncologists implement these skills. ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA100387-05
Application #
7216890
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
O'Mara, Ann M
Project Start
2003-05-01
Project End
2009-03-31
Budget Start
2007-04-10
Budget End
2009-03-31
Support Year
5
Fiscal Year
2007
Total Cost
$460,586
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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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
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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
Pollak, Kathryn I; Alexander, Stewart C; Østbye, 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

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