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Szmulewicz C, Rouby P, Boyer C, Benhamou D, Capmas P. Interdisciplinary Simulation Courses to Train Residents on Communication of Unexpected Complications from Perioperative Care: A Randomized Comparison of Within-Event (Microdebriefing) and Postscenario Debriefing. JOURNAL OF SURGICAL EDUCATION 2024; 81:858-865. [PMID: 38679493 DOI: 10.1016/j.jsurg.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/28/2024] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Training to disclose bad news in a pluridisciplinary format facilitates communication and improves learning. There are many different debriefing methods described in the literature. The aim of this study was to compare and evaluate the value of final debriefing and microdebriefing with interruptions of the scenario in a simulation program about communication in unexpected complications from perioperative care. METHODS We conducted a prospective, randomized, single center study between October 2018 and July 2019 in a simulation center. Three scenarios were related to patient or family disclosure of complications which had occurred during gynecologic surgery by a dyad involving 2 residents (a gynecology and an anesthesia resident). All sessions involved 6 residents (3 gynecologist and 3 anesthesiologist). The main outcome measure was the immediate residents' self-assessment of the impact of the course on their medical practice immediately after the session. RESULTS We performed 15 simulation sessions including 80 residents. Thirty-nine residents were included in final debriefing group and 41 in micro-debriefing group. There was no significant difference on the impact for medical practice between groups (9.3/10 in the micro-debriefing group versus 9.2 in the final debriefing group (p = 0.53)). The overall satisfaction was high in the 2 group (9.1/10 in the 2 groups). CONCLUSION This study is the first one to compare two debriefing methods in case of breaking bad news simulation. No difference between the 2 techniques was found concerning the students' feelings and short and long-term improvement of their communication skills.
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Affiliation(s)
- Claire Szmulewicz
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, 78 avenue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | - Pascal Rouby
- Unité de psycho-oncologie, Institut Gustave Roussy, 6 avenue Paul Vaillant Couturier 94800, Villejuif, France
| | - Caroline Boyer
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, 78 avenue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Dan Benhamou
- Département d'Anesthésie-Réanimation, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, 78 avenue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; LabForSIMS, Faculté de Médecine Paris Saclay, Université Paris Saclay, F-94276, Le Kremlin Bicêtre, France; Unité de Recherche CIAMS EA4532, UFR STAPS Paris Saclay, Orsay
| | - Perrine Capmas
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, 78 avenue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; LabForSIMS, Faculté de Médecine Paris Saclay, Université Paris Saclay, F-94276, Le Kremlin Bicêtre, France; Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, 16 avenue Paul Vaillant Couturier 94807, Villejuif Cedex, France
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Herzog EM, Pirmorady Sehouli A, Boer J, Pietzner K, Petru E, Heinzelmann V, Roser E, Dimitrova D, Oskay-Özcelik G, Camara O, Sehouli J. How to break bad news and how to learn this skill: results from an international North-Eastern German Society for Gynecological Oncology (NOGGO) survey among physicians and medical students with 1089 participants. Int J Gynecol Cancer 2023; 33:1934-1942. [PMID: 38052472 PMCID: PMC10804030 DOI: 10.1136/ijgc-2023-004693] [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: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Delivering bad news to patients is one of the most challenging tasks in medical practice. Despite its great relevance to patients, relatives, and medical staff, there is a paucity of data pertaining to training, experience, expectations, and preferences of physicians and medical students on breaking bad news. METHODS We conducted an international survey in Germany, Switzerland, and Austria using an online questionnaire among physicians and medical students. RESULTS A total of 786 physicians and 303 medical students completed the survey. Physicians stated that 32.7% deliver bad news several times a week and 45.2% several times a month. Difficulties controlling their emotions (35.1%) and remaining professional (43.4%) were the greatest challenges for physicians. Delivering bad news is associated with feelings of anxiety, both among experienced physicians (median of 3.8 out of 10.0) and medical students (median of 5.3). Conveying bad news is a burden to physicians and consequently has a substantial impact on their job satisfaction. All participants reported the need for more communication training concerning this subject. Only 49.5% of medical students and 67.3% of physicians mentioned having learned adequate communication skills. Our data demonstrate that communication training decreases the level of anxiety and increases the feeling of self-confidence towards breaking bad news. Preferred educational tools were seminars with simulation (students: 71.4%, physicians: 49.5%), observing more senior faculty (students: 57.4%, physicians: 55.1%), and supervision and feedback sessions (students: 36.3%, physicians: 45.7%). The largest barriers regarding education on communication were limited time (students: 77.0%, physicians: 74.9%) and missing awareness of supervisors (students: 60.6%, physicians: 41.1%). CONCLUSIONS Our study showed a great need for systematic training and education in breaking bad news among physicians and medical students. Hospitals, medical schools, and postgraduate training programs are strongly encouraged to fill this gap, and improve sustainable doctor-patient communication to overcome the psychological burden for physicians.
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Affiliation(s)
- Emilie M Herzog
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité University Hospital Berlin, Berlin, Germany
| | - Adak Pirmorady Sehouli
- Department of Psychosomatic Medicine, Charité University Hospital Berlin, Berlin, Germany
- European Art Guild for Medicine and Culture, Berlin, Germany
| | - Jolijn Boer
- North-Eastern German Society for Gynecological Oncology (NOGGO eV), Berlin, Germany
| | - Klaus Pietzner
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité University Hospital Berlin, Berlin, Germany
| | - Edgar Petru
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Viola Heinzelmann
- Department of Gynecology and Gynecological Oncology, University Hospital Basel, Basel, Switzerland
| | - Eva Roser
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité University Hospital Berlin, Berlin, Germany
| | - Desislava Dimitrova
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité University Hospital Berlin, Berlin, Germany
| | - Gülten Oskay-Özcelik
- North-Eastern German Society for Gynecological Oncology (NOGGO eV), Berlin, Germany
| | - Oumar Camara
- North-Eastern German Society for Gynecological Oncology (NOGGO eV), Berlin, Germany
- Department of Gynecological Oncology and Breast Centre, Helios Hospital Gotha, Gotha, Germany
| | - Jalid Sehouli
- Department of Gynecology, Center for Oncological Surgery, Campus Virchow Klinikum, Charité University Hospital Berlin, Berlin, Germany
- European Art Guild for Medicine and Culture, Berlin, Germany
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Chang CH, Suri K, Huang R, Machiorlatti M, Bartl M, Mifuji R. An innovative approach to comprehensive communication skills training for residents: A resident-led communication curriculum. J Investig Med 2023; 71:813-820. [PMID: 37485964 DOI: 10.1177/10815589231190562] [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: 07/25/2023]
Abstract
Innovations to enhance residency training in interpersonal and communication skills are needed and a resident-led strategy has not been well-described. In this study, we explored a resident-led comprehensive communication skills curriculum for internal medicine residents. Residents and faculty prepared the curriculum as part of an Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside Project and with "The language of caring guide for physicians." Employing active learning techniques, three residents led 43 internal medicine residents in seven 1 h sessions from 2019 to 2020. Using a 35-question survey, we assessed pre and post self-reported competence in: mindful practice, collaboration and teamwork, effective openings and closing, communicating with empathy, effective explanations, engaging patients and families as partners, and hard conversations. A Wilcoxon signed rank test was employed to explore differences in median scores after matching each person's pretest and posttest score. The median score for aggregate communication and the scores for all seven competencies assessed improved from pre to post (p < 0.05). This indicates that residents reported higher incidences of performing patient-centered communication skills after the curriculum compared to before. Using a five-point Likert scale, 100% of participants agreed the program improved their communication skills and improved confidence in bedside patient-centered communications. A resident-led comprehensive communication skills curriculum for internal medicine residents was implemented showing improvement in skills over the course of the curriculum. The curriculum was well-accepted by post-survey evaluation and was feasible with motivated resident-leaders, use of an existing guide to communication, and reserved didactic time to implement the program.
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Affiliation(s)
- Chelsea Hook Chang
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Krishna Suri
- Palliative Medicine, Washington Township Medical Foundation, Freemont, CA, USA
| | - Rex Huang
- Yale New Haven Health, Trumbull, CT, USA
| | - Michael Machiorlatti
- Department of Population Health and Biostatistics, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Mery Bartl
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | - Roque Mifuji
- Department of Internal Medicine, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA
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Al Zomia AS, AlHefdhi HA, Alqarni AM, Aljohani AK, Alshahrani YS, Alnahdi WA, Algahtany AM, Youssef N, Ghazy RM, Alqahtani AA, Deajim MA. Examining Saudi Physicians' Approaches to Communicate Bad News and Bridging Generational Gaps. Healthcare (Basel) 2023; 11:2528. [PMID: 37761725 PMCID: PMC10531216 DOI: 10.3390/healthcare11182528] [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: 08/20/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Breaking bad news is an intrinsic aspect of physicians' clinical practices. This study aims to investigate how Saudi physicians manage the process of communicating bad news and explore potential differences in breaking bad news practices between young physicians (interns) and their older colleagues. From 1 March to 15 April 2023, ok an anonymous online cross-sectional survey was conducted to explore the communication practices of Saudi physicians concerning breaking bad news using the Communicating Bad News Questionnaire. The physicians were recruited through convenience and snowball sampling methods, and the survey questionnaire was distributed on various social media platforms, including Facebook, Twitter, LinkedIn, and WhatsApp. Data were analyzed using R version 4.2.1. A total of 782 physicians were included in this study. Male physicians represented 50.9% of the participants. Three-quarters (74.7%) were aged 25-30 years. The largest proportion of physicians (45.3%) were interns, followed by junior residents (22.9%), senior residents (11.0%), and specialists (6.5%). The median years of experience was 1.0, ranging from 0 to 45 years. Regarding the place of work, most physicians (86.6%) worked in hospitals, while 13.4% worked in primary healthcare centers. A total of 14.8% said they were not comfortable with discussing patients'/relatives' issues (20.60 among interns vs. 10.50% among non-interns, χ2 = 27.50, p = 0.0001), 66.6% reported being trained to break bad news (59.60% among interns vs. 72.40% among non-interns, χ2 = 14.34, p = 0.001), 59.1% reported breaking bad news to the patient, 37.9% reported to the family, and 3.1% reported to both, with no significant difference between interns and non-interns. A substantial proportion of physicians reported feeling uncomfortable discussing sensitive issues with patients and their relatives despite having received training to deliver bad news and being willing to communicate bad news directly to patients. Notably, our analysis identified a significant disparity between intern and non-intern physicians, particularly in terms of their comfort level in addressing patient-related concerns and access to breaking bad news training.
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Affiliation(s)
- Ahmed Saad Al Zomia
- Faculty of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (Y.S.A.)
| | - Hayfa A. AlHefdhi
- Department of Family Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | | | | | | | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt;
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Lima TACD, Bruno FP, Gushken F, Degani-Costa LH, Novaes NP. Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil. EINSTEIN-SAO PAULO 2023; 21:eAO0036. [PMID: 37075459 PMCID: PMC10118364 DOI: 10.31744/einstein_journal/2023ao0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/30/2022] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE • Neurology trainees and program directors recognized a lack of structured breaking bad news training. • Program directors reported that many factors hinder the implementation of breaking bad news education. • Trainees felt capable of breaking bad news, but most did not have lectures, simulations, nor feedback. • Trainees acknowledged negative feelings when breaking bad news, including sadness and helplessness. We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. METHODS We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. RESULTS We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. CONCLUSION This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.
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Zucker BE, Leandro L, Forbes K, Blazeby JM, Chamberlain C. Training surgeons to optimize communication and symptom management in patients with life-limiting conditions: systematic review. BJS Open 2023; 7:zrad015. [PMID: 37104753 PMCID: PMC10129389 DOI: 10.1093/bjsopen/zrad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/08/2022] [Accepted: 01/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Surgeons routinely care for patients with life-limiting illness, requiring communication and symptom management skills supported by appropriate training. The objective of this study was to appraise and synthesize studies that assessed surgeon-directed training interventions that aimed to optimize communication and symptom management for patients with life-limiting illness. METHODS A PRISMA-concordant systematic review was undertaken. MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), and the Cochrane Central Register of Controlled Trials were searched from inception until October 2022 for studies reporting on the evaluation of surgeon-training interventions intending to improve surgeons' communication or symptom management of patients with life-limiting disease. Data on the design, trainer and patient participants, and the intervention were extracted. Risk of bias was assessed. RESULTS Of 7794 articles, 46 were included. Most studies employed a before-after approach (29 studies) and nine included control groups with five being randomized studies. General surgery was the most frequently included sub-specialty (22 studies). Trainers were described in 25 of 46 studies. Most training interventions aimed to improve communication skills (45 studies) and 13 different training interventions were described. Eight studies reported a measurable improvement in patient care, such as increased documentation of advance care discussions. Most study outcomes focused on surgeons' knowledge (12 studies), skills (21 studies), and confidence/comfort (18 studies) in palliative communication skills. Studies had a high risk of bias. CONCLUSION Whilst interventions exist to improve the training of surgeons managing patients with life-threatening conditions, evidence is limited, and studies measure the direct impact on patient care insufficiently. Improved research is needed to lead to better methods for training surgeons to benefit patients.
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Affiliation(s)
- Benjamin E Zucker
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lorna Leandro
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Karen Forbes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jane M Blazeby
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Charlotte Chamberlain
- Population Health Sciences, University of Bristol, Bristol, UK
- Department of Palliative Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Dias LM, Frutig MDA, Bezerra MR, Barra WF, Castro L, Rego F. Advance Care Planning and Goals of Care Discussion: Barriers from the Perspective of Medical Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3239. [PMID: 36833934 PMCID: PMC9961136 DOI: 10.3390/ijerph20043239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Advance care planning (ACP) and goals of care discussion involve the exploration of what is most important to a person to prepare for health-care decision making. Despite their well-established benefits, they are still not frequently performed in clinical oncology practice. This study aims to describe the barriers to discussion goals of care with oncology patients from the perspective of medical residents. METHODS This cross-sectional and qualitative study applied the "Decide-Oncology" questionnaire, adapted to Portuguese language, to assess barriers to goals of care discussion among medical residents from three university hospitals in Brazil. Residents were asked to rank the importance of various barriers to discuss goals of care (ranging from 1-extremely unimportant to 7-extremely important). RESULTS Twenty-nine residents answered the questionnaire (30.9%). The most reported barriers were related to patients and their families' difficulty in understanding and accepting the diagnosis and the prognosis as well as patients' desire to receive full active treatment. Furthermore, the physician and external factors such as lack of training and lack of time to have these conversations were also very important barriers. The identification of the key barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritize the next steps for future studies aimed at improving ACP and goals of care discussions.
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Affiliation(s)
- Laiane Moraes Dias
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- João de Barros Barreto University Hospital, Federal University of Pará, Belém 66075-110, PA, Brazil
| | | | - Mirella Rebello Bezerra
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- IMIP, Instituto de Medicina Integral Professor Fernando Figueira, Recife 50070-902, PE, Brazil
| | - Williams Fernandes Barra
- João de Barros Barreto University Hospital, Federal University of Pará, Belém 66075-110, PA, Brazil
| | - Luísa Castro
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Bylund CL, Vasquez TS, Peterson EB, Ansell M, Bylund KC, Ditton-Phare P, Hines A, Manna R, Singh Ospina N, Wells R, Rosenbaum ME. Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1854-1866. [PMID: 35857395 PMCID: PMC9712157 DOI: 10.1097/acm.0000000000004883] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
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Affiliation(s)
- Carma L Bylund
- C.L. Bylund is professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Taylor S Vasquez
- T.S. Vasquez is a doctoral student, Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, Florida
| | - Emily B Peterson
- E.B. Peterson is senior research analyst, University of Southern California, Los Angeles, California
| | - Margaret Ansell
- M. Ansell is associate university librarian and associate chair, Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Kevin C Bylund
- K.C. Bylund is associate professor, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Philippa Ditton-Phare
- P. Ditton-Phare is medical education support officer (psychiatry), Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - April Hines
- A. Hines is journalism and mass communications librarian, George A. Smathers Libraries, University of Florida, Gainesville, Florida
| | - Ruth Manna
- R. Manna is associate director, Patient Experience Partnerships, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Naykky Singh Ospina
- N. Singh Ospina is associate professor, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Robert Wells
- R. Wells is science writer, Office of Research, University of Central Florida, Orlando, Florida
| | - Marcy E Rosenbaum
- M.E. Rosenbaum is professor, Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Harnischfeger N, Rath H, Alt-Epping B, Brand H, Haller K, Letsch A, Rieder N, Thuss-Patience P, Bokemeyer C, Bergelt C, Oechsle K. Effects of a communication training for oncologists on early addressing palliative and end-of-life care in advanced cancer care (PALLI-COM): a randomized, controlled trial. ESMO Open 2022; 7:100623. [PMID: 36356411 PMCID: PMC9808464 DOI: 10.1016/j.esmoop.2022.100623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In advanced cancer care, early communication about palliative care (PC) and end-of-life (EoL)-related issues is recommended, but is often impeded by physicians' communication insecurities. We investigated the effect of a newly developed compact communication skills training 'PALLI-COM' on oncologists' competencies to early address PC/EoL-related issues. MATERIALS AND METHODS We conducted a randomized, controlled trial (RCT) with an intervention group (IG; 2 × 90 min training) and a wait list control group (CG) at five sites. At two assessment points, participating oncologists led videotaped medical consultations with simulated patients (SPs) via a privacy compliant video conference platform. SPs were represented by trained actors. The taped conversations were rated for primary outcome (communication skills assessed by adapted COM-ON-checklist and COM-ON-coaching rating scales) by raters blinded for study group. Secondary outcomes included oncologists' self-reported communication skills (Self-Efficacy in Palliative Care Scale, Thanatophobia-Scale, Communication about End of Life Survey, study-specific items) as well as external rating of the SPs. Univariate analyses of covariance with baseline adjustment were used to analyze intervention effects. RESULTS A total of 141 oncologists [age: mean (standard deviation) = 32.7 (6.3) years, 60% female (nIG = 73, nCG = 68)] participated. Following intervention, the IG showed significantly more improvement in four out of five assessed communication skills: 'reacting to emotions and showing empathy', 'pointing out opportunities and giving hope', 'addressing the EoL' and 'explaining the concept of PC'. IG participants also improved more than CG participants in almost all secondary outcomes assessed by participants and SPs: oncologists' self-efficacy, attitudes towards caring for terminally ill patients, communication strategies and confidence in dealing with PC/EoL-related issues as well as communication quality from the SPs' perspective. CONCLUSION Findings indicate that the compact communication skills training PALLI-COM increases oncologists' competencies in early addressing PC/EoL-related issues from different perspectives. Implementation in routine oncology residency might improve advanced cancer care by strengthening these communication skills.
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Affiliation(s)
- N. Harnischfeger
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Correspondence to: Nele Harnischfeger, Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - H.M. Rath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B. Alt-Epping
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - H. Brand
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - K. Haller
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - A. Letsch
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité – University Medicine Berlin, Berlin, Germany
| | - N. Rieder
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - P. Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - C. Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - K. Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ayou C, Vabres N, Poullaouec C, Lemesle M, Gras-le Guen C, Launay E, Balençon M. Information préoccupante ou signalement dans les violences intrafamiliales : construction, validation et mise en application d’une grille d’annonce par technique de simulation en santé avec patients standardisés. Encephale 2022; 48 Suppl 1:S34-S38. [DOI: 10.1016/j.encep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 10/14/2022]
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Libert Y, Peternelj L, Bragard I, Marchal S, Reynaert C, Slachmuylder JL, Razavi D. A randomized controlled trial assessing behavioral, cognitive, emotional and physiological changes resulting from a communication skills training in physicians caring for cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2888-2898. [PMID: 35787813 DOI: 10.1016/j.pec.2022.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This randomized study assesses behavioral, cognitive, emotional and physiological changes resulting from a communication skills training (CST) for physicians caring for cancer patients. METHODS Medical specialists (N = 90) were randomly assigned in groups to complete a manualized 30-h CST or to a waiting list. Assessments included behavioral (communication skills), cognitive (self-efficacy, sense of mastery), emotional (perceived stress) and physiological (heart rate) measures. Assessments were made at baseline (both groups), after CST program (training group), and four months after (waiting list group). All assessments were conducted before, during, and after a complex communication task with an advanced-stage cancer simulated patient (SP). RESULTS Trained physicians had higher levels of communication skills (from RR=1.32; p = .003 to RR=41.33; p < .001), self-efficacy (F=9.3; p = .003), sense of mastery (F=167.9; p < .001) and heart rate during the SP encounter (from F=7.4; p = .008 to F=4; p = .050) and same levels of perceived stress (F=3.1; p = .080). CONCLUSION A learner-centered, skills-focused and practice-oriented manualized 30-h CST induced multilevel changes indicating physician engagement in a learning process. PRACTICE IMPLICATIONS Trainers should consider the CST multilevel benefits (behavioral, cognitive, emotional and physiological) before, during and after a complex communication simulated task as an innovative way to assess the efficacy of a communication skills learning process.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Liège, Belgium
| | | | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium
| | | | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium
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Toh RQE, Koh KK, Lua JK, Wong RSM, Quah ELY, Panda A, Ho CY, Lim NA, Ong YT, Chua KZY, Ng VWW, Wong SLCH, Yeo LYX, See SY, Teo JJY, Renganathan Y, Chin AMC, Krishna LKR. The role of mentoring, supervision, coaching, teaching and instruction on professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2022; 22:531. [PMID: 35804340 PMCID: PMC9270794 DOI: 10.1186/s12909-022-03589-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/23/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Mentoring's pivotal role in nurturing professional identity formation (PIF) owes much to its combined use with supervision, coaching, tutoring, instruction, and teaching. However the effects of this combination called the 'mentoring umbrella' remains poorly understood. This systematic scoping review thus aims to map current understanding. METHODS A Systematic Evidence-Based Approach guided systematic scoping review seeks to map current understanding of the 'mentoring umbrella' and its effects on PIF on medical students and physicians in training. It is hoped that insights provided will guide structuring, support and oversight of the 'mentoring umbrella' in nurturing PIF. Articles published between 2000 and 2021 in PubMed, Scopus, ERIC and the Cochrane databases were scrutinised. The included articles were concurrently summarised and tabulated and concurrently analysed using content and thematic analysis and tabulated. The themes and categories identified were compared with the summaries of the included articles to create accountable and reproducible domains that guide the discussion. RESULTS A total of 12201 abstracts were reviewed, 657 full text articles evaluated, and 207 articles included. The three domains identified were definitions; impact on PIF; and enablers and barriers. The mentoring umbrella shapes PIF in 3 stages and builds a cognitive base of essential knowledge, skills and professional attitudes. The cognitive base informs thinking, conduct and opinions in early supervised clinical exposure in Communities of practice (COP). The COPs' individualised approach to the inculcation of desired professional characteristics, goals, values, principles and beliefs reshapes the individual's identity whilst the socialisation process sees to their integration into current identities. CONCLUSION The mentoring umbrella's provides personalised longitudinal support in the COP and socialisation process. Understanding it is key to addressing difficulties faced and ensuring holistic and timely support.
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Affiliation(s)
- Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Kai Kee Koh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Jun Kiat Lua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Aiswarya Panda
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Chong Yao Ho
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Nicole-Ann Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Victoria Wen Wei Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Sabine Lauren Chyi Hui Wong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Luke Yu Xuan Yeo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Sin Yee See
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Jolene Jing Yin Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Yaazhini Renganathan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore Blk MD6, Centre for Translational Medicine, 14 Medical Dr, #05-01, Singapore, 117599, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
- Division of Palliative and Supportive Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Harnischfeger N, Rath HM, Oechsle K, Bergelt C. Addressing palliative care and end-of-life issues in patients with advanced cancer: a systematic review of communication interventions for physicians not specialised in palliative care. BMJ Open 2022; 12:e059652. [PMID: 35715185 PMCID: PMC9207918 DOI: 10.1136/bmjopen-2021-059652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To identify and summarise evaluated interventions aiming to improve the communication of palliative care (PC) and end-of-life (EoL) issues in physicians caring for cancer patients. Such interventions are needed with regard to the aim of an earlier communication of those issues in oncology daily practice, which is associated with a range of benefits for patients and caregivers but is often impeded by physicians' communication insecurities. DESIGN Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Relevant publications were systematically searched in MEDLINE, PsycINFO, CINAHL and Web of Science databases in September 2020 with an update in July 2021. ELIGIBILITY CRITERIA We included publications reporting a quantitative evaluation of a communication intervention on one or more PC/EoL issues with a communication-related main outcome. Target group had to be physicians caring for cancer patients non-specialist in PC. DATA EXTRACTION AND SYNTHESIS Two independent raters extracted intervention characteristics, publication characteristics and publication quality. Results were narratively synthesised. RESULTS 24 publications reporting 22 interventions were included. 13 publications reported randomised controlled trials. A majority of the interventions addressed one specific PC/EoL issue, most often breaking bad news. Teaching strategies mostly involved role-plays. Target group were mainly oncologists. In addition to self-reported outcome measurements for evaluation, most publications also reported the use of external rating data. All but one publication reported significant intervention effects on at least one outcome parameter. Publication quality was overall moderate. CONCLUSIONS The empirically tested communication interventions on PC/EoL issues seem to effectively improve physicians' communication. Future interventions should focus on other issues than breaking bad news, such as preparing for the future. Target group should also be organ-specific oncologists, as all primary caring physicians are responsible for timely communication. Our risk-of-bias assessment revealed some weaknesses, indicating that more high-quality studies for evaluation are needed. PROSPERO REGISTRATION NUMBER CRD42020191054.
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Affiliation(s)
- Nele Harnischfeger
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hilke M Rath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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Levy DC, Naehrig D, Sullivan L, Chin YS. Communication and collaboration skills training in Radiation Oncology in Australia and New Zealand: A qualitative study. Asia Pac J Clin Oncol 2022; 18:e356-e362. [PMID: 35043566 DOI: 10.1111/ajco.13736] [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: 07/28/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods. MATERIALS AND METHODS Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent. RESULTS After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub-themes. CONCLUSIONS There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work-based assessments. CCST templates are recommended.
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Affiliation(s)
- David C Levy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Diana Naehrig Coaching & Communication, Sydney, Australia
| | - Lisa Sullivan
- The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Icon Cancer Centre, Bruce, Australian Capital Territory, Australia.,School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yaw S Chin
- Department of Radiation Oncology, St. George Hospital, Kogarah, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
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15
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Ibrahim H, Harhara T. Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates. Am J Hosp Palliat Care 2021; 39:1182-1187. [PMID: 34962180 DOI: 10.1177/10499091211063820] [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: 11/15/2022] Open
Abstract
BACKGROUND Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure. OBJECTIVE To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE). METHODS Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care. RESULTS Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines. CONCLUSION Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress.
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Affiliation(s)
- Halah Ibrahim
- Department of Medicine, 37532Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Thana Harhara
- Department of Medicine, 37532Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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16
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Siegrist V, Mata R, Langewitz W, Gerger H, Furger S, Hertwig R, Bingisser R. Does information structuring improve recall of discharge information? A cluster randomized clinical trial. PLoS One 2021; 16:e0257656. [PMID: 34662341 PMCID: PMC8523048 DOI: 10.1371/journal.pone.0257656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The impact of the quality of discharge communication between physicians and their patients is critical on patients' health outcomes. Nevertheless, low recall of information given to patients at discharge from emergency departments (EDs) is a well-documented problem. Therefore, we investigated the outcomes and related benefits of two different communication strategies: Physicians were instructed to either use empathy (E) or information structuring (S) skills hypothesizing superior recall by patients in the S group. METHODS For the direct comparison of two communication strategies at discharge, physicians were cluster-randomized to an E or a S skills training. Feasibility was measured by training completion rates. Outcomes were measured in patients immediately after discharge, after 7, and 30 days. Primary outcome was patients' immediate recall of discharge information. Secondary outcomes were feasibility of training implementation, patients' adherence to recommendations and satisfaction, as well as the patient-physician relationship. RESULTS Of 117 eligible physicians, 80 (68.4%) completed the training. Out of 256 patients randomized to one of the two training groups (E: 146 and S: 119) 196 completed the post-discharge assessment. Patients' immediate recall of discharge information was superior in patients in the S-group vs. E-group. Patients in the S-group adhered to more recommendations within 30 days (p = .002), and were more likely to recommend the physician to family and friends (p = .021). No differences were found on other assessed outcome domains. CONCLUSIONS AND PRACTICE IMPLICATIONS Immediate recall and subsequent adherence to recommendations were higher in the S group. Feasibility was shown by a 69.6% completion rate of trainings. Thus, trainings of discharge information structuring are feasible and improve patients' recall, and may therefore improve quality of care in the ED.
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Affiliation(s)
- Victoria Siegrist
- Emergency Department, University Hospital Basel, Basel, Switzerland
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Rui Mata
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Department of Psychosomatic Medicine–Communication in Medicine, University Hospital Basel, Basel, Switzerland
| | - Heike Gerger
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephan Furger
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
- * E-mail:
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Forsetlund L, O'Brien MA, Forsén L, Reinar LM, Okwen MP, Horsley T, Rose CJ. Continuing education meetings and workshops: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2021; 9:CD003030. [PMID: 34523128 PMCID: PMC8441047 DOI: 10.1002/14651858.cd003030.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Educational meetings are used widely by health personnel to provide continuing medical education and to promote implementation of innovations or translate new knowledge to change practice within healthcare systems. Previous reviews have concluded that educational meetings can result in small changes in behaviour, but that effects vary considerably. Investigations into which characteristics of educational meetings might lead to greater impact have yielded varying results, and factors that might explain heterogeneity in effects remain unclear. This is the second update of this Cochrane Review. OBJECTIVES • To assess the effects of educational meetings on professional practice and healthcare outcomes • To investigate factors that might explain the heterogeneity of these effects SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC, Science Citation Index Expanded (ISI Web of Knowledge), and Social Sciences Citation Index (last search in November 2016). SELECTION CRITERIA We sought randomised trials examining the effects of educational meetings on professional practice and patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. One review author assessed the certainty of evidence (GRADE) and discussed with a second review author. We included studies in the primary analysis that reported baseline data and that we judged to be at low or unclear risk of bias. For each comparison of dichotomous outcomes, we measured treatment effect as risk difference adjusted for baseline compliance. We expressed adjusted risk difference values as percentages, and we noted that values greater than zero favour educational meetings. For continuous outcomes, we measured treatment effect as per cent change relative to the control group mean post test, adjusted for baseline performance; we expressed values as percentages and noted that values greater than zero favour educational meetings. We report means and 95% confidence intervals (CIs) and, when appropriate, medians and interquartile ranges to facilitate comparisons to previous versions of this review. We analysed professional and patient outcomes separately and analysed 22 variables that were hypothesised a priori to explain heterogeneity. We explored heterogeneity by using univariate meta-regression and by inspecting violin plots. MAIN RESULTS We included 215 studies involving more than 28,167 health professionals, including 142 new studies for this update. Educational meetings as the single intervention or the main component of a multi-faceted intervention compared with no intervention • Probably slightly improve compliance with desired practice when compared with no intervention (65 comparisons, 7868 health professionals for dichotomous outcomes (adjusted risk difference 6.79%, 95% CI 6.62% to 6.97%; median 4.00%; interquartile range 0.29% to 13.00%); 28 comparisons, 2577 health professionals for continuous outcomes (adjusted relative percentage change 44.36%, 95% CI 41.98% to 46.75%; median 20.00%; interquartile range 6.00% to 65.00%)) • Probably slightly improve patient outcomes compared with no intervention (15 comparisons, 2530 health professionals for dichotomous outcomes (adjusted risk difference 3.30%, 95% CI 3.10% to 3.51%; median 0.10%; interquartile range 0.00% to 4.00%); 28 comparisons, 2294 health professionals for continuous outcomes (adjusted relative percentage change 8.35%, 95% CI 7.46% to 9.24%; median 2.00%; interquartile range -1.00% to 21.00%)) The certainty of evidence for this comparison is moderate. Educational meetings alone compared with other interventions • May improve compliance with desired practice when compared with other interventions (6 studies, 1402 health professionals for dichotomous outcomes (adjusted risk difference 9.99%, 95% CI 9.47% to 10.52%; median 16.5%; interquartile range 0.80% to 16.50%); 2 studies, 72 health professionals for continuous outcomes (adjusted relative percentage change 12.00%, 95% CI 9.16% to 14.84%; median 12.00%; interquartile range 0.00% to 24.00%)) No studies met the inclusion criteria for patient outcome measurements. The certainty of evidence for this comparison is low. Interactive educational meetings compared with didactic (lecture-based) educational meetings • We are uncertain of effects on compliance with desired practice (3 studies, 370 health professionals for dichotomous outcomes; 1 study, 192 health professionals for continuous outcomes) or on patient outcomes (1 study, 54 health professionals for continuous outcomes), as the certainty of evidence is very low Any other comparison of different formats and durations of educational meetings • We are uncertain of effects on compliance with desired practice (1 study, 19 health professionals for dichotomous outcomes; 1 study, 20 health professionals for continuous outcomes) or on patient outcomes (1 study, 113 health professionals for continuous outcomes), as the certainty of evidence is very low. Factors that might explain heterogeneity of effects Meta-regression suggests that larger estimates of effect are associated with studies judged to be at high risk of bias, with studies that had unit of analysis errors, and with studies in which the unit of analysis was the provider rather than the patient. Improved compliance with desired practice may be associated with: shorter meetings; poor baseline compliance; better attendance; shorter follow-up; professionals provided with additional take-home material; explicit building of educational meetings on theory; targeting of low- versus high-complexity behaviours; targeting of outcomes with high versus low importance; goal of increasing rather than decreasing behaviour; teaching by opinion leaders; and use of didactic versus interactive teaching methods. Pre-specified exploratory analyses of behaviour change techniques suggest that improved compliance with desired practice may be associated with use of a greater number of behaviour change techniques; goal-setting; provision of feedback; provision for social comparison; and provision for social support. Compliance may be decreased by the use of follow-up prompts, skills training, and barrier identification techniques. AUTHORS' CONCLUSIONS Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Our findings suggest that multi-strategy approaches might positively influence the effects of educational meetings. Additional trials of educational meetings compared with no intervention are unlikely to change the review findings; therefore we will not further update this review comparison in the future. However, we note that randomised trials comparing different types of education are needed.
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Affiliation(s)
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Lisa Forsén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mbah P Okwen
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Darrason M, Souquet PJ, Couraud S. Standardized vs peer-played patients for learning how to break bad news in lung cancer: A prospective crossover study. Respir Med Res 2021; 80:100856. [PMID: 34481303 DOI: 10.1016/j.resmer.2021.100856] [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: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Residents in respiratory medicine are often confronted with breaking bad news to patients. In communication skill training, a recurring question is whether to use standardized or peer-played patients for simulation METHODS: In this prospective single-center crossover study in pulmonology residents, a range of scenarios were performed during training sessions using standardized or peer-played patients. The aim was to assess whether patient type did alter the quality of the role-play. The residents completed post-scenario questionnaires about the role-play of each scenario, but also pre- and post-session questionnaires about their perception of the effectiveness of both modalities, and pre- and post-testing questionnaires about the psychological impact of the training. RESULTS Collectively, 4 scenarios were performed 52 times and evaluated 208 times by 52 residents. The use of standardized patients appeared to improve the quality of the patient role (8.8 ± 1.0 vs. 8.3 ± 1.1; p = 0.001) and the general quality of role-play (8.8 ± 1.0 vs. 8.2 ± 0.9; p = 0.008), without affecting the quality of the physician role played by the resident. There were no significant differences between standardized and peer-played patients regarding learning interest or psychological impact. Regardless of the modality, the training sessions did appear to significantly affect the residents' evaluations of their ability to break bad news to patients (5.7 ± 1.1 vs. 7.4 ± 1.1; p < 10-4). CONCLUSION Our results did not point to a superiority of either of these modalities for learning how to break bad news. Both may be used, depending on the local resources.
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Affiliation(s)
- Marie Darrason
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France.
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Plateforme Lyon Sud de Simulation en Santé (PL3S), Faculté de médecine et de maïeutique Lyon Sud, Université de Lyon, Lyon, France
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Amsalem D, Martin A, Mosheva M, Soul O, Korotkin L, Ziv A, Gothelf D, Gross R. Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills. Front Psychiatry 2021; 12:649090. [PMID: 33746804 PMCID: PMC7973022 DOI: 10.3389/fpsyt.2021.649090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Omer Soul
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
| | - Liran Korotkin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amitai Ziv
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Integrated Rehabilitation Hospital, Ramat Gan, Israel
| | - Doron Gothelf
- Division of Child & Adolescent Psychiatry, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
- Faculty of Medicine, Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Raz Gross
- MSR–Israel Center for Medical Simulation, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
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Breaking Bad News, a Pertinent Yet Still an Overlooked Skill: An International Survey Study. Healthcare (Basel) 2020; 8:healthcare8040501. [PMID: 33233556 PMCID: PMC7711660 DOI: 10.3390/healthcare8040501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
Delivering bad news to patients is a challenging yet impactful everyday task in clinical practice. Ideally, healthcare practitioners should receive formal training in implementing these protocols, practice in simulation environments, and real-time supervision with feedback. We aimed to investigate whether healthcare providers involved in delivering bad news have indeed received formal training to do so. We conducted a cross-sectional survey study that targeted all healthcare providers in the intensive care units of 174 institutions in 40 different countries. Participants included physicians, nurses, medical students, nursing students, pharmacists, respiratory technicians, and others. The survey tool was created, validated, and translated to the primary languages of these countries to overcome language barriers. A total of 10,106 surveys were collected. Only one third of participants indicated that they had received a formal training. Providers who had received formal training were more likely to deliver bad news than those who had not. Younger and less experienced providers tend to deliver bad news more than older, more experienced providers. The percentage of medical students who claimed they deliver bad news was comparable to that of physicians. Medical schools and post-graduate training programs are strongly encouraged to tackle this gap in medical education.
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Campos A, Ernest EV, Cash RE, Rivard MK, Panchal AR, Clemency BM, Swor RA, Crowe RP. The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals. PREHOSP EMERG CARE 2020; 25:539-548. [PMID: 32584686 DOI: 10.1080/10903127.2020.1785599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Death notification is a difficult task commonly encountered during prehospital care and may lead to burnout among EMS professionals. Lack of training could potentiate the relationship between death notification and burnout. The first objective of this study was to describe EMS professionals' experience with death notification and related training. The secondary objective was to assess the associations between death notification delivery, training, and burnout. Methods: We administered an electronic questionnaire to a random sample of nationally-certified EMS professionals. Work-related burnout was measured using the validated Copenhagen Burnout Inventory. Analysis was stratified by certification level to basic life support (BLS) and advanced life support (ALS). The association between the number of adult (≥18 years) patient death notifications delivered in the prior 12 months and burnout was assessed using multivariable logistic regression to adjust for confounding variables. Multivariable logistic regression modeling was used to assess the adjusted association between training and burnout among those who reported delivering at least one death notification in the prior 12 months. Adjusted odds ratios (aOR) and 95% confidence intervals are reported (95% CI). Results: We received 2,333/19,330 (12%) responses and 1,514 were included in the analysis. Most ALS respondents (77%) and one-third of BLS respondents (33%) reported at least one adult death notification in the past year. Approximately half of respondents reported receiving death notification training as part of their initial EMS education program (51% BLS; 52% ALS) and fewer reported receiving continuing education (30% BLS; 44% ALS). Delivering a greater number of death notifications was associated with increased odds of burnout. Among those who delivered at least one death notification, continuing education was associated with reduced odds of burnout. Conclusion: Many EMS professionals reported delivering at least one death notification within the past year. Yet, fewer than half reported training related to death notification during initial EMS education and even fewer reported receiving continuing education. More of those who delivered death notifications experienced burnout, while continuing education was associated with reduced odds of burnout. Future work is needed to develop and evaluate death notification training specifically for EMS professionals.
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Affiliation(s)
- Abraham Campos
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Eric V Ernest
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Rebecca E Cash
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Madison K Rivard
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Ashish R Panchal
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Brian M Clemency
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Robert A Swor
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
| | - Remle P Crowe
- Received May 7, 2020 from Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska (AC, EVE); Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (REC); South Shore Health, EMS Division, Weymouth, Massachusetts (MKR); National Registry of Emergency Medical Technicians, Columbus, Ohio (ARP); Wexner Medical Center, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio (ARP); Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (BMC); Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan (RAS); ESO, Austin, Texas (RPC)
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Zanello M, Baugnon T, Roux A, Di Rocco F. A long-term evaluation of a training program on breaking bad news in pediatric neurosurgery: a pilot study. J Neurosurg Pediatr 2020; 25:670-678. [PMID: 32168486 DOI: 10.3171/2019.12.peds19554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Breaking bad news is a difficult task in medical practice. Several breaking-bad-news training programs have been proposed. However, long-term results of such training have rarely been investigated. The aim of this study was to compare the short- and long-term evaluations by young neurosurgeons of a training program for breaking bad news to patients and their parents. METHODS Between 2012 and 2015, pediatric neurosurgery residents participated in a training day on breaking bad news in pediatric neurosurgery with professional actors. A personal debriefing, followed by a theoretical session, completed the training. Immediate feedback was evaluated through a survey administered at the end of the day. Long-term results were explored via an online form sent at least 3 years after the training completion. RESULTS Seventeen participants from 9 different countries were interviewed. Their immediate feedback confirmed their interest. For 71% of them, the program was very interesting, and 77% were extremely satisfied or very satisfied. All trainees wanted more training sessions. At a mean of 4.5 years of follow-up (range 3-6 years), 71% of the trainees fully remembered the session. Most of them (86%) reported a positive impact of the training on their career. Only 21% had another training session on breaking bad news during their residency. At long-term analysis, fewer trainees considered the duration of the training to have been sufficient (p = 0.044). CONCLUSIONS Breaking-bad-news training has a positive long-term educational impact even several years later. Such a training program should be implemented into pediatric neurosurgery residency.
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Affiliation(s)
- Marc Zanello
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris
- 2Sorbonne Paris Cité, Paris Descartes University, Paris
- 3Inserm U894, IMA-Brain, Centre Psychiatrie et Neurosciences, Paris
| | - Thomas Baugnon
- 2Sorbonne Paris Cité, Paris Descartes University, Paris
- 4Anaesthesiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker, Paris
| | - Alexandre Roux
- 1Department of Neurosurgery, Sainte-Anne Hospital, Paris
- 2Sorbonne Paris Cité, Paris Descartes University, Paris
- 3Inserm U894, IMA-Brain, Centre Psychiatrie et Neurosciences, Paris
| | - Federico Di Rocco
- 5Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civiles de Lyon and University Claude Bernard Lyon 1, Bron Cedex; and
- 6Reference Center for Craniosynostosis, Inserm 1033, Lyon, France
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Servotte JC, Bragard I, Szyld D, Van Ngoc P, Scholtes B, Van Cauwenberge I, Dardenne N, Goosse M, Pilote B, Guillaume M, Ghuysen A. Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department. West J Emerg Med 2019. [DOI: 10.5811//westjem.2019.8.43441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jean-Christophe Servotte
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Isabelle Bragard
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Demian Szyld
- Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School
| | - Pauline Van Ngoc
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Beatrice Scholtes
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | | | - Nadia Dardenne
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Manon Goosse
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Bruno Pilote
- Université Laval, Faculté des sciences infirmières, Québec, Canada
| | - Michele Guillaume
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Alexandre Ghuysen
- University of Liège, Department of Public Health Sciences, Liège, Belgium University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
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Servotte JC, Bragard I, Szyld D, Van Ngoc P, Scholtes B, Van Cauwenberge I, Donneau AF, Dardenne N, Goosse M, Pilote B, Guillaume M, Ghuysen A. Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department. West J Emerg Med 2019; 20:893-902. [PMID: 31738716 PMCID: PMC6860397 DOI: 10.5811/westjem.2019.8.43441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. Methods Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. Results Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. Conclusion A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.
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Affiliation(s)
- Jean-Christophe Servotte
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Isabelle Bragard
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
| | - Demian Szyld
- Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School
| | - Pauline Van Ngoc
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Béatrice Scholtes
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | | | | | - Nadia Dardenne
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Manon Goosse
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Bruno Pilote
- Université Laval, Faculté des sciences infirmières, Québec, Canada
| | - Michèle Guillaume
- University of Liège, Department of Public Health Sciences, Liège, Belgium
| | - Alexandre Ghuysen
- University of Liège, Department of Public Health Sciences, Liège, Belgium.,University of Liege, Interdisciplinary Medical Simulation Center of Liège, Liège, Belgium
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Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD. Communication Skills Training for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2019; 76:1223-1230. [PMID: 31005480 DOI: 10.1016/j.jsurg.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/19/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although good communication skills are essential for surgeons, there is no formal communication training during general surgery residency. OBJECTIVES To implement a communication skills training program based on evidence-based teaching methods in general surgery residency. DESIGN We developed a 2-hour communication skills training program for general surgery residents, consisting of a small group skill practice session using role play with simulated patients along with real-time feedback from facilitators and observing peer residents. A board-certified palliative care physician and a board-certified surgeon facilitated each session. Outcome measures were self-assessment of preparedness with the session immediately before and after the session and 2 months after the session, resident satisfaction, and self-report frequency of skill practice. Results were compared between junior residents (postgraduate year 1-3) and senior residents (postgraduate year 4-5). SETTING Columbia University Medical Center in New York City, a tertiary care, urban academic center with a 5-year General Surgery Residency program. PARTICIPANTS Thirty-one out of 39 (79.4%) general surgery residents (20 junior and 11 senior) were trained over a 9-month period. All participants completed the immediate pre- and post-session surveys, and twenty residents (64.5%) completed the 2-month postsession follow-up survey. RESULTS Overall, self-assessment of preparedness for specific communication challenges improved significantly for 7 of 11 tasks. At baseline, senior residents felt significantly more prepared than junior residents in all 11 tasks. Junior residents' self-assessment of preparedness improved significantly in 10 of 11 tasks. Overall satisfaction with the session was very high (mean 4.74 on a 5-point scale). Residents reported high frequency of self-directed skill practice in the 2-month follow-up survey. CONCLUSIONS This 2-hour communication skills practice session for general surgery residents was feasible, and it improved resident self-assessment of preparedness in communication and augmented self-directed skill practice.
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Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York.
| | - Katherine Fischkoff
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Ana Berlin
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York; Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Tracey D Arnell
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Craig D Blinderman
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York
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Fischer F, Helmer S, Rogge A, Arraras JI, Buchholz A, Hannawa A, Horneber M, Kiss A, Rose M, Söllner W, Stein B, Weis J, Schofield P, Witt CM. Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research. BMC Cancer 2019; 19:808. [PMID: 31412805 PMCID: PMC6694634 DOI: 10.1186/s12885-019-6022-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.
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Affiliation(s)
- F. Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Helmer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A. Rogge
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J. I. Arraras
- Radiotherapeutic Oncology Department & Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A. Buchholz
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre, Hamburg, Germany
| | - A. Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M. Horneber
- Department of Internal Medicine, Divisions of Pneumology and Oncology/Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | - A. Kiss
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - M. Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, USA
| | - W. Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - B. Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - J. Weis
- Comprehensive Cancer Center, Department of Self-Help Research, Faculty of Medicine and Medical Center University of Freiburg, Freiburg, Germany
| | - P. Schofield
- Department of Psychology, Swinburne University, Melbourne, Victoria Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria Australia
| | - C. M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD USA
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Seeber AA, Pols AJ, Hijdra A, Grupstra HF, Willems DL, de Visser M. Advance care planning in progressive neurological diseases: lessons from ALS. BMC Palliat Care 2019; 18:50. [PMID: 31196046 PMCID: PMC6567602 DOI: 10.1186/s12904-019-0433-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is increasing awareness of the need for an integrated palliative care approach in chronic progressive neurological diseases. Advance care planning (ACP) is an integral part of this approach. As a systematically organized and ongoing communication process about patients’ values, goals and preferences regarding medical care during serious and chronic illness, ACP aims to involve patients in decision-making before they become cognitively and communicatively incapable. However, it remains underutilized in daily neurological practice except for speciality clinics such as ALS centers. Our aim was to study ACP in the tertiary ALS center Amsterdam and to investigate patients’ reflections on it. Subsequently we used this knowledge to formulate recommendations for integration of ACP in the care of patients with other chronic progressive neurological diseases. Methods Non-participating observations of all appointments of patients with amyotrophic lateral sclerosis (ALS) or progressive muscular atrophy (PMA) with the treating physician, in various stages of disease, during 6 consecutive months, followed by single in-depth interviews, and an inductive analysis. Results Twenty-eight Dutch patients participated, varying in age, gender, disease onset and severity of physical decline. ACP started directly when the diagnosis was given, by means of a general outlook on the future with progressive disability and immediate introduction to a customized multidisciplinary team. During follow-up ACP was realized by regular appointments in which monitoring of the patient’s status and clear communication strategies formed the basis of tailor-made discussions on treatment options. Patients accepted this policy as careful professional guidance. Conclusions ACP is a professional communication process throughout the whole course of progressive disease. It is feasible to integrate ACP into follow-up of patients with ALS and PMA from diagnosis onwards. Supported by recent literature, we argue that such a well-structured approach would also enhance the quality of care and life of patients with other chronic progressive neurological diseases. Electronic supplementary material The online version of this article (10.1186/s12904-019-0433-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. .,Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands.
| | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Albert Hijdra
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Hepke F Grupstra
- Department of Rehabilitation, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Marschollek P, Bąkowska K, Bąkowski W, Marschollek K, Tarkowski R. Oncologists and Breaking Bad News-From the Informed Patients' Point of View. The Evaluation of the SPIKES Protocol Implementation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:375-380. [PMID: 29399734 DOI: 10.1007/s13187-017-1315-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The way that bad news is disclosed to a cancer patient has a crucial impact on physician-patient cooperation and trust. Consensus-based guidelines provide widely accepted tools for disclosing unfavorable information. In oncology, the most popular one is called the SPIKES protocol. A 17-question survey was administered to a group of 226 patients with cancer (mean age 59.6 years) in order to determine a level of SPIKES implementation during first cancer disclosure. In our assessment, the patients felt that the highest compliance with the SPIKES protocol was with Setting up (70.6%), Knowledge (72.8%), and Emotions (75.3%). The lowest was with the Perception (27.7%), Invitation (30.4%), and Strategy & Summary (56.9%) parts. There could be improvement with each aspect of the protocol, but especially in Perception, Invitation, and Strategy & Summary. The latter is really important and must be done better. Older patients felt the doctors' language was more comprehensible (r = 0.17; p = 0.011). Patients' satisfaction of their knowledge about the disease and follow-up, regarded as an endpoint, was insufficient. Privacy was important in improving results (p < 0.01). In practice, the SPIKES protocol is implemented in a satisfactory standard, but it can be improved in each area, especially in Perception, Invitation, and Summary. It is suggested that more training should be done in undergraduate and graduate medical education and the effectiveness of the disclosure continue to be evaluated and improved.
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Affiliation(s)
- Paweł Marschollek
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Katarzyna Bąkowska
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Wojciech Bąkowski
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Karol Marschollek
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Radosław Tarkowski
- Department of Oncology, Division of Surgical Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 53-413, Wrocław, Poland.
- 1st Department of Surgical Oncology, Lower Silesian Cancer Center, pl. Hirszfelda 12, 53-413, Wrocław, Poland.
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Walter HAW, Seeber AA, Willems DL, de Visser M. The Role of Palliative Care in Chronic Progressive Neurological Diseases-A Survey Amongst Neurologists in the Netherlands. Front Neurol 2019; 9:1157. [PMID: 30692960 PMCID: PMC6340288 DOI: 10.3389/fneur.2018.01157] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic progressive neurological diseases like high grade glioma (HGG), Parkinson's disease (PD), and multiple sclerosis (MS) are incurable, and associated with increasing disability including cognitive impairment, and reduced life expectancy. Patients with these diseases have complex care needs. Therefore, timely advance care planning (ACP) is required. Our aim was to investigate timing and content of discussions on treatment restrictions, i.e., to initiate, withhold, or withdraw treatment in patients with HGG, PD, and MS, from the neurologists' perspective. Methods: We performed a national online survey amongst consultants in neurology and residents in The Netherlands. The questionnaire focused on their daily practice concerning timing and content of discussions on treatment restrictions with patients suffering from HGG, PD or MS. We also inquired about education and training in discussing these issues. Results: A total of 125 respondents [89 neurologists (71%), 62% male, with a median age of 44 years, and 36 residents (29%), 31% male with a median age of 29 years] responded. Initial discussions on treatment restrictions were said to take place during the first year after diagnosis in 28% of patients with HGG, and commonly no earlier than in the terminal phase in patients with PD and MS. In all conditions, significant cognitive decline was the most important trigger to advance discussions, followed by physical decline, and initiation of the terminal phase. Most discussed issues included ventilation, resuscitation, and admission to the intensive care unit. More than half of the consultants in neurology and residents felt that they needed (more) education and training in having discussions on treatment restrictions. Conclusion: In patients with HGG discussions on treatment restrictions are initiated earlier than in patients with PD or MS. However, in all three diseases these discussions usually take place when significant physical and cognitive decline has become apparent and commonly mark the initiation of end-of-life care. More than half of the responding consultants in neurology and residents feel the need for improvement of their skills in performing these discussions.
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Affiliation(s)
- Hannah A W Walter
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Antje A Seeber
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Niglio de Figueiredo M, Krippeit L, Ihorst G, Sattel H, Bylund CL, Joos A, Bengel J, Lahmann C, Fritzsche K, Wuensch A. ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial. PLoS One 2018; 13:e0205315. [PMID: 30289905 PMCID: PMC6173449 DOI: 10.1371/journal.pone.0205315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/24/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate the effect of the number of coaching sessions after communication skills training on the medical communicative performance of oncologists in clinical practice. METHODS/DESIGN The training, consisting of a workshop and one (control group) vs. four (intervention group) sessions of individual coaching, was evaluated in a randomized controlled trial. Eligible participants included physicians working in any setting where patients with oncological diseases were treated. Real medical consultations were video recorded at three time points: before the workshop (t0), after the workshop (t1) and after completion of coaching (t2). The 1.5-day workshop was based on role-playing in small groups; in the coaching sessions, the videos recorded at t1 were analyzed in detail by both the trainer and the physician. The coaching sessions were manualized and based on the physician's learning goals. The primary hypothesis was that the intervention group would improve to a higher extent than the control group, as assessed by external raters using rating scales specially developed for this project. Physicians were stratified for sex and setting and randomized by an independent statistician. The group assignment was revealed for physicians and trainers at the end of the workshop, while the raters were blinded to group assignments and assessment points. RESULTS A total of 72 physicians participated in one of 8 workshops and could be allocated to either the control or intervention group. The intervention group showed a statistically significant improvement (ES d = 0.41, p<.01) in the All items domain of the rating scales between t1 and t2 and showed a significant advantage compared with the CG (ES = .41, p = .04). The impact on diverse specified skills was heterogeneous; a larger sample is necessary for more detailed analysis. CONCLUSIONS The training achieved some observable and significant changes in the communicative behavior of oncologists in clinical practice. The four coaching sessions showed some significant advantages compared to the single coaching session. Considerable effort is necessary to achieve sustained changes in communication in clinical every-day practice. Thus, our coaching concept is a promising method for this purpose.
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Affiliation(s)
- Marcelo Niglio de Figueiredo
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lorena Krippeit
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heribert Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carma L. Bylund
- College of Journalism and Communications, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Bengel
- Institute of Psychology, Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Douglas P. Simulation-Based Training in Brain Death Determination Incorporating Family Discussion. J Grad Med Educ 2018; 10:553-558. [PMID: 30386482 PMCID: PMC6194878 DOI: 10.4300/jgme-d-18-00185.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/15/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Good medical care relies on communication as much as technical expertise, yet physicians often overestimate the efficacy of their patient communication skills. Teaching communication skills can be cost- and time-intensive, and efforts have rarely focused on challenging situations, such as conveying the news of a patient's brain death to a family member. OBJECTIVE We developed a resource-sensitive simulation program to teach residents how to diagnose brain death and how to show empathy in discussing the diagnosis with the patient's family. METHODS From 2015 to 2017, 3 cohorts of incoming neurology residents participated in the 3-day training exercise. The 2-hour preintervention assessment involved making the diagnosis of brain death and sharing the news with an actor portraying the patient's family member. The scoring via checklists consisted of 15 clinical skills, 9 apnea test-related skills, and 37 verbal skills related to family discussion. The 5-hour didactic intervention focused on technical aspects of the brain death examination and lessons in communication with role-playing. The 2-hour postintervention assessment repeated the brain death examination and family discussion simulations. Data were analyzed using the Wilcoxon signed rank test. RESULTS A total of 18 residents (100%) were assessed, with significant differences between preintervention and postintervention testing across all areas, including clinical assessment (45%-76%, P < .001), apnea testing (57%-92%, P < .001), and verbal communication (46%-73%, P < .001). CONCLUSIONS The findings suggest a benefit in simulation training for brain death examination, apnea testing, and the subsequent family discussion regarding the patient's diagnosis.
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Abstract
Neuropalliative care is a new and growing field within neurology that focuses on improving the quality of life of patients with serious neurologic illnesses. While specialty-level palliative care training is available to interested neurologists, all neurologists can strive to provide primary palliative care for their patients. In this review, we will describe the scope of neuropalliative care, define patient populations who may benefit from palliative care, and explore the communication and symptom management skills essential to palliative care delivery.
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Affiliation(s)
- K Brizzi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - C J Creutzfeldt
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Wang Ambulatory Care Center, Boston, Massachusetts
- Department of Neurology, Harborview Medical Center, Seattle, Washington
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Fontenot JL, Bona MD, Kaleem MA, McLaughlin WM, Morse AR, Schwartz TL, Shepherd JD, Jackson ML. Vision Rehabilitation Preferred Practice Pattern®. Ophthalmology 2018; 125:P228-P278. [DOI: 10.1016/j.ophtha.2017.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
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The PEWTER Study: Breaking Bad News Communication Skills Training for Counseling Programs. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2017. [DOI: 10.1007/s10447-017-9313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Selman LE, Brighton LJ, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Ramsenthaler C, Higginson IJ, Koffman J. The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis. J Pain Symptom Manage 2017; 54:404-416.e5. [PMID: 28778560 DOI: 10.1016/j.jpainsymman.2017.04.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
CONTEXT As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. OBJECTIVES To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. METHODS Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. RESULTS Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I2 = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I2 = 44%; chi-square = 5.96, df = 3, P = 0.11; I2 = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. CONCLUSIONS The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient interactions may be beneficial. REGISTRATION NUMBER CRD42014014777.
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Affiliation(s)
- Lucy Ellen Selman
- King's College London, Cicely Saunders Institute, London, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, United Kingdom; Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom
| | - Christine McDonald
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Suzanne O'Brien
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Shaheen A Khan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rob George
- King's College London, Cicely Saunders Institute, London, United Kingdom; St Christopher's Hospice, London, United Kingdom
| | | | - Irene J Higginson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, London, United Kingdom
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Libert Y, Peternelj L, Bragard I, Liénard A, Merckaert I, Reynaert C, Razavi D. Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients. BMC Cancer 2017; 17:476. [PMID: 28693515 PMCID: PMC5504708 DOI: 10.1186/s12885-017-3437-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. Methods/design Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. Discussion The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. Trial registration US Clinical Trials Register NCT02836197.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium. .,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Liège, Belgium
| | - Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Christie D, Glew S. A clinical review of communication training for haematologists and haemato-oncologists: a case of art versus science. Br J Haematol 2017; 178:11-19. [PMID: 28543173 DOI: 10.1111/bjh.14606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The art of communication at times seems at odds with the science of medicine. Poor communication is associated with risks for patient and physician. Communication skills are highly relevant for haematologists and are associated with increased physician and patient satisfaction, positive psychosocial outcomes and possible health outcomes. Medical communication training has recently become widespread but is largely restricted to junior medical professionals. In haematology, the proliferation of high quality communication skills is low and there are few interventions catering for the required skillset. A review identified five applicable interventions for haematologists. There is variation in intervention length and structure, and most studies measure targeted skill fidelity rather than patient outcomes. Work on motivation and empowerment holds potential for haematological conditions, but is largely absent from care. This review highlights the need for new interventions for haematologists which focus on producing and maintaining positive patient outcomes.
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Affiliation(s)
- Deborah Christie
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK.,UCL Institute of Epidemiology and Public Health, London, UK
| | - Sarah Glew
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK
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40
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Wuensch A, Goelz T, Ihorst G, Terris DD, Bertz H, Bengel J, Wirsching M, Fritzsche K. Effect of individualized communication skills training on physicians' discussion of clinical trials in oncology: results from a randomized controlled trial. BMC Cancer 2017; 17:264. [PMID: 28403837 PMCID: PMC5390387 DOI: 10.1186/s12885-017-3238-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Discussing randomized clinical trials (RCTs) with cancer patients is one of the most challenging communication tasks a physician faces. Only two prior Communication Skills Trainings (CSTs) focused on RCTs in oncology have been reported. Their results demonstrated the need for further improvement. We developed and evaluated an enhanced, individually-tailored CST focused on improving physicians’ communication during discussions of RCTs. Methods The CST focused on personal learning goals derived from video pre-assessment that were addressed in a 1.5-day group workshop and one-on-one coaching sessions. Forty physicians were recruited and randomly assigned to intervention and control groups. Video-recorded standardized consultations with actor-patients were utilized. As a primary outcome (1), training success was evaluated by blinded raters using a previously developed checklist. Change in checklist items was evaluated between pre- and post-training assessment and compared against control group results. As a secondary outcome (2), the physicians’ feeling of confidence was assessed by a questionnaire. Results (1) Significant improvements in the intervention group were observed for the score on all items (p = 0.03), for the subgroup of content-specific items (p = 0.02), and for the global rating of communication competence (p = 0.04). The improvement observed for the subgroup of general communication skill items did not achieve significance (p = 0.20). (2) The feeling of confidence improved in nine out of ten domains. Conclusion While the individually-tailored CST program significantly improved the physicians’ discussions of RCTs, specifically related to discussion content, what remains unknown is the influence of such programs in practice on participant recruitment rates. The study was registered retrospectively in 2010/07/22 under DRKS-ID: DRKS00000492. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3238-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Wuensch
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstr. 8, D-79104, Freiburg, Germany. .,Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstrasse 3, D-81675, Munich, Germany.
| | - Tanja Goelz
- Department of Internal Medicine I (Hematology and Oncology), Medical Center - University of Freiburg, Faculty of Medicine, Hugstetterstr. 55, D-79106, Freiburg, Germany.,Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, Mathildenstr.1, D-79106, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit (CTU), Medical Center - University of Freiburg, Faculty of Medicine, Elsaesser Str. 2, D-79110, Freiburg, Germany
| | - Darcey D Terris
- Center for Family Research, University of Georgia, 1095 College Station Rd, Athens, GA, 30602, USA
| | - Hartmut Bertz
- Department of Internal Medicine I (Hematology and Oncology), Medical Center - University of Freiburg, Faculty of Medicine, Hugstetterstr. 55, D-79106, Freiburg, Germany
| | - Juergen Bengel
- Institute of Psychology, Department Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Engelbergerstr. 41, D-79106, Freiburg, Germany
| | - Michael Wirsching
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstr. 8, D-79104, Freiburg, Germany
| | - Kurt Fritzsche
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstr. 8, D-79104, Freiburg, Germany
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Gorniewicz J, Floyd M, Krishnan K, Bishop TW, Tudiver F, Lang F. Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients. PATIENT EDUCATION AND COUNSELING 2017; 100:655-666. [PMID: 27876220 PMCID: PMC5407084 DOI: 10.1016/j.pec.2016.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/08/2016] [Accepted: 11/12/2016] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. METHODS This randomized control study (N=66) compared intervention and control groups of students (n=28) and residents' (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. RESULTS Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=0.007, r=-0.47; breast cancer (BC), p=0.003, r=-0.53), attention to patient responses after BBN (CC, p<0.001, r=-0.74; BC, p=0.001, r=-0.65), and addressing feelings (BC, p=0.006, r=-0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r=-0.43), communication related to emotions (p=0.034, r=-0.30), determining patient's readiness to proceed after BBN and communication preferences (p=0.041, r=-0.28), active listening (p=0.011, r=-0.37), addressing feelings (p<0.001, r=-0.65), and global interview performance (p=0.001, r=-0.51). CONCLUSION This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. PRACTICE IMPLICATIONS Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.
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Affiliation(s)
- James Gorniewicz
- Department of Family Medicine, East Tennessee State University, Johnson City, USA.
| | - Michael Floyd
- Department of Family Medicine, East Tennessee State University, Johnson City, USA
| | | | - Thomas W Bishop
- Department of Family Medicine, East Tennessee State University, Johnson City, USA
| | - Fred Tudiver
- Department of Family Medicine, East Tennessee State University, Johnson City, USA
| | - Forrest Lang
- Department of Family Medicine, East Tennessee State University, Johnson City, USA
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Downar J, McNaughton N, Abdelhalim T, Wong N, Lapointe-Shaw L, Seccareccia D, Miller K, Dev S, Ridley J, Lee C, Richardson L, McDonald-Blumer H, Knickle K. Standardized patient simulation versus didactic teaching alone for improving residents' communication skills when discussing goals of care and resuscitation: A randomized controlled trial. Palliat Med 2017; 31:130-139. [PMID: 27307057 DOI: 10.1177/0269216316652278] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Communication skills are important when discussing goals of care and resuscitation. Few studies have evaluated the effectiveness of standardized patients for teaching medical trainees to communicate about goals of care. OBJECTIVE To determine whether standardized patient simulation offers benefit over didactic sessions alone for improving skill and comfort discussing goals of care. DESIGN AND INTERVENTION Single-blind, randomized, controlled trial of didactic teaching plus standardized patient simulation versus didactic teaching alone. PARTICIPANTS First-year internal medicine residents. MAIN MEASURES Changes in communication comfort and skill between baseline and 2 months post-training assessed using the Consultation and Relational Empathy measure. KEY RESULTS We enrolled 94 residents over a 2-year period. Both groups reported a significant improvement in comfort when discussing goals of care with patients. There was no difference in Consultation and Relational Empathy scores following the workshop ( p = 0.79). The intervention group showed a significant increase in Consultation and Relational Empathy scores post-workshop compared with pre-workshop (35.0 vs 31.7, respectively; p = 0.048), whereas there was no improvement in Consultation and Relational Empathy scores in the control group (35.6 vs 36.0; p = 0.4). However, when the results were adjusted for baseline differences in Consultation and Relational Empathy scores in a multivariable regression analysis, group assignment was not associated with an improvement in Consultation and Relational Empathy score. Improvement in comfort scores and perception of benefit were not associated with improvements in Consultation and Relational Empathy scores. CONCLUSION Simulation training may improve communication skill and comfort more than didactic training alone, but there were important confounders in this study and further studies are needed to determine whether simulation is better than didactic training for this purpose.
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Affiliation(s)
- James Downar
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.,2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nancy McNaughton
- 3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada
| | - Tarek Abdelhalim
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Wong
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.,4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Lapointe-Shaw
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dori Seccareccia
- 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kim Miller
- 5 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Shelly Dev
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Julia Ridley
- 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christie Lee
- 1 Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Lisa Richardson
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather McDonald-Blumer
- 4 Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kerry Knickle
- 3 Standardized Patient Program, University of Toronto, Toronto, ON, Canada
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Radziej K, Loechner J, Engerer C, Niglio de Figueiredo M, Freund J, Sattel H, Bachmann C, Berberat PO, Dinkel A, Wuensch A. How to assess communication skills? Development of the rating scale ComOn Check. MEDICAL EDUCATION ONLINE 2017; 22:1392823. [PMID: 29141516 PMCID: PMC7011842 DOI: 10.1080/10872981.2017.1392823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/09/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Good communication is a core competency for all physicians. Thus, medical students require adequate preparation in communication skills. For research purposes, as well as for evaluation in teaching, there is a clear need for reliable assessment tools. We analyzed the shortcomings of existing instruments and saw a need for a new rating scale. The aim of this publication is to describe the development process for, and evaluation of, a new rating scale. METHODS First, we developed the rating scale in 10 steps. Then, two raters evaluated the newly developed rating scale by rating 135 videotaped consultations of medical students with standardized patients. Additionally, standardized patients evaluated students' performance, which was used as an outside criterion to validate ratings. RESULTS Our rating scale comprises six domains with 13 specific items evaluated on a five-point Likert scale: initiating conversation, patient's perception, structure of conversation, patient's emotions, end of conversation, and general communication skills. Item-total correlation coefficients between the checklist items ranged from 0.15 to 0.78. Subscale consistency was calculated for domains comprised of more than one item and Cronbach's α ≥ 0.77, indicating acceptable consistency. Standardized patients' global evaluation correlated moderately with overall expert ratings (Spearman's ρ = .40, p < .001). CONCLUSION Our rating scale is a reliable and applicable assessment tool. The rating scale focuses on the evaluation of general communication skills and can be applied in research as well as in evaluations, such as objective structured clinical examinations (OSCE). ABBREVIATIONS CST: Communication skills training; ICC: Intra-class correlation coefficient; OSCE: Objective structured clinical examination; SP: Standardized patients; SD: Standard deviation; M: Mean.
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Affiliation(s)
- K. Radziej
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J. Loechner
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Ludwig-Maximilians-Universität, Munich, Germany
| | - C. Engerer
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Niglio de Figueiredo
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J. Freund
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H. Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C. Bachmann
- Institute of Medical Education, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P. O. Berberat
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Dinkel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Wuensch
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Peterson EB, Boland KA, Bryant KA, McKinley TF, Porter MB, Potter KE, Calhoun AW. Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents. J Grad Med Educ 2016; 8:739-746. [PMID: 28018540 PMCID: PMC5180530 DOI: 10.4300/jgme-d-15-00485.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Effective communication is an essential element of medical care and a priority of medical education. Specific interventions to teach communication skills are at the discretion of individual residency programs. OBJECTIVE We developed the Resident Communication Skills Curriculum (RCSC), a formal curriculum designed to teach trainees the communication skills essential for high-quality practice. METHODS A multidisciplinary working group contributed to the development of the RCSC, guided by an institutional needs assessment, literature review, and the Accreditation Council for Graduate Medical Education core competencies. The result was a cohesive curriculum that incorporates didactic, role play, and real-life experiences over the course of the entire training period. Methods to assess curricular outcomes included self-reporting, surveys, and periodic faculty evaluations of the residents. RESULTS Curricular components have been highly rated by residents (3.95-3.97 based on a 4-point Likert scale), and residents' self-reported communication skills demonstrated an improvement over the course of residency in the domains of requesting a consultation, providing effective handoffs, handling conflict, and having difficult conversations (intern median 3.0, graduate median 4.0 based on a 5-point Likert scale, P ≤ .002). Faculty evaluations of residents have also demonstrated improvement over time (intern median 3.0, graduate median 4.5 based on a 5-point Likert scale, P < .001). CONCLUSIONS A comprehensive, integrated communication skills curriculum for pediatrics residents was implemented, with a multistep evaluative process showing improvement in skills over the course of the residency program. Positive resident evaluations and informal comments from faculty support its general acceptance. The use of existing resources makes this curriculum feasible.
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Affiliation(s)
- Eleanor B. Peterson
- Corresponding author: Eleanor B. Peterson, MD, University of Louisville, Department of Pediatrics, 571 South Floyd Street, Suite 332, Louisville, KY 40202, 502.852.3720, fax 502.852.3998,
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Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences. Am J Surg 2016; 212:996-1004. [DOI: 10.1016/j.amjsurg.2016.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/18/2016] [Accepted: 02/27/2016] [Indexed: 11/18/2022]
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Min AA, Spear-Ellinwood K, Berman M, Nisson P, Rhodes SM. Social worker assessment of bad news delivery by emergency medicine residents: a novel direct-observation milestone assessment. Intern Emerg Med 2016; 11:843-52. [PMID: 26892405 DOI: 10.1007/s11739-016-1405-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
Abstract
The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.
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Affiliation(s)
- Alice Ann Min
- Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA.
| | - Karen Spear-Ellinwood
- Department of Obstetrics and Gynecology, College of Medicine, The University of Arizona, Tucson, AZ, USA
- Faculty Instructional Development, Office of Medical Student Education, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Melissa Berman
- Department of Clinical Resource Management, University of Arizona Medical Center, Tucson, AZ, USA
| | - Peyton Nisson
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Suzanne Michelle Rhodes
- Department of Emergency Medicine, College of Medicine, The University of Arizona, P.O. Box 245057, Tucson, AZ, 85724-5057, USA
- Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
- Arizona Center on Aging, The University of Arizona, Tucson, AZ, USA
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Bishop TW, Gorniewicz J, Floyd M, Tudiver F, Odom A, Zoppi K. Innovative patient-centered skills training addressing challenging issues in cancer communications: Using patient's stories that teach. Int J Psychiatry Med 2016; 51:357-66. [PMID: 27497456 DOI: 10.1177/0091217416659272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This workshop demonstrated the utility of a patient-centered web-based/digital Breaking Bad News communication training module designed to educate learners of various levels and disciplines. This training module is designed for independent, self-directed learning as well as group instruction. These interactive educational interventions are based upon video-recorded patient stories. Curriculum development was the result of an interdisciplinary, collaborative effort involving faculty from the East Tennessee State University (ETSU) Graduate Storytelling Program and the departments of Family and Internal Medicine at the James H. Quillen College of Medicine. The specific goals of the BBN training module are to assist learners in: (1) understanding a five-step patient-centered model that is based upon needs, preferences, and expectations of patients with cancer and (2) individualizing communication that is consistent with patient preferences in discussing emotions, informational detail, prognosis and timeline, and whether or not to discuss end-of-life issues. The pedagogical approach to the training module is to cycle through Emotional Engagement, Data, Modeled Practices, Adaptation Opportunities, and Feedback. The communication skills addressed are rooted in concepts found within the Reaching Common Ground communication training. A randomized control study investigating the effectiveness of the Breaking Bad News module found that medical students as well as resident physicians improved their communication skills as measured by an Objective Structured Clinical Examination. Four other similarly designed modules were also created: Living Through Treatment, Transitions: From Curable to Treatable/From Treatable to End-of-Life, Spirituality, and Family.
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Affiliation(s)
| | | | - Michael Floyd
- East Tennessee State University, Johnson City, TN, USA
| | - Fred Tudiver
- East Tennessee State University, Johnson City, TN, USA
| | - Amy Odom
- Michigan State University, MI, USA
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Hilkert SM, Cebulla CM, Jain SG, Pfeil SA, Benes SC, Robbins SL. Breaking bad news: A communication competency for ophthalmology training programs. Surv Ophthalmol 2016; 61:791-798. [PMID: 27134009 DOI: 10.1016/j.survophthal.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
As the ophthalmology accreditation system undergoes major changes, training programs must evaluate residents in the 6 core competencies, including appropriately communicating bad news. Although the literature is replete with recommendations for breaking bad news across various non-ophthalmology specialties, no formal training programs exist for ophthalmology. There are many valuable lessons to be learned from our colleagues regarding this important skill. We examine the historic basis for breaking bad news, explore current recommendations among other specialties, and then evaluate a pilot study in breaking bad news for ophthalmology residents. The results of this study are limited by a small number of residents at a single academic center. Future studies from multiple training programs should be conducted to further evaluate the need and efficacy of formal communication skills training in this area, as well as the generalizability of our pilot training program. If validated, this work could serve as a template for future ophthalmology resident training and evaluation in this core competency.
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Affiliation(s)
- Sarah M Hilkert
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Ophthalmology, University of California San Diego/Ratner Children's Eye Center, La Jolla, California, USA
| | - Colleen M Cebulla
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shelly Gupta Jain
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Sheryl A Pfeil
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Susan C Benes
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shira L Robbins
- Department of Ophthalmology, University of California San Diego/Ratner Children's Eye Center, La Jolla, California, USA
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Liénard A, Delevallez F, Razavi D, Gibon AS, Libert Y, Delvaux N, Marchal S, Etienne AM, Bragard I, Reynaert C, Slachmuylder JL, Durieux JF, Farvacques C, Scalliet P, Van Houtte P, Coucke P, Merckaert I. Is it possible to improve communication around radiotherapy delivery: A randomized study to assess the efficacy of team training? Radiother Oncol 2016; 119:361-7. [PMID: 27072941 DOI: 10.1016/j.radonc.2016.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/15/2016] [Accepted: 03/20/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the efficacy of a 38-h communication skills training program designed for multidisciplinary radiotherapy teams. MATERIALS AND METHODS Four radiotherapy teams were randomly assigned to a training program or to a waiting list. Assessments were scheduled at baseline (T1) and then after the training was completed or four months later (T2), respectively. Communication around radiotherapy delivery was assessed based on audio recordings of the first and last radiotherapy sessions in order to assess team members' communication skills and the expression of concerns by breast cancer patients (analyzed with content analysis software LaComm). RESULTS 198 radiotherapy sessions were recorded. During the first radiotherapy sessions, members of the trained teams exhibited more assessment skills (p=0.048), provided more setting information (p<0.001), and used more social words (p=0.019) compared to the members of the untrained teams. During the last radiotherapy session, members of the trained teams used more assessment skills (p=0.004) and patients interacting with members of the trained teams expressed more sadness words (p=0.023). CONCLUSION Training of multidisciplinary teams has the potential to transfer skills that affect the short exchanges that take place around radiotherapy delivery.
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Affiliation(s)
- Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - France Delevallez
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Anne-Sophie Gibon
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium
| | - Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Nicole Delvaux
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium
| | - Serge Marchal
- Institut Jules Bordet, Université Libre de Bruxelles, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium; C.P.O. (Centre de Psycho-Oncologie), Brussels, Belgium
| | - Anne-Marie Etienne
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Belgium
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Belgium
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Psychologie et des Sciences de l'Éducation, Louvain-la-Neuve, Belgium; Université Catholique de Louvain, Faculté de Médecine, Louvain-la-Neuve, Belgium
| | | | | | | | - Pierre Scalliet
- Université Catholique de Louvain, Faculté de Médecine, Louvain-la-Neuve, Belgium
| | - Paul Van Houtte
- Institut Jules Bordet, Université Libre de Bruxelles, Belgium; Université Libre de Bruxelles, Faculté de Médecine, Belgium
| | | | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
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Karkowsky CE, Landsberger EJ, Bernstein PS, Dayal A, Goffman D, Madden RC, Chazotte C. Breaking Bad News in obstetrics: a randomized trial of simulation followed by debriefing or lecture. J Matern Fetal Neonatal Med 2016; 29:3717-23. [DOI: 10.3109/14767058.2016.1141888] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Chavi Eve Karkowsky
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
| | - Ellen J. Landsberger
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
| | - Peter S. Bernstein
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
| | - Ashlesha Dayal
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
| | - Dena Goffman
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
| | - Robert C. Madden
- Department of Natural Sciences, Fordham University, New York, NY, USA
| | - Cynthia Chazotte
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA and
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