Virtual Intervention for Lung Cancer

This is a two arm experimental design PILOT test of the mHealth Tool for Lung Cancer patients
(mHealthTLC) an intervention to improve patient-clinician communication, decrease lung cancer
stigma, and decrease lung cancer symptom scores. Patients will be assigned to either the
mHealth TLC group or the Attention Control Group (ACG). Interventions in both groups will be
delivered online or by iPad in a research office in the clinician's building prior to each
visit. Assessments will be done immediately after each visit in the same research room.
Intervention and assessment pre-visit is expected to take less than one hour, the
intervention is expected to take 30mins, and post assessment is expected to take 30 minutes.
A follow-up assessment will be done at 3 months from enrollment.

mhealth TLC group will meet with a nurse just before each of 4 clinician visits and use the
mHealth TLC on an iPad with an interactive, immersive 3-dimensional (3-D) intervention that
allows individuals to experience virtual visits with their clinicians. The mHealth TLC
provides engagement and experiential learning by delivering important information about
symptom management and provides the opportunity to practice a new communication strategy in
ever increasing complex situations with a virtual coach, receptionist, assistant, and
clinician.During the mHealthTLC the patient will enter a virtual clinic office, travel
through the different aspects of a typical clinic visit, and interact with office staff and
clinicians that are represented by avatars. The avatars will be designed to reflect ethnic
and cultural diversity. First person is the preferred format for health teaching because the
patient is active as self and not represented as an avatar. The first person vantage point
facilitates the immersion and immediacy of the experience. Key aspects of mHealthTLC include
informational videos about lung cancer (i.e. etiology, diagnosis, treatment, symptoms) and
LCS. Blame and self-blame will be addressed, information about the role of addiction,
social/cultural factors, and tobacco industry influence on smoking behaviors will be
highlighted. Information and training will be provided and patients will be able to
experience practiced interaction in ever increasing complex situations with avatars (i.e.,
receptionist, medical assistant, and clinician). A "virtual coach" will accompany the patient
through the virtual visit and will provide information and coaching (as needed). The
advantages to adding a virtual coach or avatar include the availability of an always-live
agent and the capability of customizing the coach to represent an ideal social model for a
particular user or group of users.Flexibility exists in how to design not only how the coach
will appear but also how the coach will sound - with an appropriate voice and engaging
non-verbal communication). This approach contributes to cultural and ethnic sensitivity. As
the patient attempts to communicate and receive information appropriate for a self-management
plan, they will receive "points" for successful communication. A cumulative score and
explanation will be given at the end of the virtual visit. During the visit the participant
will identify specific topics and questions that they want to address during their visit with
their real clinician; they will receive a printout of their priority questions that they can
take into the visit with their real clinician. The research nurse will review the score, the
priority questions, and the overall virtual experience. Virtual environments for learning are
sufficiently promising that further investment and development of this type of research is
warranted.

Attention control group (ACG)- Patients assigned to the ACG will meet with a nurse and
receive the informational videos from the mHealth TLC on an iPad before 4 clinician visits
with assessments after each clinician visit. An effort will be made to match the intervention
condition on salience, credibility, and contact time.

Inclusion Criteria:

- Inclusion criteria are >21 years old with a diagnosis of lung cancer (any type or
stage), able to read and write English at 5th grade level, able to sign an IRB
approved consent form, and expects to have 4 visits with the same clinician in the
next 2 months.

Exclusion Criteria:

- Unable to understand or tolerate the battery of questionnaires due to physical or
mental health issues (i.e., dementia, active psychosis).