Improving Communication Between Cancer Patients & Oncologists

The primary objective of the Enhanced SCOPE program is to teach oncologists to recognize the
role of emotion in discussions with cancer patients, to increase their self-efficacy for
addressing affective concerns, and to provide them with the skills for doing so. Oncologists
are most likely to achieve competency in these areas when, in addition to didactic training,
they can also observe their own conversation and receive feedback on their interactions. The
Enhanced SCOPE program itself is an online web application that can be viewed from any
computer with internet connectivity. The investigators will be conducting a randomized
controlled trial to test the impact on patient satisfaction and medical visit quality of a
communication skills teaching intervention for oncologists that is integrated into the
American Board of Internal Medicine (ABIM) Maintenance Of Certification (MOC) process.
Oncologists who choose to enroll in this pilot Practice Improvement Module (PIM) will
complete a baseline questionnaire, send out satisfaction surveys to a sample of their
patients, and then audio record (using a smartphone application) eight clinic visits with
eight different patients. Oncologists who are assigned to the control arm will receive the
results of the patient surveys and be asked to conduct a quality improvement activity that
responds to the feedback (the current "standard" communication PIM). Oncologists assigned to
the intervention arm will receive the survey feedback as well as the enhanced SCOPE program
that provides feedback on their audio-recorded encounters via a web based interactive
program. The feedback will come from two sources: 1) Professional research assistant coders
who will identify objective learning opportunities based on specific coding criteria (e.g.,
empathic opportunities, use of open-ended questions) and 2) Trained patient reviewers who
will listen to the recordings and offer their own, subjective feedback at key moments in the
encounters. These patient reviewers will be drawn from our stakeholder partners and are
active patient advocates. They will be treated as members of the research team, paid for the
reviews, and are not patients of the study physicians. One month after reviewing their
feedback, oncologists in both arms will audio record another eight encounters and send out
satisfaction surveys to a new sample of patients.

Inclusion Criteria:

- All American Board of Internal Medicine (ABIM) Board certified oncologists practicing
in the U. S. and enrolled in Maintenance of Certification.

- Have a study-compatible smart phone.

- Eligible patients will have metastatic cancer.

- At least 18 years of age.

- Speak and read English.

- Receive oncology care from an enrolled oncologist.

Exclusion Criteria:

- Dana Farber Cancer Institute oncologists and oncologists who do not speak English to
their patients.

- Patients who do not speak English.