Empathic Communication Skills (ECS) Training

Study Overview
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Brief Summary
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Research indicates that perceived stigma within medical encounters is prevalent and problematic for lung cancer patients' well-being and quality of cancer care. Promoting empathic communication appears to be a potentially effective intervention target to help reduce patients' perceptions of stigma within clinical encounters; however, no formal trainings exist that focus on teaching empathic communication to oncology care providers (OCPs). Building upon favorable findings from a prior R21 (R21CA202793) and the importance of developing interventions to address lung cancer stigma, our goal is to conduct a national trial of empathic communication skills (ECS) training to facilitate improvements in the medical and psychosocial care of patients through de-stigmatizing interactions with OCPs for patients diagnosed with lung cancer.

Detailed Description
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The aims of this study are: to evaluate the effect of the ECS training on OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal - relevance, novelty, clarity; self-efficacy, empathy, compassion burn-out); to evaluate the effect of the ECS training vs. WLC on patients' reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with communication, psychological distress, patients' experience of clinical encounter, and overall patient satisfaction). Additionally, acceptance of referral to tobacco cessation (for those currently smoking) will be explored; and to examine potential moderators of OCP (e.g., demographic characteristics, professional role characteristics) and patient outcomes (e.g., demographic characteristics, illness characteristics). Our central hypothesis is that the ECS training will demonstrate significant short-term improvements in clinicians' uptake of empathic skills and self-efficacy and will be superior to WLC with regards to patient reported measures of stigma, clinician empathy, satisfaction, and overall experience.

Official Title
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Empathic Communication Skills Training to Reduce Lung Cancer Stigma

Conditions
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Lung Cancer

Intervention / Treatment
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* Behavioral: Empathic Communication Skills (ECS) training
* Other: Standard of Care participant interaction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Site Eligibility Employs at least 15 FTE OCPs (i.e., oncologists, nurse practitioners and physician assistants) as per self report Reports a clinic volume of at least 20 new lung cancer patients per month as per self report OCP Participant Eligibility OCPs who are thoracic oncology physicians (radiologists, medical oncologists, pulmonologists, and surgeons), NPs, or PAs and currently treating lung cancer patients, as per self-report; OCP conducts consultations with lung cancer patients, as per self-report; OCP sees at least 1 lung cancer patient per week, as per self-report; Patient Eligibility Patient under the care of a participating OCP as per self report; English and/or Spanish speaking; In general, which language do you prefer to receive your medical care, English/Spanish/both English and Spanish Equally? If English, treat as fluent in English, no additional language questions If Spanish, treat as fluent in Spanish, no additional language questions If both English and Spanish equally, ask the follow-up questions and go with whichever language is endorsed as best. If endorsed equally, assign to category patient prefers How well do you speak English? Not at all/ Not well/Well/Very well How well do you speak Spanish? Not at all/Not well/Well/Very well Is at least 18 years of age as per self report; Has a suspicious lung mass or confirmed lung cancer diagnosis, as per clinician judgment or medical record note; Is a former or current smoking as per self report; Has had no more than 10 prior visits with the participating OCP, as per the medical record and/or self report Exclusion Criteria: Patient Exclusion Individuals of impaired decision-making capacity as per a clinician's judgment or as documented in the EMR. Site and OCP Exclusion None

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Oncology Care Providers/OCP-intervention group<br>Providers participate in Empathic Communication Skills (ECS) training | Behavioral: Empathic Communication Skills (ECS) training<br>* The overall training goal of this 2.25 hour module ECS module is to enhance OCP recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, alleviating stigma and distress, and providing support. The ECS training also provides tools to OCPs to buffer/inoculate patients against stigmatizing attitudes and behaviors by others such that lung cancer patients who currently or formerly smoked can be given small doses of an opposing viewpoint (termed as preparing patients for recurring smoking questions) and suggestions of counterarguments in order to make them resistant to future stigmatizing attacks by others<br>|
| Active Comparator: Oncology Care Providers/OCP-control group<br>Providers complete all study measures and are offered ECS training after data collection is completed at their site. | Other: Standard of Care participant interaction<br>* Standard of Care participant interaction<br>|
| Experimental: Participants with Lung Cancer-intervention group<br>Participants will engage with oncology care providers/OCP who have undergone Empathic Communication Skills (ECS) training | Behavioral: Empathic Communication Skills (ECS) training<br>* The overall training goal of this 2.25 hour module ECS module is to enhance OCP recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, alleviating stigma and distress, and providing support. The ECS training also provides tools to OCPs to buffer/inoculate patients against stigmatizing attitudes and behaviors by others such that lung cancer patients who currently or formerly smoked can be given small doses of an opposing viewpoint (termed as preparing patients for recurring smoking questions) and suggestions of counterarguments in order to make them resistant to future stigmatizing attacks by others<br>|
| Active Comparator: Participants with Lung Cancer-control group<br>Waitlist control group - WLC | Other: Standard of Care participant interaction<br>* Standard of Care participant interaction<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uptake of communication skills using standardized patient assessment/SPAs | A SPA involves a 12-minute video recorded interaction between the Oncology Care Provider/OCP and the Standardized Patient/SP on a given clinical scenario, using standardized scripts by the SP. Each OCP will participate in one SPA prior to their ECS training and one SPA following training or the timed control period. In contrast to clinical consultation recordings with varied clinical situations that do not necessitate the use of all strategies and skills, the semi-structured nature of SPAs permits appraisal of all desired elements of training. | 3 months | 
| Uptake of empathy skills using standardized patient assessment/SPAs | A SPA involves a 12-minute video recorded interaction between the Oncology Care Provider/OCP and the Standardized Patient/SP on a given clinical scenario, using standardized scripts by the SP. Each OCP will participate in one SPA prior to their ECS training and one SPA following training or the timed control period. In contrast to clinical consultation recordings with varied clinical situations that do not necessitate the use of all strategies and skills, the semi-structured nature of SPAs permits appraisal of all desired elements of training. | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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lung cancer, thoracic oncology physician, thoracic oncology nurse practitioner, thoracic oncology physicians assistant, 21-339, Memorial Sloan Kettering Cancer Center