1
|
Eskola L, Silverman E, Rogers S, Zelenski A. Right-sizing interprofessional team training for serious-illness communication: A strength-based approach. PEC INNOVATION 2024; 4:100267. [PMID: 38414869 PMCID: PMC10897908 DOI: 10.1016/j.pecinn.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
Objective Palliative care communication skills help tailor care to patients' goals. With a palliative care physician shortage, non-physicians must gain these serious illness communication skills. Historically, trainings have targeted physician-only groups; our goal was to train interprofessional teams. Methods Workshops were conducted to teach palliative care communication skills and interprofessional communication. Participants completed surveys which included questions from the Interpersonal Reactivity Index, the Ekman Faces tool, the Consultation and Relational Empathy measure, open-ended questions about empathy, and measures of effective interprofessional practice. Results Participants felt the workshop improved their ability to listen (p < 0.001), understand patients' concerns (p < 0.001), and show compassion (p = 0.008). It increased the perceived value of peer observation (p < 0.001) and ability to reflect (p = 0.02) during complex conversations. Different types of professionals adopted different communication goals, though all affirmed the importance of active listening. Participants felt they improved their ability to work within an interprofessional team. Conclusions The course effectively trained 71 clinicians, the majority non-physicians, in serious illness communication and interprofessional team communication skills, and could be reproduced in similar settings. Innovation We adapted an approach common to physician-only trainings to diverse interprofessional groups, added a team-based component using Applied Improvisation, and demonstrated its effectiveness.
Collapse
Affiliation(s)
- Liana Eskola
- Department of Medicine, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, USA
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
| | - Ethan Silverman
- Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
- Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 200 Lothrop St., Suite 933W, Pittsburgh, PA 15213, USA
| | - Sarah Rogers
- Department of Social Work, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
- Department of Mental Health, Department of Veterans Affairs, William S. Middleton Memorial Hospital and Clinics, 2500 Overlook Terrace, Madison, WI 53705, United States of America
| | - Amy Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., Madison, WI 53792, USA
| |
Collapse
|
2
|
Crowe A, Koch MK, Bluck S, Amin T, Thomas L, Fitchett G, Wilkie DJ, Bylund CL. Factors and topics associated with empathic self-disclosure in dignity therapy of cancer patients. PEC INNOVATION 2024; 4:100289. [PMID: 38799259 PMCID: PMC11126944 DOI: 10.1016/j.pecinn.2024.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
Objective During Dignity Therapy a trained provider guides a patient to share their life story and legacy. Providers can demonstrate empathy through empathic self-disclosure (ESD), sharing something substantial and personal about themselves in response to the patient. The current study aims to identify the topics of ESDs and determine whether ESD frequency varied by patient and/or provider characteristics. Methods Two coders analyzed 203 audio-recorded, transcribed Dignity Therapy sessions of palliative care patients (M = 65.78 years; SD = 7.43 years, 65.69% women) for ESD. Topic modeling characterized themes of ESD and multilevel modeling examined ESD frequency based on several patient and provider characteristics. Results ESD occurred in 37% of interviews (M = 0.59, SD = 1.21). Topic modeling revealed five main themes: family, memory, school, geographical experiences, and values/beliefs. Multilevel modeling indicated patient-level differences, including greater rates of ESD when patients were men and older. Conclusion ESD seems to be dependent on the context of the patient rather than individual communication style differences. Providers may use ESD in multiple instances, including when similar and different from patients. Innovation This study introduces and defines the novel concept of ESD. It is among the first to examine patient-provider communication during Dignity Therapy, and the first to specifically examine self-disclosure.
Collapse
Affiliation(s)
- Alyssa Crowe
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - Mary Kate Koch
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, United States of America
| | - Susan Bluck
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, United States of America
| | - Tithi Amin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - Lyndsey Thomas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| | - George Fitchett
- Department of Religion, Health & Human Value, College of Health Sciences, Rush University Medical Center, United States of America
| | - Diana J. Wilkie
- Department of Nursing, College of Medicine, University of Florida, United States of America
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States of America
| |
Collapse
|
3
|
Zhang X, Li L, Zhang Q, Le LH, Wu Y. Physician Empathy in Doctor-Patient Communication: A Systematic Review. HEALTH COMMUNICATION 2024; 39:1027-1037. [PMID: 37062918 DOI: 10.1080/10410236.2023.2201735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Physician empathy is at the heart of doctor-patient communication and significantly influences patient outcomes. However, the research on how physicians express their empathy and how physician empathy affects patient outcomes and doctor-patient communication has not been well summarized in the latest literature. Thus, we conducted a systematic review to synthesize existing studies on physician empathy and its value to patient outcomes and doctor-patient communication. The systematic review consisted of studies published in English peer-reviewed journals between January 2017 and October 2021. Following the PRISMA procedure, a total of 3055 articles were retrieved, and 11 articles were retained. The thematic analysis revealed three emergent themes: physicians' empathic expressions; patient outcomes (patient functional status, patient safety, and patient satisfaction); and empathy enhancing doctor-patient communication. This study highlighted the different ways empathy may be expressed by physicians and its positive effects on patient outcomes and doctor- patient communication. This study also suggested the under-researched areas that can be expanded in the future.
Collapse
Affiliation(s)
- Xin Zhang
- Center for Medical Humanities in the Developing World, Qufu Normal University
| | - Linzi Li
- Department of Gynaecology, Rizhao Maternal and Child Health
| | - Quan Zhang
- School of International Affairs and Public Administration, Ocean University of China
| | | | - Yijin Wu
- Center for Medical Humanities in the Developing World, Qufu Normal University
| |
Collapse
|
4
|
Kaur E, Arezina J, Bryant L, Pollak KI, Harrison G, Bender Atik R, Coates J, Hardicre NK, Sicklen R, Horwood K, Lardner T, Arnold J, Wallace R, Johnson J. Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:273-283. [PMID: 37929254 PMCID: PMC10621488 DOI: 10.1177/1742271x221147860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/11/2022] [Indexed: 11/07/2023]
Abstract
Introduction Despite widespread recognition that communicating unexpected news during obstetric ultrasound examinations is challenging, there is a dearth of research investigating how to teach evidence-based communication to sonographers. Communication Coaching is a supportive, positive method that has previously been associated with improvements in communication, patient satisfaction, and reduced burnout in clinicians. However, to date, no study has coached sonographers. This study explored stakeholders' views on a proposed Communication Coaching intervention and used these data to adapt the intervention for use with qualified obstetric sonographers. Methods Semi-structured interviews were conducted with people who have a vested interest in unexpected news delivery and thematic analysis was conducted on the data. Eight sonographers, six people with lived experience of receiving unexpected news and six representatives from third-sector organisations who support expectant parents were recruited (18 women; 2 men, aged between 21 and 75 years). Results Participants viewed the planned Communication Coaching intervention favourably and suggested adaptations. The two main themes were (1) the practicalities of coaching, and (2) content. The first theme had four subthemes: (a) brief and flexible structure, (b) online modality, (c) sensitive and positive coach and (d) organisational awareness. The second theme had three subthemes: (a) specific language and behaviour recommendations, (b) adaptable to different service-users and situations and (c) confer relevant emotional skills and techniques. Conclusions Communication Coaching could be a feasible and acceptable intervention for qualified sonographers if specific, limited adaptations are made as recommended by the stakeholders. Further evaluation of the intervention in practice is necessary.
Collapse
Affiliation(s)
- Essie Kaur
- School of Psychology, University of Leeds, Leeds, UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jane Arezina
- Specialist Science Education Department (SSED), Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Bryant
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kathryn I Pollak
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Gill Harrison
- Society and College of Radiographers (SCoR), London, UK
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | | | | | - Roxanne Sicklen
- Barnet Hospital, Royal Free London NHS Foundation Trust, Barnet, UK
| | | | - Teresa Lardner
- Fetal Anomaly Screening Programme, Public Health Commissioning and Operations, NHS England, UK
| | | | - Rebecca Wallace
- Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
5
|
Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. PATIENT EDUCATION AND COUNSELING 2023; 114:107811. [PMID: 37244131 PMCID: PMC10526983 DOI: 10.1016/j.pec.2023.107811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Palliative care encounters often involve empathic opportunities conveyed by patients and their care partners. In this secondary analysis, we examined empathic opportunities and clinician responses with attention to how presence of multiple care partners and clinicians shapes empathic communication. METHODS We used the Empathic Communication Coding System (ECCS) to characterize emotion-focused, challenge-focused, and progress-focused empathic opportunities and responses in 71 audio-recorded palliative care encounters in the US. RESULTS Patients expressed more emotion-focused empathic opportunities than did care partners; care partners expressed more challenge-focused empathic opportunities than did patients. Care partners initiated empathic opportunities more frequently when more care partners were present, though they expressed fewer as the number of clinicians increased. When more care partners and more clinicians were present, clinicians had fewer low-empathy responses. CONCLUSION The number of care partners and clinicians present affect empathic communication. Clinicians should be prepared for empathic communication focal points to shift depending on the number of care partners and clinicians present. PRACTICE IMPLICATIONS Findings can guide development of resources to prepare clinicians to meet emotional needs in palliative care discussions. Interventions can coach clinicians to respond empathically and pragmatically to patients and care partners, particularly when multiple care partners are in attendance.
Collapse
Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, United States.
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, United States
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, United States
| | - Robert M Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, United States
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, United States
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Duke University, United States; Department of Population Health Sciences, Duke University School of Medicine, United States
| |
Collapse
|
6
|
van Vliet LM, Stouthard J, Gröschel LC, Meijers MC. Effect of Clinician-Expressed Empathy in Advanced Cancer on Different Ethnic Groups: Results from an Experimental Video-Vignette Study. J Palliat Med 2023; 26:1109-1114. [PMID: 37162756 DOI: 10.1089/jpm.2022.0602] [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: 05/11/2023] Open
Abstract
Background: In advanced cancer, clinician-expressed empathy can improve patients' psychological outcomes. It remains unknown whether all patients benefit equally from empathy. Objective: To explore whether the effect of clinician-expressed empathy on patients' psychological outcomes is moderated by patient ethnicity. Methods: Using an experimental video-vignette design, 160 participants watched a consultation-video with/without added empathy. Using regression analysis, the moderating effect of ethnicity (non-Western- vs. Dutch/Western-immigration background) on the relationship between empathy and psychological outcomes was assessed. Results: The main effect of empathy on satisfaction (p = 0.001), trust (p = 0.002), and self-efficacy (p < 0.001) was moderated by ethnicity (satisfaction, p = 0.050; trust, p = 0.066; self-efficacy, p = 0.075). No main effect of empathy nor moderation by ethnicity was found for anxiety (state anxiety: p = 0.284, p = 0.319; current anxiety: p = 0.357, p = 0.949). No main effects of ethnicity (satisfaction, p = 0.942; trust, p = 0.724; self-efficacy, p = 0.244; state anxiety, p = 0.812; current anxiety p = 0.523) were found. Conclusion: In advanced cancer, non-Western patients might benefit most from empathy. Dutch Trial Registration Number: NTR NL8992.
Collapse
Affiliation(s)
- Liesbeth M van Vliet
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lara C Gröschel
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Maartje C Meijers
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| |
Collapse
|
7
|
McDarby M, Silverstein HI, Carpenter BD. Effects of a Patient Question Prompt List on Question Asking and Self-Efficacy During Outpatient Palliative Care Appointments. J Pain Symptom Manage 2023; 65:285-295. [PMID: 36565794 PMCID: PMC10023338 DOI: 10.1016/j.jpainsymman.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Question prompt lists (QPLs) promote participation during medical appointments, including in the context of serious illness care. However, no studies have used parameters of a theoretical framework to examine the effects of QPL use in outpatient palliative care. OBJECTIVES The current pilot randomized controlled trial evaluated use of a 25-question QPL during initial outpatient palliative care appointments. We applied tenets of Self-Efficacy Theory to investigate how use of a QPL affected appointment participation and perceived self-efficacy. METHODS Participants were patients and care partners attending the patient's first palliative care appointment. Participants either received a QPL before the appointment (n = 29 appointments) or usual care (n = 30 appointments). Audio recordings of appointments were coded for total questions asked. Participants reported perceived self-efficacy in question asking pre- and postappointment. Analysis of variance was used to compare appointment participation between study conditions, and a linear mixed effects model was used to compare changes in ratings of perceived self-efficacy. RESULTS Participants who received the QPL did not ask significantly more questions compared to participants in usual-care appointments. There was a main effect of time on self-efficacy in question asking, such that self-efficacy increased from pre- to postappointment, but there was no effect of the intervention. CONCLUSION Despite their promise in previous studies, results of the current study suggest that QPLs may lack potency to shift patient and care partner question asking in palliative care appointments, and that other mechanisms outlined in Self-Efficacy Theory may characterize the relation between question asking and self-efficacy.
Collapse
Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences (M.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Psychological and Brain Sciences (H.I.S., B.D.C.), Washington University in St. Louis, St. Louis, Missouri, USA.
| | - Hannah I Silverstein
- Department of Psychiatry and Behavioral Sciences (M.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Psychological and Brain Sciences (H.I.S., B.D.C.), Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian D Carpenter
- Department of Psychiatry and Behavioral Sciences (M.M.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Psychological and Brain Sciences (H.I.S., B.D.C.), Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|