Factors that influence physicians' detection of distress in patients with cancer

Can a communication skills training program improve physicians' detection?

Authors

  • Isabelle Merckaert M.A.,

    1. Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
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  • Yves Libert M.A.,

    1. Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
    2. Faculté de Psychologie et des Sciences de l'Éducation, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
    3. Centre d'side aux marants, Training and Research Group (C.A.M. ), Brussels, Belgium
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  • Nicole Delvaux Ph.D.,

    1. Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
    2. Service de Psychologie, Hôpital Universitaire Erasme, Brussels, Belgium
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  • Serge Marchal M.A.,

    1. Centre d'side aux marants, Training and Research Group (C.A.M. ), Brussels, Belgium
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  • Jacques Boniver M.D., Ph.D.,

    1. Faculté de Médecine, Université de Liège, Liège, Belgium
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  • Anne-Marie Etienne Ph.D.,

    1. Faculté de Psychologie, Université de Liège, Liège, Belgium
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  • Jean Klastersky M.D., Ph.D.,

    1. Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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  • Christine Reynaert M.D., Ph.D.,

    1. Faculté de Psychologie et des Sciences de l'Éducation, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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  • Pierre Scalliet M.D., Ph.D.,

    1. Faculté de Médecine, Université Catholique de Louvain, Brussels, Belgium
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  • Jean-Louis Slachmuylder M.A.,

    1. Centre d'side aux marants, Training and Research Group (C.A.M. ), Brussels, Belgium
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  • Darius Razavi M.D., Ph.D.

    Corresponding author
    1. Faculté des Sciences Psychologiques et de l'Éducation, Université Libre de Bruxelles, Brussels, Belgium
    2. Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
    • Université Libre de Bruxelles, Av. F. Roosevelt, 50-CP 191, B-1050 Bruxelles, Belgium
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    • Fax: (011) 32 26502209


  • Contributors: Darius Razavi, Nicole Delvaux, and Christine Reynaert conceived this study, wrote the protocol, obtained funding, and supervised data collection and analysis. Darius Razavi, Nicole Delvaux, and Serge Marchal conducted the training courses. Serge Marchal supervised data collection. Jacques Boniver, Jean Klastersky, and Pierre Scalliet participated to the writing of the protocol and obtained funding. Anne-Marie Etienne supervised data collection. Isabelle Merckaert contributed to data collection and to the rating of the interviews, participated in the data analysis, and wrote the first drafts of the report. Yves Libert contributed to data collection, coordinated day-to-day management of the project, participated in preparation of data analysis, and contributed to the writing of the first drafts of the report. Jean-Louis Slachmuylder designed the data base and contributed to data collection and final analysis. All investigators contributed to the writing of the final report.

Abstract

BACKGROUND

No study to date has assessed the impact of skills acquisition after a communication skills training program on physicians' ability to detect distress in patients with cancer.

METHODS

First, the authors used a randomized design to assess the impact, on physicians' ability to detect patients' distress, of a 1-hour theoretical information course followed by 2 communication skills training programs: a 2.5-day basic training program and the same training program consolidated by 6 3-hour consolidation workshops. Then, theinvestigate contextual, patient, and communication variables or factors associated with physicians' detection of patients' distress were investigated. After they attended the basic communication skills training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Interviews with a cancer patient were recorded before training, after consolidation workshops for the group that attended consolidation workshops, and ≈ 5 months after basic training for the group that attended basic training without the consolidation workshops. Patient distress was recorded with the Hospital Anxiety and Depression Scale before the interviews. Physicians rated their patients' distress on a visual analog scale after the interviews. Physicians' ability to detect patients' distress was measured through computing differences between physicians' ratings of patients' distress and patients' self-reported distress. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual.

RESULTS

Fifty-eight physicians were evaluable. Repeated-measures analysis of variance showed no statistically significant changes over time and between groups in physicians' ability to assess patient distress. Mixed-effects modeling showed that physicians' detection of patients' distress was associated negatively with patients' educational level (P = 0.042) and with patients' self-reported distress (P < 0.000). Mixed-effects modeling also showed that physicians' detection of patient distress was associated positively with physicians breaking bad news (P = 0.022) and using assessment skills (P = 0.015) and supportive skills (P = 0.045).

CONCLUSIONS

Contrary to what was expected, no change was observed in physicians' ability to detect distress in patients with cancer after a communication skills training programs, regardless of whether physicians attended the basic training program or the basic training program followed by the consolidation workshops. The results indicated a need for further improvements in physicians' detection skills through specific training modules, including theoretical information about factors that interfere with physicians' detection and through role-playing exercises that focus on assessment and supportive skills that facilitate detection. Cancer 2005. © 2005 American Cancer Society.

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