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Guttmann KF, Meshkati M, Frydman J, Smith CB, Dow L, Weintraub AS. NeoTalk: Communication Skills Training for Neonatal Clinicians. Am J Hosp Palliat Care 2024; 41:651-657. [PMID: 37622177 DOI: 10.1177/10499091231198507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after "NeoTalk" and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses. METHODS We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course. Wilcoxon signed rank tests and Kruskal-Wallis tests were performed to compare participant responses across time points. RESULTS 34 providers completed NeoTalk training. Complete pre- and post-course data was available for 29 participants. Participants reported increased comfort with skills including 'sharing difficult news' (P = .018), and 'responding to emotion' (P = .002). Participants did not report increased frequency in using target skills 2 months after training. CONCLUSIONS A multi-disciplinary cohort of NICU providers endorsed increased confidence in key communication skills but not increased skill application 2-months post-course completion. While a single course can successfully teach skills, additional exposure may be necessary to build new communication habits. Our experience developing NeoTalk helped elucidate some of the ways in which conversations about seriously ill infants may be different from conversations about seriously ill adults.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Malorie Meshkati
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julia Frydman
- Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cardinale B Smith
- Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Hematology and Medical Oncology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lindsay Dow
- Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lin M, Williams D, Vitcov G, Sayeed S, DeCourcey DD, Wolfe J, Cummings C. Advance Care Planning and Parent-Reported End-of-Life Outcomes in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e1657-e1667. [PMID: 37116531 DOI: 10.1055/s-0043-1768488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of advance care planning (ACP) on parent-reported end-of-life (EOL) outcomes in the neonatal intensive care unit (NICU). STUDY DESIGN Single-center, cross-sectional mixed-methods survey study of bereaved parents who experienced the death of a child in the Boston Children's Hospital NICU between 2010 and 2021. Logistic regression, chi-square test, Fisher's exact test, and Wilcoxon rank-sum test were used to evaluate the relationship between ACP and parent-reported EOL outcomes. Qualitative content was analyzed through inductive coding. RESULTS A total of 40/146 (27%) of eligible parents responded to our survey. There was a significant association between ACP and improved EOL care processes and parental satisfaction with communication. Parents with ACP were more likely to report goal-concordant care and higher levels of perceived shared decision-making. Qualitatively, emerging themes in parents' descriptions of goal-concordant care included misaligned expectations and communication. Emerging themes for parental preparedness included infant symptoms, logistical aspects, impact on parents, and degrees of preparedness. For decisional regret, the primary theme was reevaluating supports. CONCLUSION ACP is associated with improved EOL care outcomes and parents qualitatively conceptualize goal-concordant care, preparedness for their child's death, and decisional regret in nuanced ways. Families should have the opportunity to participate in ACP discussions that meet their unique communication and decision-making needs. KEY POINTS · ACP is associated with improved parent-reported end-of-life outcomes.. · Parents conceptualize end-of-life care outcomes in nuanced ways.. · Families should have the opportunity to participate in ACP discussions that meet their unique needs..
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Affiliation(s)
- Matthew Lin
- Department of Pediatrics, Children's National Medical Center, Pediatric Palliative Care Program, Washington, District of Columbia
| | - David Williams
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Giselle Vitcov
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sadath Sayeed
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Danielle D DeCourcey
- Division of Medical Critical Care, Boston Children's Hospital, Boston, Massachusetts
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Christy Cummings
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
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Uemura T, Ito K, Yuasa M, Shiozawa Y, Ishikawa H, Nakagawa S, Onishi E, Ouchi K. Enduring Positive Impact of a Virtual Communication Skills Workshop of VitalTalk Pedagogy in a Non-U.S. Setting. Am J Hosp Palliat Care 2024; 41:424-430. [PMID: 37216960 DOI: 10.1177/10499091231177863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
CONTEXT While in-person workshops on serious illness communication skills using VitalTalk pedagogy have been shown to have a long-lasting impact, whether changing the format into virtual would maintain its enduring impact is unknown. Objectives. To examine long-term impacts of a virtual VitalTalk communication workshop. METHODS Physicians in Japan who participated in our virtual VitalTalk workshop were asked to complete a self-assessment survey at 3 time points: before, immediately after, and 2 months after the workshop. We examined self-reported preparedness in 11 communication skills on a 5-point Likert scale at 3 time points, as well as self-reported frequency of practice on 5 communication skills at the pre- and 2-month time points. RESULTS Between January 2021 and June 2022, 117 physicians from 73 institutions across Japan completed our workshop. Seventy-four participants returned the survey at all the 3 time points. Their skill preparedness significantly improved upon the completion of the workshop in all 11 skills (P < .001 for all items). The improvement remained at the same level at 2 months in 7 skills. In 4 of the 11 skills, there was further improvement at the 2-month point. The frequency of self-directed skill practice also increased significantly in the 2-month survey for all 5 skills. CONCLUSION A virtual workshop of VitalTalk pedagogy improved self-reported preparedness of communication skills, and the impact was long-lasting in a non-U.S. setting as it likely induced self-practice of skills. Our findings encourage the use of a virtual format in any geographical location considering its enduring impact and easy accessibility.
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Affiliation(s)
- Takeshi Uemura
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, School of Medicine, Teikyo University, Itabashi-ku, Japan
| | - Misuzu Yuasa
- Hospice Division, Seirei Mikatahara General Hospital, Tsu, Japan
| | | | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Itabashi-ku, Japan
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
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Aydın A, Savaş EH, Bingöl H, Kebudi R. Taboo words in pediatric oncology: Communication experiences of nurses and physicians with dying children and their families. Eur J Oncol Nurs 2024; 68:102466. [PMID: 38101245 DOI: 10.1016/j.ejon.2023.102466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Despite the numerous benefits of effective communication between patients, families, and healthcare professionals, there are still substantial barriers and communication challenges. This study investigated the experiences of nurses and doctors working in different pediatric hematology-oncology units in Turkey communicating with children and their parents about end-of-life issues. METHOD This qualitative study was conducted with twenty-four physicians and nurses. A descriptive phenomenological approach was used. Data were analyzed using Braun and Clarke's six-step reflexive thematic analysis. The MAXQDA software was used to facilitate data management. RESULTS The findings revealed three main themes describing end-of-life communication experiences of physicians and nurses: Avoiding communication with a dying child, Everyone knows but nobody talks, and Complicating aspects of the setting. CONCLUSIONS Communication with dying children and their families is essential. However, multiple barriers remain for healthcare providers to do so. That issue burdens the child and their family more during the end-of-life, which is already a challenging experience to handle. Healthcare professionals need urgent training in communication with the dying children and their families.
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Affiliation(s)
- Ayfer Aydın
- School of Nursing, Istanbul University, Istanbul, Turkey
| | | | - Hülya Bingöl
- Istanbul University, Oncology Institute, Istanbul, Turkey
| | - Rejin Kebudi
- Istanbul University, Oncology Institute, Istanbul, Turkey
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Kase SM, Christianson CA, Dow LA, Guttmann KF, Weintraub AS. PedsTalk: A Pilot Communication Skills Education Course for Pediatric Residents. Hosp Pediatr 2023; 13:e377-e383. [PMID: 38018161 DOI: 10.1542/hpeds.2023-007174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Communication skills are critical to pediatric practice, but few pediatric residency programs provide formal communication skills education. Pediatric residents often lack confidence in these skills. We hypothesized that a simulation-based communication skills course would improve resident confidence in the skills required for serious illness conversations with patients/families. METHODS In collaboration with multidiscipline VitalTalk-trained faculty, we developed PedsTalk, a communication skills course for pediatric residents based on the VitalTalk framework. In PedsTalk, faculty/peers offered real-time coaching during simulation sessions with actors. Resident participants self-rated confidence in 9 communication skills using a 5-point Likert scale before, immediately after, and 4 months after course participation, with course nonparticipants serving as controls. Responses were analyzed by using Friedman tests and Wilcoxon rank tests. Thematic analysis was conducted to identify themes among free-text responses. RESULTS Twenty-seven pediatric residents participated in PedsTalk, 11 of whom completed survey assessments at all timepoints. Eleven course nonparticipants served as controls. Over time, participants' confidence in the following communication skills was retained or significantly improved: "difficult conversations" (P < .001), "recognizing emotion" (P < .01), "using silence" (P < .008), "headline statements" (P < .001), eliciting "VALUES" (P < .001), and asking "permission to continue" (P < .001). Over time, controls had significant improvements in confidence in 2 skills: headline statements (P < .014) and eliciting "VALUES" (P < .031). CONCLUSIONS PedsTalk is a novel approach to communication skills education in pediatric residency. Participation improved residents' confidence in 6 communication skills, including overall confidence in having difficult conversations. Although confidence in some skills may naturally develop through clinical experiences, PedsTalk further enhances communication skills education among trainees.
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Affiliation(s)
| | - Caroline A Christianson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Lindsay A Dow
- Brookdale Department of Geriatrics and Palliative Medicine
| | - Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics,Icahn School of Medicine at Mount Sinai, New York, New York
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Guttmann K, Silverman R, Weintraub AS. Neonatal serious illness: operational definition. BMJ Support Palliat Care 2023:spcare-2023-004305. [PMID: 37620122 DOI: 10.1136/spcare-2023-004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES (1) To operationalise our previously published definition of neonatal serious illness by applying it to a patient cohort and (2) to evaluate timing of palliative care consultation, goals of care discussions and meeting serious illness criteria. METHODS This was a retrospective chart review. Inborn neonates delivered between January 2006 and December 2020 who died prior to neonatal intensive care unit discharge were identified through EPIC query. Kruskal-Wallis and Mann-Whitney-U tests were used to compare time intervals relating to transition to serious illness across causes of death and other factors. χ2 tests were used to examine frequency of goals of care conversations by factors. RESULTS Eighty-eight per cent of patients met criteria for neonatal serious illness within 48 hours of life. There were no significant differences in transition to serious illness between preterm and term infants. Time to identification of serious illness varied significantly by cause of death. Palliative care was consulted for 5.7% of patients. CONCLUSION All patients met criteria for serious illness early in life based on our definition. This definition may be useful for identifying neonates with serious illness in time to provide support. Additional work is needed to apply this definition prospectively to explore its utility for clinical care and research.
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Affiliation(s)
- Katherine Guttmann
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Silverman
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea S Weintraub
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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