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Cockle-Hearne J, Groothuizen JE, Ream E. Helping patients prepare their dependent children for parental death: mixed-methods evaluation of a codeveloped training programme for palliative and allied healthcare professionals in the UK. BMJ Open 2024; 14:e081775. [PMID: 38724050 PMCID: PMC11086417 DOI: 10.1136/bmjopen-2023-081775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To evaluate how the codesigned training programme, 'No conversation too tough', can help cancer, palliative and wider healthcare professionals support patients to communicate with their dependent children when a parent is dying. We examined perceptions of learning provided by the training, its contribution to confidence in communicating with families when a parent is dying, and subjective experience of, and reactions to, the training. We also explored potential changes in practice behaviours. DESIGN Pre-post, convergent, parallel, mixed-methods study. Motivations for practice change were measured quantitatively, and qualitatively through semi-structured interviews. Non-parametric analysis was conducted for self-efficacy and outcome expectancy measures; descriptive statistics examined perceptions of usefulness; intentions to use learning in practice and reactions to the training. Semi-structured interviews examined motivations and perceptions of learning in depth. A 6-week, practice log recorded immediate practice effects and reflections. SETTING 1-day training delivered 3 times, total delegates 36: online December 2021, February 2022, face-to-face March 2022. Questionnaires delivered correspondingly in online or paper formats, semi-structured interviews online. PARTICIPANTS Pre-post: palliative care professionals (n=14/12), acute cancer clinical nurse specialists (n=16/11), other healthcare professionals (n=5/5). RESULTS Positive changes were observed in self-efficacy (17 of 19 dimensions p<0.003) and outcome expectancies (3 of 14 beliefs p<0.036). Perceptions of usefulness and intentions to use learning in practice mean scores were 82-94 (scales 0=low to 100=high). There was high affirmation for sharing learning and influencing change in the workplace and wider practice. Content, style and delivery were positively endorsed. Further elements to be included in the training were identified. CONCLUSIONS The training programme has the potential to effect change in practice behaviours. A large-scale study will evaluate the roll-out of the training delivered to individual professionals and whole teams across the UK. It will provide longer-term feedback to understand practice behaviour and mediators of change across professional roles.
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Affiliation(s)
- Jane Cockle-Hearne
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Johanna Elise Groothuizen
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Nixon J, Turner J, Gray L, Scaife J. Communicating Actively, Responding Empathically (CARE): Perceptions of Cancer Health Professionals Attending Communication Training Workshops. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:288-295. [PMID: 32592036 DOI: 10.1007/s13187-020-01809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Communication skills training is standardly offered to health professionals working in cancer; however, there is no consensus on the precise style or duration of training, which is most effective. This study aimed to examine the experiences of health professionals who had participated in either a 1-day communication skills training workshop focusing on experiential learning or a 2-h workshop in which participants discussed different communication styles demonstrated on purpose-designed videotapes. Twenty health professionals comprising ten from each workshop type participated in a semi-structured interview with an interpretative descriptive design. Participant characteristics were summarised using descriptive statistics. Thematic analysis was conducted. Consistent themes across both groups were the importance of good communication and perceived barriers. All participants strongly endorsed the value of their respective training experience and considered this was due in part to the skill of facilitators and the creation of a supportive learning environment. Role plays were reported to be helpful in promoting skill development, and some participants in the 2-h workshop indicated that they would have liked the opportunity to practice new skills through role play, which was not possible in the short workshop. Participants self-reported increased confidence following both workshops and perceived improvements in delivery of person-centred care. Both the 1-day and the 2-h communication workshops were a positive experience for the groups who attended. The 1-day communication workshop offered an opportunity for experiential learning, which the 2-h group felt would have been worthwhile; however, both groups found value in attending the workshops.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jessica Scaife
- Department of Palliative Care, Calvary Mater Newcastle, Edith Street, Waratah, 2299, Australia
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de Sousa Mata ÁN, de Azevedo KPM, Braga LP, de Medeiros GCBS, de Oliveira Segundo VH, Bezerra INM, Pimenta IDSF, Nicolás IM, Piuvezam G. Training in communication skills for self-efficacy of health professionals: a systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:30. [PMID: 33676515 PMCID: PMC7937280 DOI: 10.1186/s12960-021-00574-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services. OBJECTIVE To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals. METHODS Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method. RESULTS Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk. CONCLUSION Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals. PROSPERO CRD42019129384.
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Affiliation(s)
- Ádala Nayana de Sousa Mata
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | - Kesley Pablo Morais de Azevedo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Liliane Pereira Braga
- Multicampi School of Medical Sciences of Rio Grande do Norte, Federal University of Rio Grande do Norte, Av. Coronel Martiniano, 541, Centro, Caicó, RN ZIP Code: 59300-000 Brazil
| | | | - Victor Hugo de Oliveira Segundo
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Isaac Newton Machado Bezerra
- Academic Center of Vitória, Federal University of Pernanmbuco, R. Aldo do reservatório, s/n, Bela Vista, Vitória de Santo Antão, PE ZIP Code: 55608-680 Brazil
| | - Isac Davidson Santiago Fernandes Pimenta
- Post-Graduate Program in Public Health, Health Science Center, Federal University of Rio Grande do Norte, Av. Sen. Salgado Filho, 1787 - Lagoa Nova, Natal, RN ZIP Code: 59056-000 Brazil
| | - Ismael Martinez Nicolás
- Department of Health Sciences, Catholic University San Antonio de Murcia, San Antonio de Murcia, Campus de los Jerónimos, 135, 30107 Guadalupe, Murcia Spain
| | - Grasiela Piuvezam
- Department of Public Health, Federal University of Rio Grande do Norte, University Campus, Av. Senador Salgado Filho, 3000, Lagoa Nova, Natal, RN ZIP Code: 59.078-970 Brazil
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Cornell KK, Coe JB, Shaw DH, Felsted KE, Bonvicini KA. Investigation of the effects of a practice-level communication training program on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics. J Am Vet Med Assoc 2020; 255:1377-1388. [PMID: 31793835 DOI: 10.2460/javma.255.12.1377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate effects of an intensive 2-day practice-level communication skills training program (CSTP) with a 3-month follow-up communication in practice program (CIPP) on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics. SAMPLE 5 US companion animal veterinary practices. PROCEDURES Following pilot testing at 1 veterinary practice, communication skills training was performed on-site at 4 practices. The 2-day CSTP focused on veterinary communication-specific content. The CIPP included in-practice training sessions every other week to reinforce and build upon communication skills. Team members' communication skills confidence (before and after the CSTP and after the CIPP) and client satisfaction with veterinary visits (2 months before and 3 months after the CSTP) were assessed with surveys. Practice-level financial metrics were collected for 18 months. Variables of interest were compared among time points. RESULTS Measures of team member communication skills confidence and initiation of client conversations regarding the value of goods and services were significantly greater after the CIPP than before the CSTP. Composite communication skills confidence scores 3 months after the CSTP were positively correlated with the mean practice transaction charge and percentage change in the number of heartworm tests performed in the 3 months after the CSTP, compared with results for the same 3 months in the previous year. Measurements of client satisfaction were high before and after the CSTP. There was no significant change in financial metrics in the 3 months after CSTP, compared with the same 3 months in the previous year. CONCLUSIONS AND CLINICAL RELEVANCE This study highlighted opportunities to increase veterinary health-care team members' communication confidence and identified future considerations for communication training in veterinary workplaces.
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Nixon J, Gray L, Turner J, Bernard A, Scaife J, Cartmill B. Communicating Actively Responding Empathically (CARE): Comparison of Communication Training Workshops for Health Professionals Working in Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:54-60. [PMID: 30386978 DOI: 10.1007/s13187-018-1439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Accessing full-day communication skills training can be challenging for health professionals working in cancer care. This study aimed to examine the effectiveness of Communicating Actively, Responding Empathically (CARE Express), a modified 2-h communication skills training course, across measures of health professional confidence, skills and attitudes. Cancer care health professionals (n = 147) were recruited from allied health, nursing and medical disciplines, using a partial randomisation to allocate to three arms: control, two-hour training (CARE Express) and 1-day training (CARE). Perceived confidence and skills were measured by self-report using a purpose-built scale, and written responses to a challenging clinical encounter were obtained at baseline, post-training and three-months post-training. Attitudes toward psychosocial issues were evaluated with the Physician Belief Scale at baseline and 3 months post-training. No changes were observed in the control group (n = 50) from baseline to 3 months follow-up. Participants in the CARE Express (n = 48) and CARE (n = 49) groups had significant improvement in confidence in identifying/responding to emotions between baseline and 3 months post-training (p < 0.001), as well as their attitude toward psychosocial care (p < 0.001). A significant increase in "acknowledging" responses from baseline to 3 months was also observed for CARE Express and CARE (p < 0.001), with no difference between groups. CARE Express and CARE resulted in changes in confidence in emotional identification/response, psychosocial focus and communication skills maintained at 3 months post-training. Whilst the 1-day workshop has been regarded as gold standard, this study has revealed positive outcomes with a modified 2-h version, thus offering a potential alternate training model.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Jessica Scaife
- Cancer Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Bena Cartmill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
- Centre for Functioning and Health Research, Princess Alexandra Hospital, Brisbane, Australia
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Riley VA, Gidlow C, Ellis NJ, Povey RJ, Barnes O, Clark-Carter D. Improving cardiovascular disease risk communication in the UK national health service health check programme. PATIENT EDUCATION AND COUNSELING 2019; 102:2016-2023. [PMID: 31130337 DOI: 10.1016/j.pec.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/11/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop and test training to improve practitioners' confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics. METHODS A CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews. RESULTS Sixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13). CONCLUSION The training workshop improved practitioners' confidence and perceived understanding of CVD risk in Health Checks. PRACTICE IMPLICATIONS The training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.
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Affiliation(s)
- V A Riley
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - C Gidlow
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - N J Ellis
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - R J Povey
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - O Barnes
- Yorkshire & Humber Academic Health Science Network, Navigation Court Calder Park, Wakefield , WF2 7BJ, United Kingdom.
| | - D Clark-Carter
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
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Ang SHM. Promoting Effective Nurse-Patient Communication in Palliative Care Using the SAGE and THYME Model: Can it be Implemented Cross-Culturally? Open Nurs J 2019. [DOI: 10.2174/1874434601913010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Effective communication in palliative care is essential in making optimal health care decisions that align with the interests of the patients and empowering them to be involved in their care planning. However, many Asian nurses lacked the prerequisite communication skills required to assess and address the informational needs of advanced cancer patients. These nurses often adopt a routinized approach of giving information to patients to overcome their inadequacies in eliciting patients’ concerns. Thus, this opinion paper seeks to understand whether the SAGE and THYME model can be utilised widely by nurses across different cultural contexts to facilitate more effective communication and to develop therapeutic relationships with advanced cancer patients who are receiving palliative care.
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Davies F, Wood F, Bullock A, Wallace C, Edwards A. Shifting mindsets: a realist synthesis of evidence from self-management support training. MEDICAL EDUCATION 2018; 52:274-287. [PMID: 29314172 DOI: 10.1111/medu.13492] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/02/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. METHODS We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. RESULTS Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. CONCLUSION The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational constraints) influences this process. Proactively addressing potential contextual barriers may facilitate implementation. These findings could be applied to other types of training designed to shift attitudes amongst HCPs.
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Affiliation(s)
- Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Carolyn Wallace
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Griffiths J. Person-centred communication for emotional support in district nursing: SAGE and THYME model. Br J Community Nurs 2017; 22:593-597. [PMID: 29189053 DOI: 10.12968/bjcn.2017.22.12.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a 'can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.
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Affiliation(s)
- Jane Griffiths
- Senior Lecturer, School of Health Sciences, Division of Nursing Midwifery and Social Work, University of Manchester
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Martin ASH, Costello J, Griffiths J. Communication in palliative care: the applicability of the SAGE and THYME model in Singapore. Int J Palliat Nurs 2017. [PMID: 28648130 DOI: 10.12968/ijpn.2017.23.6.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty. AIM To discuss the implementation of the SAGE and THYME communication model in a palliative care context. The article examines the use of the model and how its implementation can improve communication between patients and nurses. The model works by reviewing contemporary developments made in relation to improving communication in palliative care. These include, highlighting the importance of meeting individual needs, therapeutic relationship building, and advanced communication training within a Singaporean context. RESULTS The implementation of the SAGE and THYME model can be a useful way of enabling nurses to improve and maintain effective communication in a medically dominated health care system. The challenges and constraints in educating and training nurses with limited skills in palliative care, forms part of the review, including the cultural and attitude constraints specific to Singaporean palliative care.
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Affiliation(s)
| | - John Costello
- Associate Professor, University of Manchester, United Kingdom
| | - Jane Griffiths
- Senior Lecturer, University of Manchester, United Kingdom
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Brown CE, Back AL, Ford DW, Kross EK, Downey L, Shannon SE, Curtis JR, Engelberg RA. Self-Assessment Scores Improve After Simulation-Based Palliative Care Communication Skill Workshops. Am J Hosp Palliat Care 2016; 35:45-51. [PMID: 28273752 DOI: 10.1177/1049909116681972] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We conducted a randomized trial of a simulation-based multisession workshop to improve palliative care communication skills (Codetalk). Standardized patient assessments demonstrated improved communication skills for trainees receiving the intervention; however, patient and family assessments failed to demonstrate improvement. This article reports findings from trainees' self-assessments. AIM To examine whether Codetalk resulted in improved self-assessed communication competence by trainees. DESIGN Trainees were recruited from the University of Washington and the Medical University of South Carolina. Internal medicine residents, medicine subspecialty fellows, nurse practitioner students, or community-based advanced practice nurses were randomized to Codetalk, a simulation-based workshop, or usual education. The outcome measure was self-assessed competence discussing palliative care needs with patients and was assessed at the start and end of the academic year. We used robust linear regression models to predict self-assessed competency, both as a latent construct and as individual indicators, including randomization status and baseline self-assessed competency. RESULTS We randomized 472 trainees to the intervention (n = 232) or usual education (n = 240). The intervention was associated with an improvement in trainee's overall self-assessment of competence in communication skills ( P < .001). The intervention was also associated with an improvement in trainee self-assessments of 3 of the 4 skill-specific indicators-expressing empathy, discussing spiritual issues, and eliciting goals of care. CONCLUSION Simulation-based communication training was associated with improved self-assessed competency in overall and specific communication skills in this randomized trial. Further research is needed to fully understand the importance and limitations of self-assessed competence in relation to other outcomes of improved communication skill.
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Affiliation(s)
- Crystal E Brown
- 1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA
| | - Anthony L Back
- 2 Division of Medical Oncology, Department of Medicine, Seattle Cancer Care Alliance, University of Washington and Fred Hutchinson Cancer Research Center, Seattle WA, USA
| | - Dee W Ford
- 3 Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Erin K Kross
- 1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA
| | - Lois Downey
- 1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA
| | - Sarah E Shannon
- 4 School of Nursing, Oregon Health & Sciences University, Portland, OR, USA
| | - J Randall Curtis
- 1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA
| | - Ruth A Engelberg
- 1 Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle WA, USA
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Griffiths J, Wilson C, Ewing G, Connolly M, Grande G. Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model. Eur J Oncol Nurs 2015; 19:465-72. [PMID: 25782722 DOI: 10.1016/j.ejon.2015.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. METHOD Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. RESULTS SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. CONCLUSION Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom.
| | - Charlotte Wilson
- Barts & The London School of Medicine, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turnser Street, London, United Kingdom
| | - Gail Ewing
- University of Cambridge, Centre for Family Research, Free School Lane, Cambridge, United Kingdom
| | - Michael Connolly
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Lane, Wythenshawe, Manchester, United Kingdom
| | - Gunn Grande
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom
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