Use of and reactions to a tailored CD-ROM designed to enhance oncologist–patient communication: The SCOPE trial intervention

Abstract

Objective

Assess use of and reactions to an interactive, tailored CD-ROM to enhance oncologist–patient communication.

Methods

Participating oncologists (n = 48) agreed to have patient interactions audio recorded, be randomly assigned to receive/not receive a CD-ROM, have CD-ROM usage monitored (intervention group) and complete a follow-up survey.

Results

Twenty-one of 24 in the intervention group reported using the CD-ROM. Median usage minutes were 63.8. At follow-up, oncologists rated the CD-ROM from 1 (“none” or “not at all helpful”) to 5 (“a great deal” or “very helpful”). Mean responses were: 3.1 and 3.0 for 2 items assessing perceived impact on communications, 3.8–4.0 for 6 items assessing perceived helpfulness, 3.0 and 3.10 for 2 items assessing impact on affecting oncologists’ communication with patients and assistance with challenging conversations, respectively, and 3.6 for whether using the CD-ROM was worth their time. Self-report of how much oncologists had used the covered skills before and after intervention showed a perceived increase (2.8 before and 3.2 after).

Conclusions

Findings suggest the tailored interactive CD-ROM has promise for use and acceptance among oncologists.

Practice implications

If ultimately found effective in changing oncologist's communication with patients, the CD-ROM's widespread dissemination should be explored.

Introduction

Communication between patients and their oncologists is integral to high-quality cancer care. Effective communication is positively associated with patient satisfaction and treatment adherence [1], [2]. Numerous studies have also shown that patient–oncologist communication could be better, particularly in how oncologists respond to patient emotion [3], [4], [5], [6], [7], [8]. Patients whose emotional needs are unmet experience more anxiety and diminished quality of life [1], [2], [9], [10]. However, few oncologists receive formal training in effective communication.

In response to this need, several training programs have been developed to improve oncologists’ communication. These programs generally involve days of intensive in-person training format including didactic instruction, interpersonal interaction, expert examples in live or videotaped format, and practice sessions, often with simulated patients. They have been found to improve communication [11], [12], [13] among those who attend, but the required time, travel, and expense associated with these programs limit access for many oncologists.

Through the SCOPE Trial (Studying Communication in Oncologist Patient Encounters), we developed an interactive, computer-based CD-ROM that focuses on addressing patient emotion and discussing prognosis. Rather than requiring attendance at a lecture or meeting, the CD-ROM can be mailed or hand delivered and used when convenient for the recipient. Therefore, if found effective, the SCOPE CD-ROM could be widely disseminated.

Two types of evaluation are important for assessing whether the SCOPE intervention warrants dissemination. The outcome evaluation (e.g., the educational impact of the intervention) will be assessed by whether use of the CD-ROM facilitates changes in oncologists’ skills and behaviors related to their communication with patients. Because the intervention cannot have any impact if oncologists do not use it and a positive impact is not likely if they do not like or find it helpful, it is also important to measure the process evaluation outcomes of usage and reactions—the extent to which oncologists in the study used the CD-ROM, liked it, and found it helpful.

It is common for studies of tailored health behavior change interventions to report both process and outcome evaluations and to include intervention exposure as a process measure. Indeed, one of the strong findings of the initial comparisons of tailored vs. non-tailored interventions has been that recipients are more likely to read “most or all” of tailored printed communications than of similar-looking non-tailored communications [14], [15], [16], [17], and that tailored print have more positive reactions, such as perceived relevance [17]. These process evaluations have also been conducted for tailored interventions delivered via interactive computer programs showing, for example, that they are likely to be used by groups such as older people and those with lower education levels as well as those who are more computer savvy [18], [19].

In contrast, studies of computerized medical education interventions have often reported process measures such as acceptability or satisfaction [20] but with some notable exceptions [21], [22], [23] they have rarely reported on proportion of the intended audience that used the intervention [20]. This may stem from study designs that do not lend themselves to calculating usage rates; most studies either implement computerized interventions into required coursework (therefore usage is nearly universal) or make information available over the web (where usage can often only be reported in absolute numbers rather than proportions due to lack of information about the denominator of potential users). This report contributes to the literature by reporting process outcomes of usage rates and reactions for a computerized medical education intervention that depends on voluntary usage.