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Oakley C, Ream E. Role of the Nurse in Patient Education and Engagement and Its Importance in Advanced Breast Cancer. Semin Oncol Nurs 2024; 40:151556. [PMID: 38087678 DOI: 10.1016/j.soncn.2023.151556] [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: 09/23/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To show how people with cancer, including those with advanced breast cancer, engage with information and self-management and how cancer nurses can support patients to manage important aspects of care. Epstein and Street's patient-centered communication in cancer care (PCC) model provides a useful framework. The model incorporates six domains representing core mediating functions of patient-centered communication (Fostering healing relationships, Exchanging information, Responding to emotions, Managing uncertainty, Making decisions, and Enabling self-management) and additional moderating factors for PCC and health outcomes. DATA SOURCES Data sources include peer-reviewed articles sourced from electronic databases. CONCLUSION Common complex interrelated reasons for poor engagement include fear, denial, fatalism, bereavement, advanced disease, and poor clinician-patient relationships. This can have serious implications for physical and emotional outcomes. Facilitators include open, trusting relationships between patients and nurses, timing of information, focusing on patients' agendas, and understanding emotional concerns, beliefs, and motivations. Supporting patients and carers to work together, through evidence-based interventions and tailoring approaches, for example to older people, are important. IMPLICATIONS FOR NURSING PRACTICE Patient information and engagement are important aspects of cancer nursing. Interventions are largely based on behavior change theory, but new translational research is needed to demonstrate effectiveness. Nurses need education on how to develop skills to effectively manage this complex process to effectively engage and educate patients.
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Affiliation(s)
- Catherine Oakley
- Chemotherapy Nurse Consultant, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK.
| | - Emma Ream
- Professor of Supportive Cancer Care and Director of Research, School of Health Sciences, University of Surrey, Guildford, UK
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Lavecchia M, Myers J, Bainbridge D, Incardona N, Levine O, Steinberg L, Schep D, Vautour J, Kumar SJ, Seow H. Education modalities for serious illness communication training: A scoping review on the impact on clinician behavior and patient outcomes. Palliat Med 2024; 38:170-183. [PMID: 37424275 PMCID: PMC10865772 DOI: 10.1177/02692163231186180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Several clinician training interventions have been developed in the past decade to address serious illness communication. While numerous studies report on clinician attitudes and confidence, little is reported on individual education modalities and their impact on actual behavior change and patient outcomes. AIM To examine what is known about the education modalities used in serious illness communication training and their impact on clinician behaviors and patient outcomes. DESIGN A scoping review using the Joanna Briggs Methods Manual for Scoping Reviews was conducted to examine studies measuring clinician behaviors or patient outcomes. DATA SOURCES Ovid MEDLINE and EMBASE databases were searched for English-language studies published between January 2011 and March 2023. RESULTS The search identified 1317 articles: 76 met inclusion criteria describing 64 unique interventions. Common education modalities used were: single workshop (n = 29), multiple workshops (n = 11), single workshop with coaching (n = 7), and multiple workshops with coaching (n = 5); though they were inconsistently structured. Studies reporting improved clinician skills tended to be in simulation settings with neither clinical practice nor patient outcomes explored. While some studies reported behavior changes or improved patient outcomes, they did not necessarily confirm improvements in clinician skills. As multiple modalities were commonly used and often embedded within quality improvement initiatives, the impact of individual modalities could not be determined. CONCLUSION This scoping review of serious illness communication interventions found heterogeneity among education modalities used and limited evidence supporting their effectiveness in impacting patient-centered outcomes and long-term clinician skill acquisition. Well-defined educational modalities and consistent measures of behavior change and standard patient-centered outcomes are needed.
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Affiliation(s)
- Melissa Lavecchia
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jeff Myers
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Nadia Incardona
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Oren Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Leah Steinberg
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Schep
- Division of Radiation Oncology, Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Joanna Vautour
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Kastrinos A, Schofield EA, Moreno A, Korc-Grodzicki B, Nelson C, Alexander K, Parker PA, Manna R, Alici Y, Banerjee SC. Geriatric Communication Skills Training Program for Oncology Healthcare Providers: a Secondary Analysis of Patient and Caregiver Outcomes. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:12-17. [PMID: 37676422 PMCID: PMC11232120 DOI: 10.1007/s13187-023-02367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Geriatric cancer patients and their caregivers have unique needs that make it difficult for their healthcare providers (HCPs) to effectively communicate with them. As ineffective communication can lead to negative health outcomes, it is important that oncology HCPs receive specialized training on communication with older adult patients and their caregivers. We conducted a small pilot study examining audio recordings of clinical encounters between HCPs and older adult cancer patients/caregivers and questionnaires completed by the patients and their caregivers before and after the HCPs participated in a geriatric communication skills training program. Eleven HCPs completed the 6-h Geriatric Comskil Training. Two clinic consultations with unique geriatric patients (n = 44) and their caregivers (n = 29) were recorded before and after training and coded for HCPs' use of communication skills. Patients and caregivers also completed surveys measuring their satisfaction with HCP communication and perceived empathy. Analysis of the audio recordings revealed that HCPs did not increase their use of communication skills after training. Although our sample was too small to detect statistical significance, measures of effect size showed trending improvements in patients' and caregivers' perceptions of HCPs' empathy and satisfaction with their communication after training. Our findings build on previous studies evaluating the feasibility and effectiveness of the Geriatric Comskil Training in real world setting and indicate that the training may have improved HCPs' communication with older adult patients and their caregivers even if their use of their observable communication skills did not change.
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Affiliation(s)
- Amanda Kastrinos
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Elizabeth A Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Aimee Moreno
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Beatriz Korc-Grodzicki
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Koshy Alexander
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Ruth Manna
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave., 4th Floor, New York, NY, 10017, USA.
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Parker PA, Alici Y, Nelson C, Banerjee SC, Coyle N, Roth AJ, Manna R, Alexander K, Gonzalez J, Ewert R, Schofield E, Li Y, Korc-Grodzicki B. Geriatric Oncology Cognition and Communication (Geri-Onc CC): An interactive training for healthcare professionals. J Geriatr Oncol 2023; 14:101484. [PMID: 36989939 PMCID: PMC10106423 DOI: 10.1016/j.jgo.2023.101484] [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] [Received: 08/02/2022] [Revised: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The number of older adults with cancer continues to increase. Many national and international organizations have called for the development of training opportunities for healthcare professionals (HCPs) to meet the unique needs of older adults with cancer and their families. MATERIALS AND METHODS We developed and implemented the Geriatric Oncology Cognition and Communication (Geri-Onc CC) training program for HCPs of all disciplines. This program included a two-day, intensive didactic and experiential training followed by six bi-monthly booster videoconference calls. We describe the format and content of this training, the preliminary results of program evaluation, as well as changes in knowledge, self-efficacy, and attitudes toward older adults pre- to post-training. RESULTS We describe data from the first six cohorts of HCPs who attended the training (n = 113). Participants rated the training highly favorably and reported that it met their training goals Mean = 4.8 (1-5 Scale). They also demonstrated a significant increase in their knowledge about geriatric oncology [(Pre-Mean = 6.2, standard deviation [SD] = 1.7; Post-Mean 6.8, SD = 1.6), p = 0.03] and self-efficacy in their ability to utilize the knowledge and skills they learned in the course [(Pre-Mean = 3.3, SD = 0.7; Post-Mean 4.5, SD = 0.4), p < 0.001]. There were no significant changes in attitudes toward older adults (p > 0.05), which were already very positive before the training. DISCUSSION There is a strong need for training in geriatric oncology. We have demonstrated that implementing this training was feasible, highly regarded, and positively impacted knowledge and self-efficacy regarding utilization of the knowledge and skills learned in the training.
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Affiliation(s)
- Patricia A Parker
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
| | - Yesne Alici
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Christian Nelson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Smita C Banerjee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Nessa Coyle
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Roth
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Ruth Manna
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Koshy Alexander
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | | | - Rebecca Ewert
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
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Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open 2023; 13:e070734. [PMID: 36997248 PMCID: PMC10069593 DOI: 10.1136/bmjopen-2022-070734] [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] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any? DESIGN Scoping review, informed by the Joanna Briggs Institute guidelines. DATA SOURCES The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched. ELIGIBILITY CRITERIA Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types. DATA EXTRACTION AND SYNTHESIS Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format. RESULTS In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures. CONCLUSIONS This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.
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Affiliation(s)
- Lauren Connell
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
| | - Yvonne Finn
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Jane Sixsmith
- Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
- CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
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Rosa WE, Cannity K, Moreno A, Cardillo C, Schofield EA, Korc-Grodzicki B, Parker PA, Manna R, Alici Y, Nelson C, Alexander K, Banerjee SC. Geriatrics communication skills training program for oncology healthcare providers to improve the management of care for older adults with cancer. PEC INNOVATION 2022; 1:100066. [PMID: 36741338 PMCID: PMC9894477 DOI: 10.1016/j.pecinn.2022.100066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective We evaluated the feasibility, acceptability, and preliminary efficacy of a novel intervention, the Geriatric Communication Skills Training Program (Geriatric Comskil Training) for multidisciplinary healthcare providers (HCPs). Methods Three 2-h modules comprised the training: Geriatrics 101, Cognitive Syndromes, and Shared Decision-Making. Modules consisted of didactic knowledge, exemplary videos, and experiential learning role plays with standardized patients. We collected pre- and post-training data from 11 HCPs (module evaluations, self-efficacy, communication skills uptake in interaction with standardized patients, perceived ageism) and 44 patients (perceived HCP empathy, satisfaction with HCP communication). Results HCPs rated all modules high, with over 90% agreement on all course evaluation items assessing involvement, critical thinking, and reflectiveness, and significant improvements in self-efficacy. HCPs demonstrated an uptake in communication skills from pre- to post-training in agenda setting and overall skill use and reported promising trends towards lower ageism scores (d = 0.58). Promising trends in patient-reported HCP empathy (d = 0.39) and satisfaction with communication (d = 0.29) emerged from pre- to post-training. Conclusion Continued efforts are needed to strengthen HCP education related to geriatric communication across the cancer continuum. Innovation The Geriatric Comskil Training demonstrated feasibility, acceptability, and increases in self-efficacy and communication skills uptake for HCPs.
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Affiliation(s)
| | | | - Aimee Moreno
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cara Cardillo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Ruth Manna
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yesne Alici
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Smita C. Banerjee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA,Corresponding author at: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022, USA., (S.C. Banerjee)
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Saslaw M, Kaplan S, Pavlicova M, Rosenbaum M, Sirota DR. Evaluation of Physician Assistants’ Self-Reported Attitudes and Behaviors After Completion of a Hospital-Wide Multidisciplinary Communication Skills Training Workshop. J Patient Exp 2022; 9:23743735221092626. [PMID: 35425849 PMCID: PMC9003642 DOI: 10.1177/23743735221092626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physician's assistants (PA) are an integral part of hospital teams. To the best of our knowledge, this is the first study to examine the effects of a multidisciplinary hospital-wide communication skills training (CST) workshop on PAs. From November 2017 to November 2019, all participants in the CST workshop were sent a web-based retrospective pre-post survey to measure self-reported attitudes and behaviors related to communicating with patients, CST, and specific skills taught. PA responses were analyzed alone and were compared to non-PAs. Non-PAs were physicians and 1 nurse practitioner. In total, 258 PA and 333 non-PA participants were surveyed for an overall response rate of 25%. Among PAs, in 9 out of 10 domains measured, there was a significant change in self-reported attitudes and behaviors toward communicating with patients, CST, and skills taught (P < .05). Similar to other providers, PAs experienced positive changes in these self-reported attitudes and behaviors after CST, however, there were some significant differences found when comparing PAs and non-PAs in the covariate analysis.
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Affiliation(s)
- Minna Saslaw
- Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Martina Pavlicova
- Irving Center for Clinical and Translational Research, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marcy Rosenbaum
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Dana R. Sirota
- Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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