Patients with advanced cancer suffer from physical and emotional distress. Living with cancer generates anxiety and depression that can lead to impaired function and worse health outcomes. Oncologists can alleviate patients'emotional concerns, and research shows that patients want their oncologists to attend to their emotional needs. However, patients'emotional concerns are frequently missed. In the SCOPE Trial (Study of Communication in Oncologist Patient Encounters), we observed 398 clinic visits between 51 oncologists and 270 advanced cancer patients and found that patients expressed emotion in only 37% of visits, and physicians responded empathically to only 27% of these cues. In response, we created an innovative CD- ROM intervention to train physicians to recognize and respond to patient concerns. Using a randomized, controlled design, we found that oncologists receiving the intervention were more than twice as likely to respond to patient expressions of emotion with empathic statements. Yet, improving physician behavior can only be part of the solution. In this competing renewal, we propose a randomized, controlled trial of a web- based intervention that trains patients to express emotion to their oncologists, request support, and overcome barriers to having their emotional needs met. We hypothesize that this approach will have additive effect over information only approaches to patient activation. We will enroll 50 oncologists, 50 mid-level providers and 400 advanced cancer patients from our two study sites (Duke and the University of Pittsburgh). In a 2x2 factorial design, we will randomly assign patients into one of four arms: Control (standard internet access);CHESS (an established, cognitively oriented cancer information website);COPE (interactive, tailored communication training with review of patients'own clinic encounters);and CHESS+COPE. We will audio- record three clinic encounters (baseline and two subsequent visits), expose patients to the intervention, and conduct post-visit patient surveys. Our outcomes are patient expressions of emotional concerns and requests for emotional support in the visit, and post-visit patient affect. This project aims to create an easily disseminable intervention to help cancer patients receive emotional support.
Many patients with late stage cancer suffer emotionally in ways that can lead to anxiety, depression, and even decreased survival. Research suggests that when patients discuss their concerns with their doctors, they feel better and have better outcomes. This study will test a web-based educational program for patients with cancer to help them discuss their emotional concerns with their doctors and request their support. If successful, we will have developed a tool that is easily accessible to cancer patients, will enhance their communication with their oncologists, and improve their quality of life.
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