Eliciting patients’ cancer stories and health disparities with an integrated patient-centered storytelling interview, and the use of these recorded stories to educate and train health care personal in effective patient physician communication.

B18

Introduction: In Southern Appalachia, a number of factors result in high rates of cancer incidence and mortality. We decided to explore and document the factors responsible for this disparity through a qualitative research method. The project involves a set of patient interviews conducted over time with cancer patients that focus on key oncology-care transition points. The interviews integrate patient centered communication (an emphasis on the patient’s ideas, concerns and expectations) with elements of the story-telling tradition. The stories they communicate will be video recorded and distributed to medical audiences through a module. In the initial phase of this American Society of Clinical Oncology (Young Investigators Award) and Appalachian Center for Translational Research In Disparities (ACTRID) funded study the investigators interviewed and analyzed a pilot cohort of cancer patients.
 Methods and Results: The initial beta testing began by interviewing six patients, each selected from the University cancer center. The recorded, interviews lasted between 1.5 to 2.5 hours.
 At this point in our beta trial, we will present and discuss:
 1) Our interview template that incorporates important elements of oncology care, patient-centered communication skills and the story telling tradition.
 2) Initial “stories and perspectives” from the beta test that identify potential sources of factors influencing health care disparities.
 3) Common themes which have evolved in our interviews highlighting the similarities and differences in the experiences and preferences of cancer patients.
 Conclusion: From our Patient-Centered/Storytelling Beta trial we are beginning to identify certain emerging themes. The themes provide moving video-audio records of patients’ experience and reactions to a set of common communication issues in cancer care. Examples include:
 1) Jargon and Medical Obfuscation. Patients preferred that their physicians not talk to them in medical terms.
 2) Understanding of prognostic communications. Appalachian patients prefer not to make decisions in regards to their cancer care based on numbers given in terms of response rates and overall survival from their oncologist.
 3) Nursing support roles. Nurses played a crucial role in terms of offering emotional support to cancer patients.
 4) Examples of insensitive communication about bad news. Patients expressed concerns that health care providers appeared emotionally distant during the communication of bad news.
 5) Emotion handling-the good, the bad and the ugly. Patients have provided vivid stories in which physicians and nurses have ignored patients’ feelings, and also stories of great human compassion.
 6) Role of spirituality and religion in dealing with cancer.
 In addition to publishing our data, we will develop and distribute a module to help practicing oncologists to communicate more effectively with patients. This will enable, physicians to reach common ground with their patients regarding cancer treatment plans. By achieving better patient-physician relationship and integration of the patient’s personal and cultural beliefs with evidence based cancer treatment we hope to reduce cancer related health care disparity in southern Appalachia.