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Information about ongoing health services research and public health projects

Improving communication between cancer patients and oncologists using patient feedback on actual conversations and the American Board of Internal Medicine (ABIM) Maintenance of Certification Program
Investigator (PI): Tulsky, James
Performing Organization (PO): (Current): Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care (POPC) / (617) 632-6464
(Past): Duke University, School of Medicine, Department of Medicine / (919) 668-1755
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2015
Final Year: 2020
Record Source/Award ID: PCORI/CDR-091501-IC
Funding: Total Award Amount: $1,768,800
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: This research project is in progress. PCORI will post the research findings on this page (the PCORI website) within 90 days after the results are final. What is the research about? People who are diagnosed with cancer often feel scared, anxious, or depressed. Patients who are depressed or anxious may not understand everything their doctor says. They may be less likely to follow their treatment plans. Emotional concerns such as anxiety and depression also lessen the cancer patient's quality of life. Unfortunately, some cancer doctors may not respond to their patients' emotional concerns. The study team is trying to help cancer doctors learn to communicate better with their patients, particularly when patients are distressed. In a previous study, the research team created a program called Studying Communication in Oncologist-Patient Encounters (SCOPE) to help train cancer doctors how to communicate better with distressed patients. Doctors audio-recorded their conversations with their patients. Then the doctors received feedback from reviewers trained to look for how well doctors respond to their patients' emotional concerns. The previous study found that cancer doctors who received training through this program responded to their patients' emotional concerns twice as often as doctors who did not receive the training. In the current study, doctors are using the SCOPE program as part of a process to maintain their professional certification. The professional certification process requires doctors to study and improve some part of the way they practice medicine. In this version of SCOPE, the doctor receives feedback not only from the research team, but also from cancer patients who listen to the recordings. The research team wants to see if this program improves the cancer doctors' communication skills. Who can this research help? This research can help cancer doctors communicate better with their patients. What is the research team doing? The researchers are enrolling 100 cancer doctors who are certified by the American Board of Internal Medicine and treat patients in the United States. The research team is assigning doctors in the study to one of two groups by chance. Both groups send satisfaction surveys to a sample of their patients. After getting the satisfaction survey results, doctors in both groups audio-record conversations, using a smartphone app, with eight cancer patients during clinic visits. The doctors may select any patient with advanced cancer. In the first group, doctors plan a project on their own to try to improve their communication with their patients. In the second group, doctors participate in the SCOPE program. Doctors in this group learn ways to improve how they talk to patients and show that they hear patients' emotional concerns. Researchers who listen to the recordings tell doctors how many opportunities they have to respond to patients' emotional concerns, and how often they actually do. Trained patient reviewers also tell the doctors what they liked in the recorded conversations and what the doctors could say differently. One month after the doctors in the second group get their feedback, all the doctors in the study send out satisfaction surveys to a new group of patients and audio-record conversations with eight more patients. The study team is trying to figure out if there is a change in patients' satisfaction with the way their cancer doctors respond to their concerns after doctors have completed the program. The researchers listen to the new set of recordings and count how often each doctor responds appropriately to their patient's emotional concerns. Patient advocates are participating in this project and serve as the patient reviewers. The team pays these advocates to review the doctors' recordings. They are not patients of the doctors in the study. Research methods at a glance. Design: The design is a randomized controlled trial. Population: The population is 148 oncologists who are certified by American Board of Internal Medicine and enrolled in its Maintenance of Certification program, practicing in the United States. Interventions/comparators are (a) standard communication training: doctors do an activity of their choice that responds to patient satisfaction survey feedback and (b) enhanced SCOPE training: doctors get feedback from professional researchers (coders) and patients on their audio-recorded conversations with patients. Outcomes: Outcomes are (a) primary: provider-to-patient communication score from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questionnaire and (b) secondary: empathetic response to patient expression of negative emotions as coded from audio-recorded conversations. Timeframe: The timeframe is 6-month follow-up for primary outcome.
Abstract Archived: Cancer patients face numerous physical and emotional challenges. Anxiety and depression can decrease quality of life and even decrease survival. High-quality cancer care depends upon recognizing and responding to patients' emotional needs. Unfortunately, oncologists frequently do not respond to patients' emotional concerns. Oncologists can learn to communicate better. The most successful teaching occurs in intensive courses with patient actors. However, these courses take time and are expensive. We created a computerized program called SCOPE in which oncologists audio record conversations with real patients and then receive feedback on how well they did. Oncologists who used this program in a research study doubled how often they responded to patients' emotional concerns and increased their patients' trust. In this grant, we propose to take this program and add an additional feature where real patients also listen to the conversations and give feedback to these doctors. We will then have doctors who are being recertified in oncology by the American Board of Internal Medicine (ABIM) use this program as part of that recertification process. We will test how well it increases their patients' satisfaction in their communication, and whether it improves their communication skills. If successful, this intervention will represent an effective communication training program for physicians in which they improve their communication skills through direct feedback from patients. Because of the integration with the ABIM Maintenance of Certification Program, if fully adopted into that program, it could have an extraordinary impact on thousands of physicians and their patients.

MeSH Terms:
  • Certification
  • Communication
  • Emotions
  • Humans
  • Internal Medicine /methods
  • Licensure
  • Medical Oncology /*methods
  • Neoplasms /*therapy
  • Patient Participation
  • * Physician-Patient Relations
  • Program Development
  • Quality of Life
  • Societies, Medical
  • Tape Recording
  • United States
Country: United States || United States
State: Massachusetts || North Carolina
Zip Code: 02215 / 27710
UI: 20152117
CTgovId: NCT02969031
Project Status: Ongoing
Record History: ('2019: Project extended to 2020\n2017: Project extended to 2019',) ('2020: Abstract archived to Abstract Archived 1 field and added new abstract.',)