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New computer course may improve cancer treatment

Computers are now teaching doctors effective interpersonal communication skills.

Researchers found that a new CD-ROM course curriculum targeted toward oncologists looking to develop better patient-communication skills elicited more empathetic responses from the physicians. Patients were also found to have greater trust in doctors who had successfully completed the program—a key factor in bettering their quality of life and the outcomes of their treatments. The study, published in the Nov. 1 issue of Annals of Internal Medicine, looked at the interactions between 48 oncologists and 264 patients with advanced cancer.

“Oncologists are among the most devoted to the care of their patients, but they are not always clear to articulate their empathy,” said Dr. James Tulsky, senior author of the study and director of the Center for Palliative Care. “It’s not that the doctors are uncaring, but they just have not been trained to connect with patients at a more emotional level through language.”

The interactive program includes a five-module course on basic communication skills, focusing on patients’ emotions and how physicians should share prognosis information with patients. The tutorial includes feedback of actual pre-recorded clinical visits. Physicians were reminded to apply these changes in their practices before future clinic visits.

When confronted with patient concerns or fears, oncologists who had not taken the CD-ROM course showed no improvement in their communication and response to patients. On the other hand, doctors who had participated in the trained group responded empathetically to their patients twice as often.

“The results are exciting because this program has been proven to be an inexpensive and easy alternative to multi-day courses that are both time-consuming and expensive,” Tulsky noted.

The current method for teaching doctors effective communication skills is a multi-day course that consists of lectures and role-playing with actors hired to simulate clinical situations, he added.

Randa McNamara, education training coordinator for the Standardized Patient Program—a required program for medical students in which they interact with role-playing actors—said she was in favor of Tulsky’s program.

“By going back to the skills I teach the medical students in residency or even for practicing physicians, it’s a great tool to re-enforce what they may have forgotten in medical school,” McNamara said,

Effective communication skills are critical for doctors when interacting with their patients, said Sharon Campen, chair-elect of the Duke Patient Advocacy Council. Increased communication allows for the patient to make better, more informed decisions, and it also helps provide a safe treatment environment.

Patients expect straightforward communication from their doctors, especially when the outlook is not positive, Campen added, noting that Tulsky’s study will help doctors become more comfortable in relaying bad news.

Several of Tulsky’s peers have also expressed approval of the program.

Dr. Michael Kastan, executive director of the Duke Cancer Institute, noted that the key advantage of this tutorial is its ability to show doctors videos of their own clinical interactions with patients.

“[The tutorial] makes doctors take a step back and powerfully shows them how they’re communicating and not just whether they’re communicating,” Kastan said.

Both Kastan and McNamara noted that the electronic format of the tutorial contributes to a more convenient and effective program.

“The difference between an electronic course and a course taught by a great teacher are the limits—even if you have a great teacher, their influence can only go far in their access to a wide reach of students,” Kastan said.

Although the CD-ROM course is not yet widely available, Tulsky noted that efforts are underway to develop it for greater distribution.

“This [software program] is just one piece to a larger puzzle to teach doctors how to communicate effectively to their patients and ultimately improving the quality of life for patients in the long run,” he said.

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