title: Factors that influence physicians' detection of distress in patients with cancer: can a communication skills training program improve physicians' detection?
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, 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 approximately 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.
authors.affiliation: Faculté des Sciences Psychologiques et de l'Education, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Merckaert
authors.forename: Yves
authors.initials: Y
authors.lastname: Libert
authors.forename: Nicole
authors.initials: N
authors.lastname: Delvaux
authors.forename: Serge
authors.initials: S
authors.lastname: Marchal
authors.forename: Jacques
authors.initials: J
authors.lastname: Boniver
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Etienne
authors.forename: Jean
authors.initials: J
authors.lastname: Klastersky
authors.forename: Christine
authors.initials: C
authors.lastname: Reynaert
authors.forename: Pierre
authors.initials: P
authors.lastname: Scalliet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Slachmuylder
authors.forename: Darius
authors.initials: D
authors.lastname: Razavi
mesh_terms: D003142:Communication; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000193:education*; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010817:Physician-Patient Relations; D013315:Stress, Psychological / Q000175:diagnosis*