Cognitive-behavioral intervention to enhance communication skills for cancer patients.

摘要

Introduction: With nearly 12 million Americans living with or having a history of cancer, the patient-doctor communication process is especially important for this population. Cancer patients are often dissatisfied with the quality of the information they receive regarding their treatment, side effects, symptom control, and the quality of the relationship with their healthcare provider. A patient's self-efficacy during patient-doctor interactions influences the level of trust in his/her doctor, satisfaction with care, and the type of information exchanged. Studies have focused on intervening in patient communication, but there are limitations in the literature, including a focus on improving self-efficacy, addressing communication issues of patients from lower socioeconomic status backgrounds and those with more lethal cancers, and utilizing empirically-supported theories for interventions. Aim: This dissertation study aimed to develop and implement a cognitive-behavioral communication intervention designed to enhance cancer patients' self-efficacy. Design and Analyses: Medically indigent cancer patients were recruited and randomized to either an intervention or wait-list control group. The two conditions were compared on self-efficacy across three timepoints (baseline, post-intervention, and 1-month post-intervention) using an analysis of variance procedure. Relationships between several psychosocial concepts were also explored. Results: Twenty-nine participants entered the study, and were predominantly women, African American, and middle-aged. No significant main effects were found in self-efficacy between the groups, F(1, 21) = .007, p = .94, or across the three timepoints, F(1, 21) = 3.57, p = .073. Several significant correlations were found between psychosocial variables at baseline. Positive relationships were seen between self-efficacy and trust in doctor and satisfaction with doctor. Negative relationships were seen between self-efficacy and information needs and illness uncertainty. Negative relationships were also found between illness uncertainty and trust in doctor and between illness uncertainty and satisfaction with doctor. Conclusions: This is the first known study to utilize cognitive-behavioral theory in an intervention targeting cancer patient's self-efficacy in communicating with healthcare providers. Although no significant changes were found in participants' level of self-efficacy after completing the intervention, several significant relationships between the psychosocial variables were found that are consistent with the literature. Limitations of the study, including power, are discussed.