Physician Focused Interventions

Communication Skills Training

Communication skills training for oncologists has been shown to promote high-quality cancer care. Dr. Brown'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 he co-developed the Comskil Lab. Within that context, Dr. Brown 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. In addition to the formative journal articles listed in SECTION A above, the additional articles below detail the implementation and assessment of the training and detail the development of two modules.

Additional Articles

1. 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.

2. 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.

3. 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.

4. 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.

Physician Communication Skills training about cancer clinical trials

Dr. Brown commenced a program of research to explore gaps in physician communication skills in discussions about cancer clinical trials. The goal of the research program was to develop, implement and evaluate a targeted communication skills training program focused on Phase II and III clinical trial discussions. Through comprehensive qualitative review of consultation audiotapes he identified several areas of communication difficulty including effective information exchange and decision-making. Dr. Brown developed a set of communication skills that were benchmarks to aid oncologists in effective clinical trial communication. Further work revealed that these benchmarks were rarely met during consultations with several essential items of ethical and clinical information either not discussed or poorly conveyed by oncologists. In two funded studies, including an international randomized controlled trial (conducted in Europe and Australia/New Zealand), he demonstrated that communication skills training for oncologists based on the communication bench marks was successful in altering oncologists’ communication behaviors and patient outcomes. Dr. Brown then explored the communication strategies oncologists employ in discussions about joining a Phase I clinical trial. This exploratory study aimed to gain a better understanding of oncologist-patient interactions through analysis of conversational data from consultation audio recordings. The findings showed that although there was some common ground between communication in Phase I and the Phase II and III settings, there were distinct differences. For example, oncologists used persuasive communication in Phase I consultations as compared to Phase II and III consultations. This highlights the additional complexity of discussing Phase I trials and the need to develop strategies to aid oncologists and patients in these difficult conversations.

Related Articles

1. Brown, R.F., Butow, P.N., Butt, D., Moore, A & Tattersal, M.H.N. (2004) Developing ethical strategies to assist oncologists seek informed consent to cancer clinical trials. Social Science and Medicine, 58 (2) 379 – 390.

2. Brown, R.F., Butow, P., Boyle, F & Tattersall. (2007) Seeking informed consent to cancer clinical trials: Evaluating the efficacy of doctor communication skills training. Psycho-oncology. 16(6) 507-516

3. Brown R F., Bylund, C L, Siminoff, L.A & Slovin, S F (2011) Seeking informed consent to Phase 1 Cancer Clinical Trials: Identifying Oncologists’ Communication Strategies. Psycho-oncology, 20;361-368.

4. Bernhard, J., Butow PN, Aldridge J, Juraskova I., Ribi K., & Brown R F (2012) Communication about standard treatment options and clinical trials: can we teach doctors new skills that improve patient outcomes? Psycho- Oncology ; 21(12) 1265 – 12.