Grantee: Ronald Epstein

Ronald Epstein

• University of Rochester

Ronald Epstein, M.D., directs the Center for Communication and Disparities Research at the University of Rochester School of Medicine and Dentistry where he is Professor of Family Medicine, Psychiatry, Oncology and Nursing. He is widely regarded as an exemplary family physician, palliative care physician and medical educator, and draws on his clinical and educational expertise to guide his research, which largely focuses on the relationship of patient-centered communication to patient outcomes and health care costs.

Believing that communication is at the heart of medical practice, Dr. Ronald Epstein has been passionately devoted to promoting effective communication in health care for over 25 years. Patients with advanced cancer and other serious illnesses in which prognosis is uncertain often have an inadequate understanding of their illness and their chances of survival, while their physicians are often unaware of patients’ concerns and worries. Effective communication, however, can promote understanding, compassion and patient involvement in decision-making, in addition to reducing the distress experienced by patients and their families.

Dr. Epstein serves as the PI for the VOICE (Values and Options in Cancer Care) study, which is intended to improve communication and self-awareness by coaching patients with advanced cancer, family caregivers and physicians to communicate more effectively. As part of the study, physicians receive individualized coaching sessions led by trained standardized patient-instructors while patients and their caregivers meet with trained communication coaches to help them organize and express their questions and concerns to their physicians. After the intervention, patients have an audio-recorded physician visit to assess the quality and content of communication. Patients and caregivers complete surveys every three months to assess quality of life and the patient-physician relationship. Health care utilization at the end of life is abstracted from patient charts. In addition, caregivers complete surveys after the patient’s death to assess caregiver bereavement and mental health.

The complexity of decision-making in serious illness calls for a different model of care, in which the health care team helps patients to inform, explore, express and enact their preferences based on open and clear information exchange and a trusting relationship with their physician. Interventions such as those in the VOICE study can help physicians to engage with patients more meaningfully while also heeding the pressures of the current clinical environment.