Empathic Communication Skills Training to Reduce Lung Cancer Stigma

PROJECT SUMMARY
Nearly all (95%) patients diagnosed with lung cancer report perceiving stigma, defined as a perception and
internalization of negative appraisal and devaluation by self and others attributable to a lung cancer diagnosis.
Prior research indicates that 48% of patients with lung cancer experience stigma during clinical encounters
with their oncology care providers (OCPs), which may be potentially triggered and/or exacerbated by OCPs’
routine assessment of smoking history. Perceived stigma has negative effects on patients’ psychological well-
being as well as their medical outcomes. 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 OCPs. To address this key need,
we developed an Empathic Communication Skills (ECS) training focusing on the communication challenges
inherent in OCPs’ discussions of smoking behavior and history with lung cancer patients. Building upon
favorable findings from a prior R21 (R21CA202793), our goal is to conduct a national trial of ECS training to
facilitate improvements in the medical and psychosocial care of lung cancer patients through de-stigmatizing
interactions with OCPs. We will conduct a cluster randomized trial at 16 lung cancer care delivery sites,
comparing ECS training (intervention group) with a Waitlist Control Group (WLC) among 160 OCPs (thoracic
oncology physicians and advance practice providers) and 960 lung cancer patients (6 patients per clinician).
The ECS training will be offered remotely and include all the didactic and experiential training materials that
were developed for the pilot trial. To increase the real-world generalizability of our trial, we will leverage two
national networks of community oncology practices, the Care Continuum Centers of Excellence coordinated by
our lung cancer patient advocacy partner, the Go2 Foundation for Lung Cancer and the Extension for
Community Healthcare Outcomes (ECHO) sites for lung cancer care, supported by an American Cancer Society
ECHO Hub. The aims of this study are (1) to evaluate the impact of the ECS training on OCP primary outcomes
(communication and empathic skill uptake) and secondary outcomes (training appraisal – relevance, novelty,
clarity; self-efficacy, attitude towards communication with patients); (2) to evaluate the impact 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, social isolation, and
patients’ experience of clinical encounter). Additionally, acceptance of referral to tobacco cessation (for current
smokers) and relapse prevention (for former smokers) will be explored; and (3) to examine potential
moderators of OCP and patient outcomes. Our central hypothesis is that the ECS training will demonstrate
significant 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.

Grant Number: 4R01CA255522-05
NIH Institute/Center: NIH
Principal Investigator: Smita Banerjee