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Medline ® Abstract for Reference 72

of 'Discussing serious news'

Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial.
Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, Pollak KI
Ann Intern Med. 2011 Nov;155(9):593-601.
BACKGROUND: Quality cancer care requires addressing patients' emotions, which oncologists infrequently do. Multiday courses can teach oncologists skills to handle emotion; however, such workshops are long and costly.
OBJECTIVE: To test whether a brief, computerized intervention improves oncologist responses to patient expressions of negative emotion.
DESIGN: Randomized, controlled, parallel-group trial stratified by site, sex, and oncologic specialty. Oncologists were randomly assigned to receive a communication lecture or the lecture plus a tailored CD-ROM. (ClinicalTrials.gov registration number: NCT00276627)
SETTING: Oncology clinics at a comprehensive cancer center and Veterans Affairs Medical Center in Durham, North Carolina, and a comprehensive cancer center in Pittsburgh, Pennsylvania.
PARTICIPANTS: 48 medical, gynecologic, and radiation oncologists and 264 patients with advanced cancer.
INTERVENTION: Oncologists were randomly assigned in a 1:1 ratio to receive an interactive CD-ROM about responding to patients' negative emotions. The CD-ROM included tailored feedback on the oncologists' own recorded conversations.
MEASUREMENTS: Postintervention audio recordings were used to identify the number of empathic statements and responses to patients' expressions of negative emotion. Surveys evaluated patients' trust in their oncologists and perceptions of their oncologists' communication skills.
RESULTS: Oncologists in the intervention group used more empathic statements (relative risk, 1.9 [95% CI, 1.1 to 3.3]; P = 0.024) and were more likely to respond to negative emotions empathically (odds ratio, 2.1 [CI, 1.1 to 4.2]; P = 0.028) than control oncologists. Patients of intervention oncologists reported greater trust in their oncologists than did patients of control oncologists (estimated mean difference, 0.1 [CI, 0.0 to 0.2]; P = 0.036). There was no significant difference in perceptions of communication skills.
LIMITATIONS: Long-term effects were not examined. The findings may not be generalizable outside of academic medical centers.
CONCLUSION: A brief computerized intervention improves how oncologists respond to patients' expressions of negative emotions.
PRIMARY FUNDING SOURCE: National Cancer Institute.
Duke University, Veterans Affairs Medical Center, Durham, North Carolina, USA. jtulsky@duke.edu