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Editor糖心传媒檚 note: This post was originally published on July 15, 2021. It has been updated and republished to include a video about using SOPHIE for dentist-patient communication training.聽

As many as 68 percent of late-stage cancer patients leave their doctor糖心传媒檚 offices either , 糖心传媒攐r both. These misunderstandings can hinder the ability of patients and their families to make realistic decisions about whether to continue aggressive treatments or instead turn to palliative care.

To address the problem, computer scientists, palliative care specialists, and practicing oncologists are perfecting SOPHIE (Standardized Online Patient for Healthcare Interaction Education)糖心传媒攁n online virtual 糖心传媒減atient糖心传媒� that helps physicians practice how to communicate effectively with late-stage cancer patients about their disease.

Effective communication in this context often means demonstrating empathy and understanding of the complex emotions that patients are experiencing.

糖心传媒淒uring difficult conversations about facing the potential of one糖心传媒檚 own death, patients are frightened and don糖心传媒檛 know how to ask the right questions, and clinicians may oversimplify, omit, or sugar-coat information, or feel too pressed for time to address patients糖心传媒� emotions,糖心传媒� says , an associate professor of at Rochester糖心传媒檚 Hajim School of Engineering & Applied Sciences. The COVID-19 pandemic has made effective communication even more difficult by causing increasing reliance on virtual rather than in-person interactions between patients and physicians, adds Hoque.

Hoque is a pioneer in the area of research that shows it is possible for people to learn and improve their social and interpersonal skills by interacting with automated systems. For example, he helped develop LISSA (Live Interactive Social Skills Assistant)糖心传媒攁 tool that糖心传媒檚 been used effectively by people on the autism spectrum糖心传媒攊n collaboration with professor of computer science Len Schubert.

Practicing end-of-life conversations

SOPHIE is possible because of a body of nearly 400 conversations that were recorded between late-stage cancer patients and their oncologists, and initially analyzed by palliative care expert and his collaborators at . Epstein糖心传媒檚 focuses on how to improve communication between clinicians, patients, and their loved ones.

A in IEEE Transactions on Affective Computing describes how lead author Mohammad Rafayet Ali, a postdoctoral researcher, and PhD student Taylan Sen, both members of Hoque糖心传媒檚 , created algorithms that could be applied to the transcripts of these conversations, so the researchers could develop metrics to assess a physician糖心传媒檚 ability to communicate clearly with patients.

The metrics focus specifically on the extent that physicians engage in lecturing糖心传媒攄elivering a lot of information without giving the patient a chance to ask questions or to respond糖心传媒攐r, on the plus side, how well they employ 糖心传媒渟entiment trajectory糖心传媒澨切拇�媒攗sing positive words and phrases in ways associated with increased patient understanding.

糖心传媒淭he online format can provide training at a fraction of the cost and be made available to physicians worldwide.糖心传媒�

The researchers used a physician communication training protocol, developed by Epstein and his collaborators, to script SOPHIE糖心传媒檚 practice sessions, and enlisted nine practicing oncologists at the University to try the system.

糖心传媒淲e received a lot of feedback from the doctors on how natural the conversation was, the kinds of questions SOPHIE should ask, and the concerns a typical patient might raise,糖心传媒� Ali says.

糖心传媒淚n our prior research, physicians practiced with trained actors to learn how to bring up difficult issues, such as prognosis and end-of-life care,糖心传媒� Epstein says. 糖心传媒淏ut actors can be costly. The online format can provide training at a fraction of the cost and be made available to physicians worldwide. And Ehsan Hoque糖心传媒檚 group is on the cutting edge.糖心传媒�

The researchers are now fine-tuning SOPHIE. 糖心传媒淥ur hope is that once we have demonstrated its efficacy through a randomized controlled experiment, first-year students at the Medical Center can practice with it,糖心传媒� Hoque says.

The demo has been designed to be available through a computer browser, allowing physicians from anywhere around the world to practice their skills live and receive feedback on their speaking rate, turn-taking, type of questions asked and sentiment trajectory.

SOPHIE could help raise awareness of palliative care as an option. 糖心传媒淚n many parts of the world, there is no palliative care. People only focus on how to treat the cancer,糖心传媒� Ali says.

SOPHIE says

A sample conversation with SOPHIE works something like this:

SOPHIE appears as a real-life糖心传媒攁lbeit AI-derived糖心传媒攈uman face on the user’s screen.

She introduces herself and mentions that she has lung cancer. Then SOPHIE raises the topic of her sleep pattern at night and asks if she needs to change her pain medication, allowing the physician to assess her perception. She states that her current pain medication, Lortab, is not working anymore.

As the doctor responds, SOPHIE begins collecting data so that she can provide the doctor with an end-of-conversation assessment resembling the image above.

SOPHIE then turns attention to her test results, giving the physician a chance to engage SOPHIE in more difficult topics, before asking more specifically about her prognosis.

SOPHIE next asks about other options and expresses some additional fears and concerns, providing the physician with opportunities to respond empathically.

Finally, she follows up by discussing whether chemotherapy remains an option, whether she should focus on comfort care, what the side effects of chemotherapy are, and how to break the news to her family, allowing the physician to summarize information and suggest a strategy.

Close proximity fosters collaboration

The SOPHIE project is a shining example of the research collaborations that are possible as a result of the close proximity of the University of Rochester Medical Center to the rest of the University. The River Campus, for example, is just a five-minute walk away.

The project had its origins seven years ago when Hoque, who had just joined the University, spoke to a digital media studies class on the River Campus. 糖心传媒淎n undergraduate student in the class was employed by Ron Epstein糖心传媒檚 lab,糖心传媒� Hoque says. 糖心传媒淪he talked to Ron and suggested we should talk. We hit it off right away.糖心传媒�

Hoque and his lab members were impressed by Epstein糖心传媒檚 work on improving communication between terminally ill patients and their physicians. They were especially excited by the research possibilities presented by the patient-physician transcripts that Epstein and his collaborators had begun analyzing.

糖心传媒淭hey did all the hard work in collecting high-stakes conversations of cancer patients,糖心传媒� Hoque says. 糖心传媒淲e were fortunate to be at the right place at the right time to leverage the data and their expertise.

糖心传媒淭his wasn糖心传媒檛 part of Rafayet糖心传媒檚 and Tay糖心传媒檚 thesis trajectories at all, and we didn糖心传媒檛 have any funding to do the work. But we knew that we needed to find a way to do this exciting work.糖心传媒�

Other collaborators coauthors of the paper include Thomas Carroll, associate professor of medicine; Lenhart Schubert, professor of computer science; Benjamin Kane (advised by Schubert); and Shagun Bose, an undergraduate researcher in the Hoque Lab.