Trial Information

Virtual Intervention for Lung Cancer

This is a two arm experimental design PILOT test of the mHealth Tool for Lung Cancer
patients (mHealthTLC) an intervention to improve patient-clinician communication, decrease
lung cancer stigma, and decrease lung cancer symptom scores. Patients will be assigned to
either the mHealth TLC group or the Attention Control Group (ACG). Interventions in both
groups will be delivered online or by iPad in a research office in the clinician's building
prior to each visit. Assessments will be done immediately after each visit in the same
research room. Intervention and assessment pre-visit is expected to take less than one hour,
the intervention is expected to take 30mins, and post assessment is expected to take 30
minutes. A follow-up assessment will be done at 3 months from enrollment.

mhealth TLC group will meet with a nurse just before each of 4 clinician visits and use the
mHealth TLC on an iPad with an interactive, immersive 3-dimensional (3-D) intervention that
allows individuals to experience virtual visits with their clinicians. 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 increasing complex situations with a virtual coach, receptionist, assistant, and
clinician.During the mHealthTLC the patient will enter a virtual clinic office, travel
through the different aspects of a typical clinic visit, and interact with office staff and
clinicians that are represented by avatars. The avatars will be designed to reflect ethnic
and cultural diversity. First person is the preferred format for health teaching because the
patient is active as self and not represented as an avatar. The first person vantage point
facilitates the immersion and immediacy of the experience. Key aspects of mHealthTLC include
informational videos about lung cancer (i.e. etiology, diagnosis, treatment, symptoms) and
LCS. Blame and self-blame will be addressed, information about the role of addiction,
social/cultural factors, and tobacco industry influence on smoking behaviors will be
highlighted. Information and training will be provided and patients will be able to
experience practiced interaction in ever increasing complex situations with avatars (i.e.,
receptionist, medical assistant, and clinician). A "virtual coach" will accompany the
patient through the virtual visit and will provide information and coaching (as needed). The
advantages to adding a virtual coach or avatar include the availability of an always-live
agent and the capability of customizing the coach to represent an ideal social model for a
particular user or group of users.Flexibility exists in how to design not only how the coach
will appear but also how the coach will sound - with an appropriate voice and engaging
non-verbal communication). This approach contributes to cultural and ethnic sensitivity. As
the patient attempts to communicate and receive information appropriate for a
self-management plan, they will receive "points" for successful communication. A cumulative
score and explanation will be given at the end of the virtual visit. During the visit the
participant will identify specific topics and questions that they want to address during
their visit with their real clinician; they will receive a printout of their priority
questions that they can take into the visit with their real clinician. The research nurse
will review the score, the priority questions, and the overall virtual experience. Virtual
environments for learning are sufficiently promising that further investment and development
of this type of research is warranted.

Attention control group (ACG)- Patients assigned to the ACG 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. An effort will be made to match the
intervention condition on salience, credibility, and contact time.