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Lung cancer, the leading cause of cancer death in both men and women, is unique because of the inequalities based on race, a poor persistent cure rate, and a social stigma. African- Americans are more likely than whites to be diagnosed later with more advanced lung cancer, wait longer after diagnosis to receive treatment, refuse treatment, and more likely to die in the hospital after surgery. Lung cancer patients who report poor communication with their health care providers are more likely to be African American and less likely to proceed with treatment. Lung cancer stigma (LCS) and difficult patient-clinician communication may be an underlying factor in health disparities in lung cancer. Stigma is a significant barrier to early cancer detection. Stigma in lung cancer is based on the belief that one caused their own cancer (i.e., smoking). LCS is a significant barrier to effective patient-clinician communication, early detection and being able to manage one’s own care. Patients who report poor patient-clinician communication are more likely to be African American and less likely to proceed with treatment.
In our earlier work, we found that regardless of smoking status, LCS predicted a worse symptom experience and diminished quality of life. While stigma-reduction interventions are effective in other diseases, no interventions are available to decrease lung cancer stigma and improve patient-clinician communication. With the rise of technology in health care, the use of electronic or virtual interventions provides new possibilities for cost effective and culturally sensitive health care interventions. The advantages of virtual interventions are to provide opportunities for patients to interact and receive positive feedback for behavior change, and provide the patient with a printed list of personalized questions for their clinicians.
The purpose of this study is to PILOT test, in a diverse sample of lung cancer patients the effectiveness of the mHealth Tool for Lung Cancer patients (mHealthTLC), an interactive, immersive 3-dimensional iPad application that allows individuals to experience first person virtual visits with their clinicians, to improve patient-clinician communication, decrease LCS, and promote optimal self-management. The primary aims in a sample of lung cancer patients are to: Estimate the effect size for the effects of mHealth TLC compared to the attention control group (ACG) on 1. patient-clinician communication, 2. perceived LCS, and 3. lung cancer symptoms; and 4. Compare the feasibility of the mHealth TLC across ethnic groups.
This is an experimental design pilot test of the mHealthTLC. Fifty participants will be randomized to treatment and control (25 in each group) and will be sorted into groups by ethnic groups, African American and non-African American. The mhealth TLC group will meet with a nurse just before each of 4 clinician visits and use 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 increasingly complex situations with a virtual coach, receptionist, assistant, and clinician. The ACG group 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.
It is expected that this intervention will be effective in the reduction of the lung cancer stigma experience; improve patient-clinician communication; promote optimal self-management; and decrease symptom burden. It is also expected that the intervention will help to decrease disparities in lung cancer care by providing an ethnic and culturally sensitive lung cancer stigma and communication intervention. |
