Much of Dr. Brown's research has been designed to aid cancer patients to communicate more effectively with their physician. This research largely centers on developing, implementing and evaluating interventions using the physician- patient consultation as the unit of analysis. Dr. Brown has been involved in formative work in Australia to develop Question Prompt Lists (QPLs) to aid cancer patient to ask difficult question during their initial consultation with their physician. This research highlighted the difficulties patients experience in gaining salient, information about their illness. It also showed that the QPL coupled with oncologist endorsement, increased patient question asking (particularly in the difficult area of discussing prognosis) reduced situational anxiety, promoted recall of information and did not increase consultation length. Since moving to the United States, Dr. Brown has extended QPL research to focus on conversations between physicians and patients about joining a therapeutic clinical trial. Funded by an NCI RO3 (NCI CA130598) he developed the Clinical Trial Question Prompt List QPL-CT and conducted pilot efficacy studies to assess its clinical feasibility. The results revealed that the QPL-CT was comprehensive and could prompt patients to consider novel issues, gain salient information, and be better informed for future trial discussions and to help make a trial decision. Subsequently, many other researchers have developed and applied QPLs in a variety of health care settings.

More Information on Patient Focused Interventions

Related Publications

• Brown, R.F., Butow, P.N., Boyer, M.J. & Tattersall, M.H.N. (1999). Promoting Patient Participation in the Cancer Consultation: Evaluation of a Prompt Sheet and Coaching in Question Asking. British Journal of Cancer, 80, (1/2), 242 – 248. doi: 10.1038/sj.bjc.6690346.

• Brown, R.F., Butow, P.N., Dunn, S.M. & Tattersall, M.H.N. (2001). Promoting patient participation and shortening cancer consultation: a randomized trial. British Journal of Cancer, 85: 1273-9. doi: 10.1054/bjoc.2001.2073.

• Brown, R F.,Shuk, E., Butow, P.N., Edgerson, S., Ostroff, J & Tattersall, M H N (2010) Enhancing Decision Making about Participation in Cancer Clinical Trials: Development of a Question Prompt List. Supportive Care in Cancer. 19(8) 1227 -1338.doi: 10.1007/s00520-010-0942-6.

• Brown, R F., Bylund, C L., Edgerson, S., Li, Y., & Butow, P.N. (2012) Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations. Patient Education and Counseling; 88(2):311-7. doi: 10.1016/j.pec.2012.02.009.

Communication skills training for oncologists have been shown to promote high quality cancer care. The CIHClab's research focus has been to design, implement and evaluate communication skills training programs within a delivery and research context. At Memorial Sloan Kettering Cancer Center Dr. Brown co-developed the Comskil Lab. Within that context he co-developed a new model of Communication skills training, the Comskil model. The model was developed to support a newly emerging curriculum that provided training in several challenging communication contexts such as delivering bad news to patients, discussing prognosis and making shared treatment decisions. The research agenda of the Comskil Lab was to provide efficacy data to show that physician competency in communication improved through sustained improvements in communication skills uptake. This was measured through pre and post testing in live consultations and through standardized patient assessments. Our published results revealed significant skills uptake and that oncologists reported an increased confidence in their communication skills and improved self-efficacy in their consultation communication as a result of training. A second focus of this research was to evaluate the efficacy of a systematic program to train physicians to facilitate communication skills training. Our published results revealed that our training program significantly increased facilitation skills and improved fidelity to the Comskil training model. The Comskil model formed the foundation of all communication skills training described in the text. Kissane D, Butow P & Bultz BD, Eds. Handbook of Communication in Cancer and Palliative Care, Oxford University Press: Oxford. The Comskil model is being implemented in many international and national training programs. Additional articles below detail the implementation and assessment of the training and detail the development of two modules.

More information on Physician-Focused Interventions

Related Publications

• Bylund, C L, Brown, R F., Gueguen, J A., Diamond, C Bianculli, J., Kissane, D. W (2010) The implementation and assessment of a comprehensive communication skills training curriculum for oncologists. Psycho-Oncology. 19(6). 582 – 593. doi: 10.1002/pon.1585.

• Bylund, C L., Brown, R F., Lubrano di Ciccone, B., Levin, T., Gueguen, J., Hill, C & Kissane, D (2008) Training faculty to facilitate communication skills training: Development and Evaluation of a workshop. Patient Education and Counseling. 70: 430-436. doi: 10.1016/j.pec.2007.11.024.

• Brown, R F., Bylund, C L., Eddington, J., Gueguen, J., Kissane, D W. (2009) Discussing Prognosis in an Oncology Setting: Initial Evaluation of a Communication Skills Training Module. Psycho-Oncology. 19, 408 – 414. doi: 10.1002/pon.1580

• Brown R F., Bylund, C L., Kline, N., De La Cruz A., Solan, J., Kelvin, J., Eddington, J., Kissane, D., Passik, S (2009). Identifying and responding to depression in adult cancer patients. Evaluating the efficacy of a pilot communication skills training program for oncology nurses. Journal of Cancer Nursing. 32 (3) E1 – E7. doi: 10.1097/NCC.0b013e31819b5a76.

Dr. Brown's research has been motivated by the desire to align the communication exchange between patients and physicians resulting in concordant decision making. Shared decision making (SDM) is now considered the gold standard for treatment decision making, yet, patients vary in their preferences for being involved in making decisions. His early work in decision-making processes in the oncology context focused on understanding how to quantify SDM, particularly oncologists’ communication styles that promote or inhibit SDM during discussions of treatment options including clinical trials. To that end, Dr. Brown developed a coding system called the Decision Analysis System-Oncology (DAS-O) that is applied to transcripts of consultation audio recordings to identify various aspects of oncologist’s use of SDM. Validation studies showed that the DAS-O was highly correlated with other SDM measures such as the OPTION scale. This scale was then applied to communication interactions to quantify various aspects of SDM and showed considerable variation in oncologist skills around SDM.

The CIHClab's other research in this area is to understand the nature of patient expectations of oncology consultation communication. This research explored whether failure to meet patient expectations in areas such as information exchange and decisional role preference, including a preference for SDM, impacts patient outcomes such as satisfaction and decision outcomes such as decision regret. Dr. Brown's early work in this area showed that patients express high levels of satisfaction with their oncologist even when their preferences for the type of consultation they prefer are not met. He then conducted one of the few studies to date that explored the impact on patient outcomes of oncologists meeting or not meeting their patient’s decision role preferences. The results showed that patients' decision role preferences could change during the course of a single treatment discussion. It also showed that when oncologists involve their patients at the level of decisional involvement they prefer or more than they prefer, patient decision outcomes are improved.

Related Publications

• Brown, R.F., Dunn, S.M. & Butow, P.N. (1997). Meeting Patient Expectations in the Cancer Consultation. Annals of Oncology, 8, 877 –882. doi: 10.1023/a:1008213630112.

• Brown, R. F. Hill, C, Burant, C., & Siminoff, L.A. (2008) Satisfaction with Service Delivery in Breast Cancer Patient Consultations. Psycho-Oncology, 18 (1) 42 -49.

• Brown, R F., Butow, P N., Juraskova, I., Ribi, K., Gerber, D., Bernhard, J & Tattersall, M H N. (2011). Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology to identify shared decision making during treatment consultations. Health Expectations 14;29-37. doi: 10.1111/j.1369-7625.2010.00613.x.

• Brown, R F., Butow, P N., Wilson-Genderson, M., Bernhard,J., Ribi, K & Juraskova, I (2012) Meeting breast cancer patients’ decision-making preferences in oncology consultations: impact on decision related outcomes. Journal of Clinical Oncology 30(8) 857 - 862. doi: 10.1200/JCO.2011.37.7952.

The CIHClab has a research focus in exploring racial disparities in minority recruitment to cancer clinical trials. There is mounting evidence about the communication challenges present in treatment discussions, including clinical trials that contribute to low minority recruitment to clinical trials.

Dr. Brown conducted a quantitative study of 1,995 African American (AA) cancer patients’ reasons for refusing to join a clinical trial. These patients were 1.8 times more likely to refuse trial participation than white patients and were more likely to cite no interest in trials, pressures from family members and feeling overwhelmed by the decision-making process, or provide no refusal reason than white patients. In a subsequent qualitative study, Dr. Brown explored trial refusal reasons among a sample of 22 AA cancer patients and gathered insight into their perceptions of the potential benefit of an array of decision support tools. Refusal reasons were largely centered on mistrust, failure to understand important information and family pressures. Participants were amenable to communication aids to help gain information and make educated trial decisions. Finally, Dr. Brown participated in a project to develop and test a minority focused Question Prompt List intervention to help overcome communication barriers for minority patients facing cancer treatment decision. In October 2014, he was awarded a four-year research scholar grant (Jan 2015 – Dec 2018) by the American Cancer Society to develop and evaluate the efficacy of a Tailored Heath Messaging intervention to aid physician - African American (AA) cancer patient consultation communication (RSG-14-227-01 CPPB). This ongoing work is designed to promote AA patient engagement in consultation communication to help overcome health disparities in trial accrual and promote the generalizability of newly emerging therapies.

Related Publications

• Penberthy, L., Brown, R .F., Wilson – Genderson, M., Dahman, B., Ginder, G & Siminoff, L, A. (2012) Barriers to Therapeutic Clinical Trials Enrollment: Differences between African-American and White cancer patients identified at the time of eligibility assessment. Clinical Trials. 9(6) 788 – 797. doi: 10.1177/1740774512458992.

• Brown, R F., Cadet, D L., Houlihan, R H., Thomson, M D., Pratt, E C., Sullivan, A. & Siminoff, L A. (2013) African American cancer patients’ perceptions of participation in a phase I, II, or III clinical trial: What do refusers say? Journal of Oncology Practice 9(6) 287- 293. doi: 10.1200/JOP.2013.001039.

• Eggly, S., Tkatch, R., Penner, L.A., Mabunda, L., Hudson, J., Chapman, R.,Griggs, J.J., Brown, R., Albrecht, T.L. (2013) Development of a Question Prompt List as a Communication Intervention to Reduce Racial Disparities in Cancer Treatment. Journal of Cancer Education Jun 28(2):282-9.

• Brown, R.F., Grant, S., Davis, R., Wilson-Genderson, M., Cadet, D., Lessard, M., Alpert, J., Ward, J & Ginder, G. (2016) African American cancer patients Talking About Clinical Trials (TACT) with oncologists during consultations: Evaluating the efficacy of tailored health messages in a randomized controlled trial – the TACT study protocol. British Medical Journal (Open) 2016 Dec 16 doi 10.1136/bmjopen-2016-012864

The CIHClab has a focus on understanding and reducing health disparities that exist for Sexual and Gender Minority (SGM) Cancer Patients. In order to achieve that goal, Dr. Brown and Dr. Quinn have submitted multiple grant applications that are listed and briefly described below. These applications aim to successfully find research aimed to a) better understand the experiences of SGM cancer patients as they face treatment decisions and b) to investigate methods to ensure that Sexual Orientation and Gender Identity data are gathered across institutions to ensure that SGM patients’ needs are understood and addressed in clinical care.

Submitted Grants

• R21 NOSI- "Exploring Sexual & Gender Minority (SGM) breast cancer patients communication about surgical decision making: reducing disparities in outcomes"

• NCI Supplement- "Massey Cancer Center CCSG: Sexual Orientation & Gender Identity (SOGI) Data Completeness in the Massey Cancer Center EHR: Facilitating Research" Evidence for Sexual & Gender Minority (SGM) Cancer Care

• Uo1 Award- "Transformative Research to Improve Health Equity and Reduce Health Disparities for Sexual and Gender Minority Population"

For further descriptions of these submitted grants visit our Grants page.

Sexual and gender minority individuals are a diverse group. There is a lack of general knowledge surrounding the terminology used to describe the different sexual and gender identities. We have created a list of SGM terminology to help others better understand the differences between these identities and to respect differences within this group of individuals.