Improving emotion regulation in breast cancer patients in the early survivorship period: Efficacy of a brief ecologically boosted group intervention.

PURPOSE: This study reports the short- and mid-term benefits of an eight-session emotion and self-regulation group intervention ecologically boosted through daily app-based prompts. The intervention was designed for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. METHODS: Patients were randomly assigned to the immediate intervention arm (n = 61; intervention received immediately) or to the delayed intervention arm (n = 59; intervention received 5 months later). Psychological symptoms, including anxiety, depressive symptoms, emotional distress, fear of cancer recurrence (FCR), worry, and intrusive thoughts were assessed through questionnaires. Emotion regulation was assessed in a dynamic emotion regulation task and in everyday life. Assessments were completed at baseline (T1), 5 months (T2) and 10 months (T3) later. RESULTS: Treated patients reported lower levels of worry and intrusive thoughts. They improved their ability to down-regulate the intensity of their negative emotions when exposed to cancer-related triggers in the dynamic emotion regulation task. They reported fewer and less intense negative emotions and more positive emotions in their everyday life. Benefits were maintained 5 months later, except for positive emotions in everyday life. CONCLUSIONS: The results showed that focusing on emotion regulation is a relevant approach in the treatment of psychological symptoms for breast cancer patients in the early survivorship period meeting criteria for clinical levels of psychological symptoms. The intervention led to changes in patients' dynamic and everyday life emotion regulation. Consolidation sessions may be needed to sustain benefits in positive emotions and to increase the effect sizes.

Efficacy of a support intervention designed to improve parents' communication with children dealing with parental cancer: a randomized pilot trial.

OBJECTIVE: Cancer-related communication is critical for parents' and children's adaptation to the disease. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a 4-session intervention designed to improve parents' communication. METHODS: A 4-session intervention was developed to aid parents to support their children through more open/adapted communication. Sixty-six parents were assigned randomly to informational booklet with and without 4-session support intervention arms. Parents' communication self-efficacy, communication behaviors, communication difficulties, knowledge about age-appropriate communication, theoretical knowledge about concerns of children, parenting concerns, and distress were assessed by questionnaires at baseline and post-interventions. Multivariate analyses of variance were performed to compare data between and within groups over time. RESULTS: The intervention attrition rate was 6%. Data from 60 participants were included in analyses. Parents in the informational booklet with 4-session support group increased their communication self-efficacy (F = 4.5, p = 0.04), reduced communication difficulties (F = 4.0, p = 0.05), and increased their knowledge about how to communicate (F = 4.8, p = 0.03). CONCLUSION: The results indicate that the 4-session intervention is acceptable, and shows preliminary evidence of efficacy. PRACTICE IMPLICATIONS: A short support intervention associated with an informational booklet may be useful for parents wishing to improve their communication with their children.

How to support parenting in patients with cancer and co-parents? From research to practice.

PURPOSE OF REVIEW: When a parent is diagnosed with cancer, the entire family is impacted. Patients with cancer and co-parents may no longer feel able to fulfill their parenting roles. The aims of this article are to describe interventions designed to support parenting in the oncological context and to make suggestions for the development and assessment of such interventions. RECENT FINDINGS: Ten parenting support interventions published in the last 10 years in oncology were identified, among which four randomized controlled trials (RCTs). The therapeutic aims, techniques, and modalities of these interventions were heterogeneous. Five main therapeutic aims were addressed to: increase parents' knowledge, promote parents' emotion regulation, enhance parents' self-efficacy related to parenting, promote parents' support of their children's reactions and coping strategies, and promote open and appropriate parent-child communication. Few studies have combined informational resources with experiential techniques. SUMMARY: Very few studies examining the efficacy of parenting support interventions have been published. There is still a need to develop, test, and compare interventions that meet the many needs of parents and their children. Suggestions are made about the contents and formats of parenting support interventions in oncology.

Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial.

OBJECTIVE: Cancer-related communication is critical for patients' and caregivers' adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication. METHODS: A four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention. RESULTS: The intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants' cancer-related dyadic communication frequency (ß = -1.30; SE = 0.31; p = .004), self-efficacy (ß = -10.03; SE = 3.90; p = .011) and dyadic coping (ß = -5.93; SE = 2.73; p = .046) after the intervention. CONCLUSION: These results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy. PRACTICE IMPLICATIONS: Encouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.

How does physicians' decisional conflict influence their ability to address treatment outcomes in a decision-making encounter with an advanced-stage cancer simulated patient? A descriptive study.

OBJECTIVES: This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS: Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS: Physicians' Spe-DCS (ß = -.21 ; p = .014) and weekly time spent with cancer patients (ß = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION: Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS: Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.

Development of the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP) during medical encounters.

OBJECTIVE: Our first objective was to develop the Multi-Dimensional analysis of Patient Outcome Predictions (MD.POP), an interaction analysis system that assesses how HCPs discuss precisely and exclusively patient outcomes during medical encounters. The second objective was to study its interrater reliability. METHOD: The MD.POP was developed by consensus meetings. Forty simulated medical encounters between physicians and an actress portraying a patient were analysed. Interrater reliability analysis was conducted on 20 of those simulated encounters. RESULTS: The MD.POP includes six dimensions: object, framing, value, domain, probability and form of POP. The coding method includes four steps: 1) transcription of the encounter, 2) POP identification, 3) POP dimension coding and 4) POP scoring. Descriptive analyses show that the MD.POP is able to describe verbal expressions addressing the patient's outcomes. Statistical analyses show excellent interrater reliability (Cohen's Kappa ranging from 0.92 to 0.94). CONCLUSION: The MD.POP is a reliable interaction analysis system that assesses how HCPs discuss patient medical, psychological or social outcomes during medical encounters. PRACTICAL IMPLICATION: The MD.POP provides a measure for researchers to study how HCPs communicate with patients about potential outcomes. Results of such studies will allow to provide recommendations to improve HCP's communication about patients' outcomes.

Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients.

BACKGROUND: Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. METHODS/DESIGN: Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. DISCUSSION: The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. TRIAL REGISTRATION: US Clinical Trials Register NCT02836197 .

Predictors of physicians' communication performance in a decision-making encounter with a simulated advanced-stage cancer patient: A longitudinal study.

OBJECTIVES: Physicians' characteristics that influence their communication performance (CP) in decision-making encounters have been rarely studied. In this longitudinal study, predictors of physicians' CP were investigated with a simulated advanced-stage cancer patient. METHODS: Physicians (n=85) performed a decision-making encounter with a simulated patient (SP). Their CP was calculated by analyzing encounter transcripts with validated interaction analysis systems. Potential specific psychological predictors were physicians' empathy towards the SP (Jefferson Scale of Physician Empathy, JSPE) and their decisional conflict about the treatment (Decisional Conflict Scale, DCS). Potential general psychological predictors were physicians' empathy towards cancer patients (JSPE), their decisional conflict about cancer patients' treatments (DCS), and their affective reactions to uncertainty (Physicians' Reactions to Uncertainty, PRU). RESULTS: Physicians' CP was predicted by their decisional conflict about the SP's treatment (DCS) (ß=0.41; p< 0.001) and their affective reactions to uncertainty regarding cancer treatments (PRU) (ß=-0.31; p=0.003). CONCLUSION: During encounters with advanced-stage cancer patients, physicians' awareness of uncertainty about which treatments to consider may facilitate their communication performance, whereas physicians' affective reactions to uncertainty may inhibit their performance. PRACTICE IMPLICATIONS: Physicians' decisional conflict and reactions to uncertainty should be addressed in communication skills training programs.

Cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy: A longitudinal cohort study.

OBJECTIVE: Despite the well-known negative impacts of cancer and anticancer therapies on cognitive performance, little is known about the cognitive compensatory processes of older patients with cancer. This study was designed to investigate the cognitive compensatory processes of older, clinically fit patients with hematologic malignancies undergoing chemotherapy. METHODS: We assessed 89 consecutive patients (age ≥ 65 y) without severe cognitive impairment and 89 age-, sex-, and education level-matched healthy controls. Cognitive compensatory processes were investigated by (1) comparing cognitive performance of patients and healthy controls in novel (first exposure to cognitive tasks) and non-novel (second exposure to the same cognitive tasks) contexts, and (2) assessing psychological factors that may facilitate or inhibit cognitive performance, such as motivation, psychological distress, and perceived cognitive performance. We assessed cognitive performance with the Trail-Making, Digit Span and FCSR-IR tests, psychological distress with the Hospital Anxiety and Depression Scale, and perceived cognitive performance with the FACT-Cog questionnaire. RESULTS: In novel and non-novel contexts, average cognitive performances of healthy controls were higher than those of patients and were associated with motivation. Cognitive performance of patients was not associated with investigated psychological factors in the novel context but was associated with motivation and psychological distress in the non-novel context. CONCLUSIONS: Older, clinically fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and increasing motivation may improve cognitive compensatory processes of patients in non-novel contexts.

Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study.

OBJECTIVE: Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. METHODS: In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. RESULTS: Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (ß = -0.135, p = 0.058) and ADL (ß = -0.148, p = 0.037) scores, and higher HADS (ß = 0.283, p < 0.001) and FACT-Cog perceived cognitive impairments subscale (ß = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. CONCLUSIONS: Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.

Improving anxiety regulation in patients with breast cancer at the beginning of the survivorship period: a randomized clinical trial comparing the benefits of single-component and multiple-component group interventions.

OBJECTIVE: To compare in a multicenter randomized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention (SGI) based on support with those of a 15-session multiple-component structured manualized group intervention (MGI) combining support with cognitive-behavioral and hypnosis components. METHODS: Patients with nonmetastatic breast cancer were randomly assigned at the beginning of the survivorship period to the SGI (n = 83) or MGI (n = 87). Anxiety regulation was assessed, before and after group interventions, through an anxiety regulation task designed to assess their ability to regulate anxiety psychologically (anxiety levels) and physiologically (heart rates). Questionnaires were used to assess psychological distress, everyday anxiety regulation, and fear of recurrence. Group allocation was computer generated and concealed till baseline completion. RESULTS: Compared with patients in the SGI group (n = 77), patients attending the MGI group (n = 82) showed significantly reduced anxiety after a self-relaxation exercise (P = .006) and after exposure to anxiety triggers (P = .013) and reduced heart rates at different time points throughout the task (P = .001 to P = .047). The MGI participants also reported better everyday anxiety regulation (P = .005), greater use of fear of recurrence-related coping strategies (P = .022), and greater reduction in fear of recurrence-related psychological distress (P = .017) compared with the SGI group. CONCLUSIONS: This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer.

Is it possible to improve communication around radiotherapy delivery: A randomized study to assess the efficacy of team training?

BACKGROUND AND PURPOSE: The aim of this study was to assess the efficacy of a 38-h communication skills training program designed for multidisciplinary radiotherapy teams. MATERIALS AND METHODS: Four radiotherapy teams were randomly assigned to a training program or to a waiting list. Assessments were scheduled at baseline (T1) and then after the training was completed or four months later (T2), respectively. Communication around radiotherapy delivery was assessed based on audio recordings of the first and last radiotherapy sessions in order to assess team members' communication skills and the expression of concerns by breast cancer patients (analyzed with content analysis software LaComm). RESULTS: 198 radiotherapy sessions were recorded. During the first radiotherapy sessions, members of the trained teams exhibited more assessment skills (p=0.048), provided more setting information (p<0.001), and used more social words (p=0.019) compared to the members of the untrained teams. During the last radiotherapy session, members of the trained teams used more assessment skills (p=0.004) and patients interacting with members of the trained teams expressed more sadness words (p=0.023). CONCLUSION: Training of multidisciplinary teams has the potential to transfer skills that affect the short exchanges that take place around radiotherapy delivery.

Transfer of communication skills to the workplace: impact of a 38-hour communication skills training program designed for radiotherapy teams.

PURPOSE: This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. METHODS: Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members' communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. RESULTS: Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses' interventions (P = .028). CONCLUSION: The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients' satisfaction with care.

Anxiety at the first radiotherapy session for non-metastatic breast cancer: key communication and communication-related predictors.

BACKGROUND AND PURPOSE: Patients may experience clinically relevant anxiety at their first radiotherapy (RT) sessions. To date, studies have not investigated during/around the RT simulation the key communication and communication-related predictors of this clinically relevant anxiety. MATERIAL AND METHODS: Breast cancer patients (n=227) completed visual analog scale (VAS) assessments of anxiety before and after their first RT sessions. Clinically relevant anxiety was defined as having pre- and post-first RT session VAS scores ⩾4 cm. Communication during RT simulation was assessed with content analysis software (LaComm), and communication-related variables around the RT simulation were assessed with questionnaires. RESULTS: Clinically relevant anxiety at the first RT session was predicted by lower self-efficacy to communicate with the RT team (OR=0.65; p=0.020), the perception of lower support received from the RT team (OR=0.70; p=0.020), lower knowledge of RT-associated side effects (OR=0.95; p=0.057), and higher use of emotion-focused coping (OR=1.09; p=0.013). CONCLUSIONS: This study provides RT team members with information about potential communication strategies, which may be used to reduce patient anxiety at the first RT session.

Anxiety and its time courses during radiotherapy for non-metastatic breast cancer: a longitudinal study.

PURPOSE: To our knowledge, no study has specifically assessed the time course of anxiety during radiotherapy (RT). The objective of this study was to assess anxiety time courses in patients with non-metastatic breast cancer. MATERIAL AND METHODS: This multicenter, descriptive longitudinal study included 213 consecutive patients with breast cancer who completed visual analog scales (VASs) assessing state anxiety before and after the RT simulation and the first and last five RT sessions. RESULTS: Pre- and post-session anxiety mean levels were highest at the RT simulation (respectively, 2.9±2.9 and 1.6±2.5) and first RT session (respectively, 3.4±2.9 and 2.0±2.4), then declined rapidly. Clinically relevant mean differences (⩾1cm on the VAS) between pre- and post-simulation/session VAS scores were found only for the RT simulation (-1.3±2.7; p<0.001) and first RT session (-1.4±2.4; p<0.001). Five percent to 16% of patients presented clinically relevant anxiety (pre- and post-simulation/session VAS scores⩾4cm) throughout treatment. CONCLUSIONS: To optimize care, RT team members should offer all patients appropriate information about treatment at the simulation, check patients' understanding, and identify patients with clinically relevant anxiety requiring appropriate support throughout RT.

Is it possible to improve radiotherapy team members' communication skills? A randomized study assessing the efficacy of a 38-h communication skills training program.

BACKGROUND AND PURPOSE: Optimizing communication between radiotherapy team members and patients and between colleagues requires training. This study applies a randomized controlled design to assess the efficacy of a 38-h communication skills training program. MATERIAL AND METHODS: Four radiotherapy teams were randomly assigned either to a training program or to a waiting list. Team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints. These encounters were scheduled at the baseline and after training for the training group, and at the baseline and four months later for the waiting list group. Encounters were audiotaped and transcribed. Transcripts were analyzed with content analysis software (LaComm) and by an independent rater. RESULTS: Eighty team members were included in the study. Compared to untrained team members, trained team members used more turns of speech with content oriented toward available resources in the team (relative rate [RR]=1.38; p=0.023), more assessment utterances (RR=1.69; p<0.001), more empathy (RR=4.05; p=0.037), more negotiation (RR=2.34; p=0.021) and more emotional words (RR=1.32; p=0.030), and their self-efficacy to communicate increased (p=0.024 and p=0.008, respectively). CONCLUSIONS: The training program was effective in improving team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient. Future study should assess the effect of this training program on communication with actual patients and their satisfaction. Moreover a cost-benefit analysis is needed, before implementing such an intensive training program on a broader scale.

The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task.

OBJECTIVE: Breaking bad news (BBN) is a complex task which involves dealing cognitively with different relevant dimensions and a challenging task which involves dealing with intense emotional contents. No study however has yet assessed in a randomized controlled trial design the effect of a communication skills training on residents' physiological arousal during a BBN task. METHODS: Residents' physiological arousal was measured, in a randomized controlled trial design, by heart rate and salivary cortisol before, during and after a BBN simulated task. RESULTS: Ninety-eight residents were included. MANOVA showed significant group-by-time effects. Trained residents' mean heart rate levels remained elevated after training and cortisol areas under the curve increased after training compared to untrained residents. CONCLUSION: Communication skills training has an effect on residents' physiological arousal. Residents' self-efficacy and communication skills improvements in a BBN simulated task are associated with an elevated physiological arousal, which becomes proportional to the complexity of the task and reflects a better engagement and performance. PRACTICE IMPLICATIONS: Residents should be informed that, to perform a task, they need to engage in the task with a physiological arousal proportional to the complexity of this task. Communication skills training should be adapted.

How much is residents' distress detection performance during a clinical round related to their characteristics?

OBJECTIVE: The aim of this study was to investigate residents' characteristics associated with their performance in detecting patients' distress (detection performance). METHODS: Residents' detection performance was assessed in a clinical round. A mean detection performance score was calculated for each resident by comparing residents' rating of patients' distress (VAS) with patients' reported distress (HADS). Residents' characteristics include general (socio-demographic, professional and psychological), detection (self-efficacy, attitudes and outcome expectancies) and performance characteristics (communication skills (LaComm), psychological arousal (STAI) and physiological arousal (heart rate and blood pressure) in a highly emotional and complex simulated interview task). RESULTS: Ninety-four residents and 442 inpatients were included. 30% of the variance in residents' detection performance was related to residents' performance characteristics: anxiety level (p=.040) and mean arterial blood pressure (p=.019) before the task; empathy (p=.027) and mean heart rate (p=.043) during the task; mean arterial blood pressure changes (p=.012) during the assessment procedure. CONCLUSION: Residents' detection performance is partly related to their performance characteristics. Psychological and physiological arousals are key characteristics--beside empathic skills--that need to be considered in models designed to determine detection performance. PRACTICE IMPLICATIONS: Future interventions designed to improve residents' detection performance should focus notably on their performance characteristics.

Transfer of communication skills to the workplace during clinical rounds: impact of a program for residents.

BACKGROUND AND PURPOSE: Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training. Meanwhile, the importance of transfer of communication skills to the workplace has not been sufficiently studied. This study aims to assess the efficacy of a 40-hour training program designed to improve patients' satisfaction and residents' communication skills during their daily clinical rounds. METHODS: Residents were randomly assigned to the training program or to a waiting list. Patients' satisfaction was assessed with a visual analog scale after each visit. Transfer of residents' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round. Transcripted audiotapes were analyzed using content analysis software (LaComm). Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models. RESULTS: Eighty-eight residents were included. First, patients interacting with trained residents reported a higher satisfaction with residents' communication (Median=92) compared to patients interacting with untrained residents (Median=88) (p=.046). Second, trained residents used more assessment utterances (Relative Risk (RR)=1.17; 95% Confidence intervals (95%CI)=1.02-1.34; p=.023). Third, transfer was also observed when residents' training attendance was considered: residents' use of assessment utterances (RR=1.01; 95%CI=1.01-1.02; p=.018) and supportive utterances (RR=0.99; 95%CI=0.98-1.00; p=.042) (respectively 1.15 (RR), 1.08-1.23 (95%CI), p<.001 for empathy and 0.95 (RR), 0.92-0.99 (95%CI), p=.012 for reassurance) was proportional to the number of hours of training attendance. CONCLUSION: The training program improved patients' satisfaction and allowed the transfer of residents' communication skills learning to the workplace. Transfer was directly related to training attendance but remained limited. Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer.

Predictors and correlates of burnout in residents working with cancer patients.

There are few studies which have investigated variables associated with the development of burnout among residents working with cancer patients. The aim of this study is to identify variables leading to residents' burnout in order to develop effective interventions. Burnout was assessed with Maslach Burnout Inventory. Person- (i.e., emotional-focused coping) and work-related (i.e., changes in lack of organizational support index) variables explain 28% of the variance in changes in emotional exhaustion. Training programs may be improved by adding specific modules for residents, about problem-focused coping in interviewing patients, and for supervisors, about effective team management.