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Karimi Z, Darban F, Karimi S, Safarzai E. The effectiveness of communication skills training on professional performance and quality of work life of pre-hospital emergency medical staff: An experimental study in Iran. Int Emerg Nurs 2024; 74:101426. [PMID: 38484686 DOI: 10.1016/j.ienj.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 05/28/2024]
Abstract
AIM Communication skills are one of the components that influence the performance of pre-hospital emergency staff who provide services to patients. This study aimed to determine the effectiveness of communication skills training on the professional performance and quality of work life of pre-hospital emergency staff. METHODS This experimental study with pretest-posttest design was conducted on 150 pre-hospital emergency staff in Iran from March 2022 to May 2023. The participants were randomly assigned into two control (n = 75) and experimental (n = 75) groups. The intervention included 4 sessions (3 h each) of communication skills training, weekly. The data gathering scales were Stamm's quality of work life questionnaire and Patterson's job performance questionnaire, which were used at start point, 4 and 8 weeks after that. RESULTS The mean score professional performance in experimental group increased significantly to 42.4 ± 0.70 in the second stage and to 44.5 ± 0.55 in the third stage (P < 0.05). The mean score of the quality of work life was also 96.9 ± 0.9 and 99.8 ± 0.9 in the 4th and 8th weeks after the intervention, which was significantly more than control group (P < 0.05). CONCLUSIONS The results showed the communication skills training improves professional performance and increases the quality of work life of pre-hospital emergency staff.
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Affiliation(s)
- Zahra Karimi
- Department of Psychiatric Nursing, Emergency Medical Services, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Fatemeh Darban
- Department of Nursing, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran.
| | - Samira Karimi
- Department of Clinical Psychology, Zahedan Branch, Islamic Azad University, Zahedan, Iran
| | - Enayatollah Safarzai
- Department of Nursing, Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Byrne M, Campos C, Daly S, Lok B, Miles A. The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review. PATIENT EDUCATION AND COUNSELING 2024; 119:108063. [PMID: 38008647 DOI: 10.1016/j.pec.2023.108063] [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: 04/26/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness. METHODS We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis. RESULTS Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations. CONCLUSIONS For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.
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Affiliation(s)
- Monika Byrne
- School of Psychology, University of Auckland, New Zealand.
| | - Carlos Campos
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, New Zealand
| | - Svetlana Daly
- School of Psychology, University of Auckland, New Zealand
| | - Benjamin Lok
- Virtual Experiences Research Group, University of Florida, USA
| | - Anna Miles
- School of Psychology, University of Auckland, New Zealand
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Schwalbe D, Timmermann C, Gregersen TA, Steffensen SV, Ammentorp J. Communication, Cognition and Competency Development in Healthcare: A Model for Integrating Cognitive Ethnography and Communication Skills Training in Clinical Interventions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205231223319. [PMID: 38204973 PMCID: PMC10777782 DOI: 10.1177/23821205231223319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to conduct and evaluate the Blended Learning communication skills training program. The key objective was to investigate (i) how clinical intervention studies can be designed to include cognitive, organizational, and interactive processes, and (ii) how researchers and practitioners could work with integrated methods to support the desired change. METHODS The method combined design and implementation of a 12-week Blended Learning communication skills training program based on the Calgary-Cambridge Guide. The training was implemented in a patient clinic at a Danish university hospital and targeted all healthcare professionals at the clinic. Cognitive ethnography was used to document and evaluate healthcare professionals' implementation and individual competency development, and support the design of in-situ simulation training scenarios. RESULTS Thirteen participants completed the program. The synergy within the teams, as well as the opportunities for participants to coordinate, share, discuss, and reflect on the received knowledge with a colleague or on-site researcher, affected learning positively. The knowledge transfer process was affected by negative feedback loops, such as time shortages, issues with concept development and transfer, disjuncture between the expectations of participants and instructors of the overall course structure, as well as participant insecurity and a gradual loss of motivation and compliance. CONCLUSION We propose a novel 3-step model for clinical interventions based on our findings and literature review. This model will effectively support the implementation of educational interventions in health care by narrowing the theory-practice gap. It will also stimulate desired change in individual behavior and organizational culture over time. Furthermore, it will work for the benefit of the clinic and may be more suitable for the implementation of communication projects than, for example, randomized setups.
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Affiliation(s)
- Daria Schwalbe
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind, Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Connie Timmermann
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Trine A Gregersen
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language, Culture, History and Communication, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
- Center for Ecolinguistics, South China Agricultural University, Guangzhou, China
- College of International Studies, Southwest University, Chongqing, China
| | - Jette Ammentorp
- Center for Human Interactivity, Department of Culture and Communication, University of Southern Denmark, Odense, Denmark
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Findlay-White F, Dornan T, Davies M, Archer A, Kilvert A, Fox C. From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education. F1000Res 2023; 11:78. [PMID: 38434003 PMCID: PMC10904953 DOI: 10.12688/f1000research.73596.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/05/2024] Open
Abstract
Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.
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Affiliation(s)
- Florence Findlay-White
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Mark Davies
- Clinical Psychology Department, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AE, UK
| | - Alan Archer
- Derbyshire Community Health Service, Walton Hospital, Chesterfield, England, S40 3HW, UK
| | - Anne Kilvert
- Northampton Community Diabetes Service, Danetre Hospital, Daventry, England, NN11 4DY, UK
| | - Charles Fox
- Diabetes Research Centre, University of Leicester, Leicester, England, LE5 4PW, UK
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Massa E, Lai E, Donisi C, Scartozzi M, Orgiano L, Mulas O, Pretta A, Caocci G, Carta MG. Understanding the User's Point of View: When the Doctor Gets Sick with Cancer and Seeks Help. Clin Pract Epidemiol Ment Health 2023; 19:e17450179241325. [PMID: 38164454 PMCID: PMC10758133 DOI: 10.2174/0117450179241325231011070735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 01/03/2024]
Abstract
Background When physicians confront a serious personal illness, they may discover that the transition to the "sick" role is challenging and not easy. We conducted a qualitative study in which a group of doctors with cancer (DP) was compared with a group of patients with cancer, not doctors (NDP) but with a degree of education, qualifications, and a professional role comparable to that of a doctor. Objectives The main objective was to evaluate the effect of the diagnosis and the treatment of cancer on both the patient's personal and professional life. It was also designed to understand the effect that the experience of cancer may have on the subsequent clinical practice of DP. Methods The eligibility criteria included diagnosis of tumors of different sites and at any stage of disease treated with local (surgery, radiotherapy) or systemic (chemotherapy, hormonal, target) therapies or a combination of both; patients actively working. A semi-structured interview was used to collect information about the patient's cancer experiences. In both groups, six main themes and ten subthemes were identified. Results From July to November 2021, 59 patients were enrolled in the study. Among them, 29 were DP and 30 were NDP. The median age and gender were 55.9 years ± 9.3 SD (range 38-82 y), M/F ratio 12/17 for DP, and 56.3 years ± 8.9 SD (range 40-83 y), M/F ratio 11/19 for NDP, respectively. The main themes were: theme 1, practical aspects related to diagnosis: most of the DP did not encounter difficulties in performing the tests necessary to confirm the diagnosis of cancer, unlike what was observed in NDP. Theme 2, cancer diagnosis experience: Many DP and NDP felt prepared for their own cancer experience. Two-thirds of DP already knew their cancer prognosis from their previous background knowledge and one-third of NDP did not want to discuss the prognosis in depth with their referring oncologists for the fear of learning that their cancer had a poor prognosis. Theme 3, treatment experience: for many DP, having a professional background contributed to more active participation in care and also in the management of side effects of treatments. Most NDP were satisfied with the treatment received in the hospital and the relationship with the health professionals. Theme 4, changes in work: None of the patients from both the groups stopped working permanently or lost their job because of the disease. A higher number of DP and NDP reported a loss of interest in their job. Theme 5, changes in personal/family life and friendships: more than half of the patients in both groups developed a new perspective on their private lives. Theme 6, comfort from faith: most of the patients in both groups who followed a faith, found comfort in that faith. For DP only, we explored the theme of the change in the doctor/patient relationship. Important findings from our study included positive changes in the doctor's clinical practice including having a more empathic relationship with patients, greater consideration of the psychological impact of cancer, and greater attention to certain symptoms of cancer reported by patients. Conclusion This study suggests the need to know the special needs of professional patients, in particular, related to the emotional difficulties, maintenance of privacy, and the need for support on their return to work. These results can help to foster improvements in current cancer care practices.
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Affiliation(s)
- Elena Massa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Lai
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Clelia Donisi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Scartozzi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Orgiano
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Olga Mulas
- Ematology Hematology and e CTMOHSCT Center, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy
| | - Andrea Pretta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Ematology Hematology and e CTMOHSCT Center, Businco Hospital, ARNAS “G. Brotzu”, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Wolderslund M, Waidtløw K, Kofoed PE, Ammentorp J. Facilitators and Barriers to a Hospital-Based Communication Skills Training Programme: An Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4834. [PMID: 36981743 PMCID: PMC10048912 DOI: 10.3390/ijerph20064834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to investigate the facilitators and barriers experienced by the department management (DMs) and communication skills trainers (trainers) during the implementation of a 3-day communication skills training (CST) programme for healthcare professionals (HCPs). Thus, we conducted semi-structured interviews with 23 DMs and 10 trainers from 11 departments concurrently implementing the CST programme. Thematic analysis was undertaken to elucidate the themes across the interviews. Five themes were developed: resource consumption; obstacles; management support; efforts and outcomes; and a lack of systematic follow-up. Although the DMs and trainers were largely in agreement, the theme of a lack of systematic follow-up was derived exclusively from the trainers, as were two of the subthemes within obstacles: (b) seniority, profession, and cultural differences, and (c) the trainers' competencies. The greatest perceived barrier was resource consumption. In addition, DMs found planning and staff resistance to be a challenge. However, the HCPs' resistance diminished or even changed to satisfaction after participating. The mandatory approach served as both a facilitator and a barrier; DMs' support was an essential facilitator. Explicit communication related to resource demands, planning, and participation is crucial, as is management support and the allocation of resources.
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Affiliation(s)
- Maiken Wolderslund
- Centre for Research in Patient Communication, Odense University Hospital, 5000 Odense, Denmark (J.A.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Karin Waidtløw
- Centre for Research in Patient Communication, Odense University Hospital, 5000 Odense, Denmark (J.A.)
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, 6000 Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jette Ammentorp
- Centre for Research in Patient Communication, Odense University Hospital, 5000 Odense, Denmark (J.A.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Lundeby T, Finset A, Kaasa S, Wester TE, Hjermstad MJ, Dajani O, Wist E, Aass N. A complex communication skills training program for physicians providing advanced cancer care - content development and barriers and solutions for implementation. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:46-57. [PMID: 36919800 DOI: 10.1080/17538068.2022.2039468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Early integration of oncology and patient-centered palliative care is the recommended clinical practice model for patients with advanced cancer. General and specific communication skills are necessary to achieve integrated patient-centered care, but require organized training to be adequately mastered. Challenges and barriers on several levels, i.e. organizational, professional and individual may, however, hamper implementation. The development, implementation, and evaluation of such an educational program focusing on communication skills contain many steps, considerations and lessons learned, which are described in this article.Methods: A multi-professional faculty developed, implemented, and evaluated an educational program through a 5-step approach. The program was part of a Norwegian cluster-randomized controlled trial aiming to test the effect of early integration of oncology and palliative care for patients with advanced cancer.Results: The result is the PALLiON educational program; a multi-faceted, evidence-based, and learner-centered program with a specific focus on physicians' communication skills. Four modules were developed: lectures, discussion groups, skills training, and coaching. These were implemented at the six intervention hospitals using different teaching strategies. Evaluation in a subgroup of participants showed a positive appraisal of the group discussions and skills training.Conclusion:We present our experiences and reflections regarding implementation and lessons learned, which should be considered in future developments and implementations; (1) Include experienced faculty with various backgrounds, (2) Be both evidence-based and learner-centered, (3) Choose teaching strategies wisely, (4) Expect resistance and skepticism, (5) Team up with management and gatekeepers, (6) Expect time to fly, and (7) Plan thorough assessment of the evaluation and effect.Trial registration: ClinicalTrials.gov identifier: NCT03088202.
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Affiliation(s)
- Tonje Lundeby
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torunn Elin Wester
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Erik Wist
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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De Vleminck A, Craenen L, Stevens J, Lemaigre V, Pype P, Deliens L, Pardon K. Emotional cues and concerns of patients with a life limiting, chronic illness during advance care planning conversations in general practice. PATIENT EDUCATION AND COUNSELING 2023; 107:107563. [PMID: 36428170 DOI: 10.1016/j.pec.2022.11.005] [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: 03/24/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore a) to what extent patients with serious illness express emotional cues and concerns during advance care planning (ACP) conversations with their general practitioner (GP), b) the content of cues/concerns and c) GPs' responses to cues/concerns. METHODS Cues/concerns and GPs' responses in 20 conversations were coded using the Verona Codes (VR-CoDES and Verona Codes-P). A qualitative thematic analysis was used to identify overarching themes within the content of the cues/concerns. RESULTS A total of 216 cues/concerns were identified (range: 1-28; mean: 13) in 85% of conversations; with 85% of these being cues/implicit expressions of emotions. In 72% of responses, the GP provided space for the patient to elaborate on cues/concerns. The most common theme cues/concerns were expressed about was "the consequences of illness on quality of life and burdening others". CONCLUSION Emotions were mainly communicated implicitly as cues and the content varied greatly. The amount of cues/concerns expressed show that ACP can evoke many emotions. PRACTICE IMPLICATIONS GPs should be attentive to implicit expressions of emotions as these provide opportunities to engage patients in tailored ACP conversations. As patients expressed many cues/concerns, GPs are recommended to have recurrent conversations with patients and actively ask about diverse ACP topics.
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Affiliation(s)
- Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium.
| | - Lara Craenen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
| | - Julie Stevens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Valentine Lemaigre
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium; Department of Public Health and Primary Care, Ghent University, Belgium
| | - Koen Pardon
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Belgium
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Karger A, Petermann-Meyer A, Vitinius F, Geiser F, Kraus D, Ernsten L, Mayers AJ, Heuser C, Hiltrop K, Bremen R, Marx A, Ernstmann N. Effectiveness of interprofessional communication skills training for oncology teams: study protocol for a three-arm cluster randomised trial (KommRhein Interpro). BMJ Open 2022; 12:e062073. [PMID: 36581438 PMCID: PMC9806046 DOI: 10.1136/bmjopen-2022-062073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Patient-provider communication is an important factor influencing the quality of care in oncology. The study examines the comparative effectiveness of a 10-hour interprofessional communication skills training (CST) programme for physicians and nurses in cancer centres. METHODS AND ANALYSIS KommRhein Interpro is a cluster-randomised trial sponsored by the German Cancer Aid (Deutsche Krebshilfe, DKH) and conducted at the cancer centres of the university hospitals of Aachen, Bonn, Cologne and Düsseldorf. Thirty oncology teams of four cancer centres are randomly assigned to three study arms, providing healthcare professionals with either (a) only written information on patient-centred communication or (b) written information plus CST for physicians or (c) written information plus interprofessional CST for physicians and nurses. For summative evaluation, standardised surveys from three measurement points for patients (T0pat: study enrollment; T1pat: after discharge; T2pat: 3 months' follow-up) and two measurement points for physicians and nurses (T0hcp: before the intervention; T1hcp: after the intervention) are used. N=1320 valid patient cases are needed for data evaluation. The primary endpoint is fear of progression in patients with cancer after discharge. Data will be analysed according to the intention-to-treat principle using a mixed model for repeated measurement. Secondary outcome is the providers' self-efficacy in patient centeredness. Individual confounders and possible moderating effects of organisational factors will be considered. Secondary analysis will be performed by means of multilevel analysis and structural equation modelling. ETHICS AND DISSEMINATION A vote of approval has been obtained from the ethics committees of the medical faculties of RWTH Aachen University (EK325/20), University of Bonn (391/20), University of Cologne (20-1332) and Heinrich Heine University Düsseldorf (2019-796). Data protection regulations are adhered to for all processed data. The conduct of the study will be monitored. Dissemination strategies include a transfer workshop with cancer teams and distribution of the final study report to participants. TRIAL REGISTRATION NUMBER DRKS00022563; DRKS (German Clinical Trials Register).
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Affiliation(s)
- Andre Karger
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Petermann-Meyer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Center for Integrated Oncology Aachen, RWTH Aachen University, Medical Faculty and University Hospital, Aachen, Germany
| | - Frank Vitinius
- Department for Psychosomatics and Psychotherapy, University Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Franziska Geiser
- Psychosomatic Medicine and Psychotherapy, University Bonn, Medical Faculty and University Hospital, Bonn, Germany
| | - Daria Kraus
- Clinical Trials Center Cologne, University of Cologne, Cologne, Germany
| | - Luisa Ernsten
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Antonia J Mayers
- Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
| | - Kati Hiltrop
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
| | - Rebecca Bremen
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Center for Integrated Oncology Aachen, RWTH Aachen University, Medical Faculty and University Hospital, Aachen, Germany
| | - Ambra Marx
- Psychosomatic Medicine and Psychotherapy, University Bonn, Medical Faculty and University Hospital, Bonn, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, University of Bonn, Medical Faculty and University Hospital Bonn, Bonn, Germany
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Child- and family-specific communication skills trainings for healthcare professionals caring for families with parental cancer: A systematic review. PLoS One 2022; 17:e0277225. [DOI: 10.1371/journal.pone.0277225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction
As part of high-quality cancer care, healthcare professionals (HCPs) play a significant role in identifying and addressing specific needs of cancer patients parenting minor children. However, HCPs experience various barriers to adequately support parents with cancer. This systematic review explores current CSTs incorporating child- and family- specific modules for HCPs in oncology. Moreover, outcome measures and effectiveness of trainings are systematically investigated.
Methods
The systematic review was registered within PROSPERO (registration code: CRD42020139783). Systematic searches were performed in four databases (PubMed, Cinahl, PsycInfo, Web of Science) in 12/2020, including an update in 12/2021 and 08/2022. Quantitative, primary studies fulfilling the pre-defined inclusion criteria were included. Due to the expected heterogeneity a meta-analysis was not conducted. Study selection and quality assessment were conducted by two independent researchers, data extraction by one. Study quality was assessed using an adapted version of the National Institutes of Health quality assessment tool for pre-post studies without control group.
Results
Nine studies were included in this review following an experimental pre-post design only. Two CSTs were specifically designed to improve communication with cancer patients parenting minor children, the remaining seven incorporated a brief family module only. Seven programs were face-to-face trainings, one an e-learning and one a webinar. Eight studies found at least one statistically significant improvement in communication after training. However, quality of most studies was fair.
Conclusion
This is the first review exploring specific CSTs for HCPs caring for cancer patients parenting minor children. As only two CSTs focused on parental cancer, evidence on the effectiveness of such CSTs is limited. Existing CSTs should be evaluated properly and include details on content of family modules. Further studies including and evaluating specific CSTs focusing on parental cancer are needed in order to strengthen HCPs’ competencies to meet specific needs of patients parenting minor children.
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11
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Ammentorp J, Chiswell M, Martin P. Translating knowledge into practice for communication skills training for health care professionals. PATIENT EDUCATION AND COUNSELING 2022; 105:3334-3338. [PMID: 35953393 DOI: 10.1016/j.pec.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits. Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as 'core business', otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding.
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Affiliation(s)
- Jette Ammentorp
- Centre for Research in Patient Communication, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia.
| | - Meg Chiswell
- Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia
| | - Peter Martin
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia
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12
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Parry R, Whittaker B, Pino M, Jenkins L, Worthington E, Faull C. RealTalk evidence-based communication training resources: development of conversation analysis-based materials to support training in end-of-life-related health and social care conversations. BMC MEDICAL EDUCATION 2022; 22:637. [PMID: 35996125 PMCID: PMC9395846 DOI: 10.1186/s12909-022-03641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Training to enhance healthcare practitioners' capabilities in engaging people in sensitive and end-of life-related conversations is in demand. However, evaluations have either not measured, or found very limited impact on actual practice and patient experience. Training effectiveness is improved when it is based on in-depth evidence, reflects the complexity of real-life interactions, and instils principles adaptable to everyday practice. A relatively new source of in-depth evidence and practice-relevant insights on healthcare interactions is conversation analytic research, a form of observational analysis of real-life interactions. However, conversation analytic research findings have largely been disseminated by and for scientists, rather than clinicians and trainers. We used conversation analytic evidence to develop resources for use by healthcare trainers. The aim was to increase training's evidence-base and authenticity. We further aimed to develop resources applicable to working with learners ranging from novices to advanced practitioners. METHODS Using an intervention development approach, we created online video-clips and supplementary written materials for professionals who deliver training, supervision, and support in healthcare communication for staff and students. The materials were reviewed by an advisory group comprising clinicians, lay consultees, educators, and researchers, and piloted by trainers in UK universities, NHS organisations and independent hospices. We refined materials based on their feedback. RESULTS The resulting 'RealTalk' resources focus on practices for communicating with patients and their companions about end-of-life and prognosis. Two core training modules were developed, each comprising several patient case studies featuring video-clips from real-life healthcare consultations. The clips featured practices that patients and experienced practitioners use in approaching end-of-life matters. The case studies also included evidence-based descriptions of observable practices and the principles underlying these, alongside transcripts and case synopses. CONCLUSIONS RealTalk training resources aim to facilitate evidence-based, experiential and reflective learning, focusing on communication challenges, practices and principles for end-of-life-related interactions. The resources are designed for use by trainers for delivering all levels of training, from introductory to advanced, in both formal and informal training settings. Our development process may serve as a blueprint for the production of future evidence-based training resources based on conversation analytic research.
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Affiliation(s)
- Ruth Parry
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Becky Whittaker
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Marco Pino
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Laura Jenkins
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Esme Worthington
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Christina Faull
- LOROS Hospice Leicester, University Hospitals of Leicester and Honorary Professor University of Leicester, Leicester, LE3 9QE UK
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13
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Van Scoy LJ, Scott AM, Green MJ, Witt PD, Wasserman E, Chinchilli VM, Levi BH. Communication Quality Analysis: A user-friendly observational measure of patient-clinician communication. COMMUNICATION METHODS AND MEASURES 2022; 16:215-235. [PMID: 37063460 PMCID: PMC10104441 DOI: 10.1080/19312458.2022.2099819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Communication Quality Analysis (CQA) is a rigorous transcript-based coding method for assessing clinical communication quality. We compared the resource-intensive transcript-based version with a streamlined real-time version of the method with respect to feasibility, validity, reliability, and association with traditional measures of communication quality. Simulated conversations between 108 trainees and 12 standardized patients were assessed by 7 coders using the two versions of CQA (transcript and real-time). Participants also completed two traditional communication quality assessment measures. Real-time CQA was feasible and yielded fair to excellent reliability, with some caveats that can be addressed in future work. CQA ratings were moderately correlated with traditional measures of communication quality, suggesting that CQA captures different aspects of communication quality than do traditional measures. Finally, CQA did not exhibit the ceiling effects observed in the traditional measures of communication quality. We conclude that real-time CQA is a user-friendly method for assessing communication quality that has the potential for broad application in training, research, and intervention contexts and may offer improvements to traditional, self-rated communication measures.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Allison M Scott
- Department of Communication; University of Kentucky, Lexington, USA
| | - Michael J. Green
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
| | - Pamela D. Witt
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Pediatrics Penn State College of Medicine, Hershey, USA
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14
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Moslehpour M, Shalehah A, Rahman FF, Lin KH. The Effect of Physician Communication on Inpatient Satisfaction. Healthcare (Basel) 2022; 10:healthcare10030463. [PMID: 35326941 PMCID: PMC8954154 DOI: 10.3390/healthcare10030463] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
(1) Background: The importance of physician-patient communication and its effect on patient satisfaction has become a hot topic and has been studied from various aspects in recent years. However, there is a lack of systematic reviews to integrate recent research findings into patient satisfaction studies with physician communication. Therefore, this study aims to systematically examine physician communication’s effect on patient satisfaction in public hospitals. (2) Methods: Using a keywords search, data was collected from five databases for the papers published until October 2021. Original studies, observational studies, intervention studies, cross-sectional studies, cohort studies, experimental studies, and qualitative studies published in English, peer-reviewed research, and inpatients who communicated with the physician in a hospital met the inclusion criteria. (3) Results: Overall, 11 studies met the inclusion criteria from the 4810 articles found in the database. Physicians and organizations can influence two determinants of inpatient satisfaction in physician communication. Determinants of patient satisfaction that physicians influence consist of amounts of time spent with the patient, verbal and nonverbal indirect interpersonal communication, and understanding the demands of patients. The organization can improve patient satisfaction with physician communication by the organization’s availability of interpreter service and physician workload. Physicians’ communication with inpatients can affect patient satisfaction with hospital services. (4) Conclusions: To improve patient satisfaction with physician communication, physicians and organizational determinants must be considered.
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Affiliation(s)
- Massoud Moslehpour
- Department of Business Administration, College of Management, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan; (M.M.); (A.S.)
- Department of Management, California State University, San Bernardino, CA 92407, USA
| | - Anita Shalehah
- Department of Business Administration, College of Management, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan; (M.M.); (A.S.)
- International Relations Department, Faculty of Economy, Bussines and Politics, Universitas Muhammadiyah Kalimantan Timur, Jl. Ir. H. Juanda No. 15, Samarinda 75124, Kalimantan Timur, Indonesia
| | - Ferry Fadzlul Rahman
- Department of Public Health, College of Public Health, Universitas Muhammadiyah Kalimantan Timur, Jl. Ir. H. Juanda No. 15, Samarinda 75124, Kalimantan Timur, Indonesia;
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan
- Correspondence:
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15
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Zehm A, Scott E, Schaefer KG, Nguyen PL, Jacobsen J. Improving Serious Illness Communication: Testing the Serious Illness Care Program with Trainees. J Pain Symptom Manage 2022; 63:e252-e259. [PMID: 34743012 DOI: 10.1016/j.jpainsymman.2021.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Early conversations about patients' goals and values improve care, but clinicians struggle to conduct them. The systems-based Serious Illness Care Program (SICP) helps clinicians have more, better, and earlier conversations. Central to this approach is a clinician conversation guide for patient encounters. While the SICP works for practicing clinicians, it has not been tested with medical trainees. INTERVENTION We adapted the SICP training to emphasize assessing prognostic awareness and responding to emotion. We developed a 2.5-hour SICP workshop for medical students and medical interns that included large- and small-group work, practice with an actor, and interdisciplinary clinician facilitators. We trained 81 students and 156 interns and obtained anonymous quantitative and qualitative feedback. OUTCOMES Eighty-six percent of students and 91% of residents rated the session as "very good" or "excellent" and >90% of all learners would either recommend this training or intended to apply this to their practice. Post-session learner confidence increased in all communication skills. Learners said the training provided a helpful framework and useful language for these conversations. Resident documentation of serious illness conversations in the medical record increased dramatically during the year following training commencement. CONCLUSIONS Grounded in principles of adult learning theory, this training was rated highly by trainees and resulted in demonstrable practice change. These early learners were more flexible and willing to try this approach than practicing clinicians who tend to resist or revert to old habits. A Guide represents a new paradigm for teaching communication skills and is valued by early learners.
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Affiliation(s)
- April Zehm
- Medical College of Wisconsin (A.Z.), Milwaukee, Wisconsin, USA.
| | - Erin Scott
- The Ohio State University College of Medicine (E.S.), Columbus, Ohio, USA
| | | | - Phuong L Nguyen
- Massachusetts General Hospital (P.L.N., J.J.), Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Harvard Medical School (K.G.S., J.J.), Boston, Massachusetts, USA; Massachusetts General Hospital (P.L.N., J.J.), Boston, Massachusetts, USA
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16
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Lie HC, Juvet LK, Street RL, Gulbrandsen P, Mellblom AV, Brembo EA, Eide H, Heyn L, Saltveit KH, Strømme H, Sundling V, Turk E, Menichetti J. Effects of Physicians' Information Giving on Patient Outcomes: a Systematic Review. J Gen Intern Med 2022; 37:651-663. [PMID: 34355348 PMCID: PMC8858343 DOI: 10.1007/s11606-021-07044-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors. METHODS The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies', interventions', and information-giving strategies' characteristics. PRISMA guidelines were followed. RESULTS Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients' behavioral outcomes. DISCUSSION Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health-related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019115791.
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Affiliation(s)
- Hanne C Lie
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene K Juvet
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Norvegian Institute of Public Health, Oslo, Norway
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway
| | - Anneli V Mellblom
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lena Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristina H Saltveit
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Vibeke Sundling
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Eva Turk
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway.
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17
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Kim MS, Bae EJ, Uhm JY. Psychometric Properties of the Korean Version of ComOn Coaching for Oncology Nurses. Asia Pac J Oncol Nurs 2022; 9:210-216. [PMID: 35571629 PMCID: PMC9096732 DOI: 10.1016/j.apjon.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/23/2021] [Indexed: 11/02/2022] Open
Abstract
Objective Methods Results Conclusions
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18
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Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ. Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis. JCO Oncol Pract 2021; 17:e645-e653. [PMID: 33974829 DOI: 10.1200/op.21.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.
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Affiliation(s)
- Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Aisa Iyawe-Parsons
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Stephanie Navarro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA
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19
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Wolderslund M, Kofoed PE, Ammentorp J. The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. PATIENT EDUCATION AND COUNSELING 2021; 104:1423-1430. [PMID: 33303282 DOI: 10.1016/j.pec.2020.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE As a part of an evaluation of a large-scale communication skills training (CST) programme, this study aimed to investigate the effect on health care professionals' (HCPs) self-efficacy (SE) and perceived importance (PI) of the skills taught. METHODS A pre-post intervention design was used, and 1647 HCPs responded to the SE-12 questionnaire. Changes in self-efficacy were examined at an item and scale level. RESULTS The responses of 74% of the HCPs who replied to at least two of the three questionnaires were analysed. A significant increase in the SE-12 scale scores by 12.45 points between Q1 (baseline) and Q2 (immediately after the intervention) across all professions was found. There was a small albeit statistically significant decrease in the SE-12 scale scores by 2.06 points between Q2 and Q3 (24 weeks after the intervention). CONCLUSION The implementation of the CST course significantly improved the self-efficacy of HCPs. The findings were supported by an increase in the number of HCPs who considered the skills that they had acquired to be very important. PRACTICE IMPLICATIONS The findings suggest that the large-scale implementation of evidence-based CST programmes can yield the same outcomes that have been observed in smaller and better controlled studies.
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Affiliation(s)
- Maiken Wolderslund
- Health Services Research Unit, Lillebaelt University Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Poul-Erik Kofoed
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Pediatrics, Lillebaelt University Hospital, Kolding, Denmark.
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt University Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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20
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Hulbert-Williams NJ, Hulbert-Williams L, Patterson P, Suleman S, Howells L. Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme. BMJ Support Palliat Care 2021:bmjspcare-2020-002786. [PMID: 33762268 DOI: 10.1136/bmjspcare-2020-002786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT). AIMS We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach. METHOD We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions. RESULTS At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees' stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility. DISCUSSION Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.
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Affiliation(s)
| | | | - Pandora Patterson
- Research and Youth Cancer Services, CanTeen Australia, Newtown, New South Wales, Australia
| | - Sahil Suleman
- Cancer Psychological Support (CaPS) Team, St George's University Hospitals NHS Foundation Trust, London, UK
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21
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Ammentorp J, Bigi S, Silverman J, Sator M, Gillen P, Ryan W, Rosenbaum M, Chiswell M, Doherty E, Martin P. Upscaling communication skills training - lessons learned from international initiatives. PATIENT EDUCATION AND COUNSELING 2021; 104:352-359. [PMID: 32888756 DOI: 10.1016/j.pec.2020.08.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To collect experiences and to identify the main facilitators and barriers for the implementation process of large scale communication training programs. METHODS Using a multiple case study design, data was collected from leaders of the individual programs in Australia, Ireland, Austria and Denmark. The RE-AIM framework was used to evaluate the components: Reach, Effectiveness, Adoption, Implementation, and Maintenance of the programs. RESULTS The programs, all based on the Calgary-Cambridge Guide, succeeded in reaching the intended target groups corresponding to between 446 and 3000 healthcare workers. New courses are planned and so far the outcome of the intervention has been investigated in two countries. The fact that implementation, including educating trainers, relies on a few individuals was identified as the main challenge. CONCLUSION Large scale communication training programs based on the Calgary-Cambridge Guide can be implemented and adopted in multiple different healthcare settings across a national health system culture. The importance of standardized trainer education and adaption of the programs to clinical practice was highlighted. PRACTICE IMPLICATIONS In order to address the sustainability of the programs and to allow the intervention to scale up, it is important to prioritise and allocate resources at the political and organizational level.
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Affiliation(s)
- Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia.
| | - Sarah Bigi
- Dept. of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milano, Italy
| | - Jonathan Silverman
- Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia
| | - Marlene Sator
- Austrian Public Health Institute, Department Health and Society, Vienna, Austria; The Austrian Health Literacy Alliance, Vienna, Austria
| | - Peter Gillen
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Winifred Ryan
- National Healthcare Communication Programme, Health Service Executive, Dublin, Ireland
| | | | - Meg Chiswell
- Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia
| | - Eva Doherty
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Martin
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Organisational Change in Person-Centred Healthcare, School of Medicine, Deakin University, Geelong, Australia.
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Improving symptom-related communication skills among cancer patients in an oncology ward: a best practice implementation project. JBI Evid Implement 2021; 20:87-100. [PMID: 33703851 DOI: 10.1097/xeb.0000000000000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS As a symptom is a subjective perception of patients, good symptom management requires the patients to actively talk to clinicians about their symptom experience and to effectively express concerns about treatment. It has been found that the patients displayed poor communication behaviors and lacked communication knowledge and skills in the oncology ward of a tertiary hospital in PR China, indicating the need for improvement. This project aimed to promote the cancer patients' symptom-related communication with clinicians in this hospital setting. METHOD A baseline audit against six evidence-based audit criteria derived from best practice recommendations was conducted, utilizing the JBI Practical Application of Clinical Evidence System tool. Identification of facilitators and barriers to best practice was then carried out and strategies were implemented to overcome identified barriers. A postimplementation audit was undertaken to assess any improvement in practice. RESULTS The baseline audit showed that the nurses' compliance with best practice recommendations was unsatisfactory, with five out of six criteria recording 0% compliance. Strategies including nurse education, patient symptom assessment, patient education and use of communication tools were implemented. The postimplementation audit showed significantly improved compliance in the nurses' practice with all best practice recommendations, with all audit criteria achieving at least 69% compliance. CONCLUSION The project achieved improved practice in patient communication promotion across all six audit criteria. However, further effort is needed to strengthen and maintain best practice. Patient symptom-related communication behavior should be measured in the future.
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Tanzi S, De Panfilis L, Costantini M, Artioli G, Alquati S, Di Leo S. Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the 'Teach to Talk' programme. BMC MEDICAL EDUCATION 2020; 20:363. [PMID: 33059642 PMCID: PMC7560022 DOI: 10.1186/s12909-020-02275-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is widespread agreement about the importance of communication skills training (CST) for healthcare professionals caring for cancer patients. Communication can be effectively learned and improved through specific CST. Existing CSTs have some limitations with regard to transferring the learning to the workplace. The aim of the study is developing, piloting, and preliminarily assessing a CST programme for hospital physicians caring for advanced cancer patients to improve communication competences. METHODS This is a Phase 0-I study that follows the Medical Research Council framework; this paper describes the following sections: a literature review on CST, the development of the Teach to Talk training programme (TtT), the development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and the pilot programme. The study was performed at a 900-bed public hospital. The programme was implemented by the Specialized Palliative Care Service. The programme was proposed to 19 physicians from 2 departments. RESULTS The different components of the training course were identified, and a set of quality indicators was developed. The TtT programme was implemented; all the physicians attended the lesson, videos, and role-playing sessions. Only 25% of the physicians participated in the bedside training. It was more challenging to involve Haematology physicians in the programme. CONCLUSIONS The programme was completed as established for one of the two departments in which it was piloted. Thus, in spite of the good feedback from the trainees, a re-piloting of a different training program will be developed, considering in particular the bed side component. The program should be tailored on specific communication attitude and believes, probably different between different specialties.
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Affiliation(s)
- S Tanzi
- Palliative Care Unit, Azienda USL- IRCCS Reggio Emilia, Reggio Emilia, Italy.
- Clinical and Experimental Medicine PhD Programme, University of Modena and Reggio Emilia, Modena, Italy.
| | - L De Panfilis
- Unit of Bioethics, Azienda USL- IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - M Costantini
- Scientific Directorate, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - G Artioli
- Palliative Care Unit, Azienda USL- IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - S Alquati
- Palliative Care Unit, Azienda USL- IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - S Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
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24
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Leal-Costa C, Tirado González S, Ramos-Morcillo AJ, Ruzafa-Martínez M, Díaz Agea JL, van-der Hofstadt Román CJ. Communication Skills and Professional Practice: Does It Increase Self-Efficacy in Nurses? Front Psychol 2020; 11:1169. [PMID: 32595561 PMCID: PMC7304242 DOI: 10.3389/fpsyg.2020.01169] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
The relationship between nurses and their patients is changing significantly, resulting in a patient-focused model. This work aims to contribute new knowledge about the effect of communication skills on perceived self-efficacy of nursing professionals. A cross-sectional descriptive study was conducted with a final sample consisting of 242 nurses. Different instruments that measured communication skills and the general and specific self-efficacy of nursing professionals were utilized. A positive and statistically significant correlation (p < 0.01) between the communication skills and the perceived general and specific self-efficacy was obtained. Nursing professionals who have adequate communication skills feel more confident and more competent, fostering good interpersonal relationships with their patients, and therefore, their perceived general and specific self-efficacy improved as well. Teaching communication skills is important to help nurses cope with a broad range of stressors in their daily interactions with patients, increasing their perceived self-efficacy.
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Affiliation(s)
- César Leal-Costa
- Nursing Department, University of Murcia (UM), Murcia, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Sonia Tirado González
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Health Psychology Department, Miguel Hernandez University (UMH), Elche, Spain
| | | | | | | | - Carlos Javier van-der Hofstadt Román
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Hospital Psychology Unit, University Hospital of Alicante, Alicante, Spain
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Kerr D, Ostaszkiewicz J, Dunning T, Martin P. The effectiveness of training interventions on nurses' communication skills: A systematic review. NURSE EDUCATION TODAY 2020; 89:104405. [PMID: 32244125 DOI: 10.1016/j.nedt.2020.104405] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/03/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice. DESIGN A systematic review of literature. DATA SOURCES Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures. REVIEW METHODS The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis. RESULTS Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills. CONCLUSIONS Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.
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Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia.
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
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Singh Ospina N, Toloza FJK, Barrera F, Bylund CL, Erwin PJ, Montori V. Educational programs to teach shared decision making to medical trainees: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1082-1094. [PMID: 32005556 DOI: 10.1016/j.pec.2019.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/06/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is a process of collaboration between patients and clinicians. An increasing number of educational programs to teach SDM have been developed. We aimed to summarize and evaluate the body of evidence assessing the outcomes of these programs. METHODS We conducted a systematic review of studies that aimed to teach SDM to medical trainees. Reviewers worked independently and in duplicate to select studies, extract data and evaluate the risk of bias. RESULTS Eighteen studies were included. Most studies focused on residents/fellows (61 %) and combined a didactic component with a practical experience (50 % used a standardized patient). Overall, participants reported satisfaction with the courses. The effects on knowledge, attitudes/confidence and comfort with SDM were small; no clear improvement on SDM skills was noted. Evaluation of clinical behavior and outcomes was limited (3/18 studies). Studies had moderate risk of bias. CONCLUSION Very low quality evidence suggests that educational programs for teaching SDM to medical trainees are viewed as satisfactory and have a small impact on knowledge and comfort with SDM. Their impact on clinical skills, behaviors and patient outcomes is less clear. PRACTICAL IMPLICATIONS Integration of formal and systematic outcomes evaluation (effects on behavior/clinical practice) should be part of future programs.
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Affiliation(s)
| | - Freddy J K Toloza
- Division of Endocrinology, University of Arkansas for Medical Sciences, Little Rock, US; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US
| | | | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, US
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, US; Division of Endocrinology, Mayo Clinic, Rochester, US
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Orcajada Muñoz I, Amo Setien FJ, Díaz Agea JL, Hernández Ruipérez T, Adánez Martínez MDG, Leal Costa C. The communication skills and quality perceived in an emergency department: The patient's perspective. Int J Nurs Pract 2020; 26:e12831. [PMID: 32159265 DOI: 10.1111/ijn.12831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 12/30/2022]
Abstract
AIM To examine the influence of health care provider's communication skills on the quality of care perceived by Emergency Department patients. BACKGROUND Communication between patients and health care providers in the context of Emergency Department is challenging and can potentially have a negative impact on the quality of care perceived by patients. DESIGN Cross-sectional descriptive study conducted in the Emergency Department at the University Clinical Hospital Virgen de la Arrixaca of Murcia, Spain. METHOD Data were collected from 6 to 9 June 2016. Different instruments were used to evaluate the perception of patients on the communication skills and quality of care at the Emergency Department. RESULTS The sample was composed of 200 patients, with an average age of 44.1 (SD = 18.3), of which 106 (53%) were men. The multiple linear regression analysis showed the association between communication skills (respect, problem solving, and nonverbal communication) and age with the quality of care perceived by the patients. CONCLUSIONS We found that the communication skills of the health care providers were explanatory variables of the quality of care perceived in an Emergency Department.
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Affiliation(s)
| | | | | | - Tomás Hernández Ruipérez
- Faculty of Medicine, Catholic University of Murcia (UCAM), Murcia, Spain.,Emergency Department, Hospital General Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María de Gracia Adánez Martínez
- Emergency Department, Hospital General Universitario Virgen de la Arrixaca, Murcia, Spain.,Faculty of Medicine, University of Murcia (UM), Murcia, Spain
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Skovlund PC, Ravn S, Seibaek L, Thaysen HV, Lomborg K, Nielsen BK. The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings. J Patient Rep Outcomes 2020; 4:10. [PMID: 32048085 PMCID: PMC7013008 DOI: 10.1186/s41687-020-0174-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. METHODS PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patient-centred communication, a literature review, and didactic considerations. RESULTS The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. CONCLUSIONS This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should be applied in other clinical settings were patients are seen regularly. An evaluation of the tool is planned to be performed in future studies. Training in PROmunication may further systematic and consistent use of PRO data in the consultation, leading to patient-centred consultations and increased patient involvement.
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Affiliation(s)
- Pernille C. Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sissel Ravn
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Lene Seibaek
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 137, 8200 Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
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Feldenzer K, Rosenzweig M, Soodalter JA, Schenker Y. Nurses' perspectives on the personal and professional impact of providing nurse-led primary palliative care in outpatient oncology settings. Int J Palliat Nurs 2019; 25:30-37. [PMID: 30676160 DOI: 10.12968/ijpn.2019.25.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: Palliative care (PC) workforce shortages have led to a need for primary PC provided by non-specialists. The Care Management by Oncology Nurses (CONNECT) intervention provides infusion room oncology nurses with training and support to provide primary PC. AIMS: To describe nurses' perspectives on the personal and professional impact of training and provision of primary PC as part of CONNECT. METHODS: This qualitative study consisted of in-depth telephone interviews with 11 nurses at oncology practices in Pennsylvania. Data was analysed using qualitative content analysis. FINDINGS: Nurses reported a sense of personal and professional fulfillment from providing primary PC, while noting the risk of increased emotional attachment to patients. Participation improved nursing communication skills. A supportive workplace helped to minimise stress related to incorporating primary PC into busy treatment schedules. CONCLUSION: Providing primary PC challenges the task-oriented paradigm of nursing practice and will potentially alter the professional roles and workloads of infusion room nurses.
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Affiliation(s)
| | - Margaret Rosenzweig
- Professor and Vice Chair of Research, School of Nursing Department of Acute and Tertiary Care, University of Pittsburgh
| | - Jesse A Soodalter
- Post-doctoral Research Fellow in Palliative Care, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh
| | - Yael Schenker
- Associate Professor of Medicine, Director of Palliative Care Research, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh
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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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Rumpold T, Lütgendorf-Caucig C, Löffler-Stastka H, Roider-Schur S, Pötter R, Kirchheiner K. Attitude Towards End of Life Communication of Austrian Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:743-748. [PMID: 29687186 DOI: 10.1007/s13187-018-1366-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.
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Affiliation(s)
- Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | | | - Henriette Löffler-Stastka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Sophie Roider-Schur
- Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
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COMSKIL Communication Training in Oncology-Adaptation to German Cancer Care Settings. Recent Results Cancer Res 2019; 210:191-205. [PMID: 28924687 DOI: 10.1007/978-3-319-64310-6_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Medical communication is a skill which can be learned and taught and which can substantially improve treatment outcomes, especially if patients' communication preferences are taken into account. Here, we give an overview of communication training research and outline the COMSKIL program as a state-of-the-art communication skills training in oncology. COMSKIL has a solid theoretical foundation and teaches core elements of medical communication in up to ten fully operationalized modules. These address typical situations ranging from breaking bad news to responding to difficult emotions, shared decision-making, and communicating via interpreters.
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Lagad A, Hodgkinson K, Newton-John TRO. Is ignorance bliss, or is knowledge power? When cancer healthcare professionals become cancer patients. Eur J Cancer Care (Engl) 2019; 28:e13066. [PMID: 31016805 DOI: 10.1111/ecc.13066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
Cancer healthcare professionals who are diagnosed with cancer enter the patient journey with considerable illness-specific and healthcare expertise, which may influence the nature of their experience. Insights gained from having personal cancer experience may also lead to changes in professionals' subsequent clinical practice. This study explored cancer professional-patients' experiences of their own cancer diagnosis, changes in practice, and recommendations for cancer care improvements. Participants were current or former cancer healthcare professionals who had ever received a cancer diagnosis. Semi-structured interviews were conducted with 26 participants. Thematic analysis with an inductive approach was used for data analysis. Cancer professional-patients faced unique needs, benefits and disadvantages due to their professional background, which both aided and marred their personal cancer experience. Individuals reported subjective practical and emotional-related improvements in their clinical practice, although adverse emotional consequences upon returning to work were also prevalent. Care recommendations highlighted the importance of communication skills training for professionals, integrating psychological support, and providing patient-centred care. In order to provide optimal care for cancer professional-patients, providers must acknowledge their distinct challenges. Findings may help to foster improvements in cancer care practices through developing guidelines for treating cancer professional-patients, and as part of narrative-based medicine.
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Affiliation(s)
- Avnee Lagad
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Toby R O Newton-John
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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van Beusekom MM, Cameron J, Bedi C, Banks E, Humphris G. Communication skills training for the radiotherapy team to manage cancer patients' emotional concerns: a systematic review. BMJ Open 2019; 9:e025420. [PMID: 31005920 PMCID: PMC6500273 DOI: 10.1136/bmjopen-2018-025420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Many cancer patients experience high levels of anxiety and concern during radiotherapy, often with long-lasting effects on their well-being. This systematic review aims to describe and determine the effectiveness of communication skills training (CST) for the radiotherapy team (RT) to improve conversations in this setting and to support patients with emotional concerns. DESIGN Systematic review. INTERVENTIONS CST for RT members. DATA SOURCES On 17 April 2018, databases Medline, Embase, Scopus and PsycNET were searched. ELIGIBILITY CRITERIA, POPULATION, INTERVENTION, COMPARISON, OUTCOMEPICO: Quantitative and/or qualitative articles were included that evaluate the effect of a CST for RT members (vs no CST) on communication behaviours and patients' emotional concerns. DATA EXTRACTION AND SYNTHESIS Articles were appraised using the mixed-methods appraisal tool, and a narrative synthesis was performed. RESULTS Of the nine included articles, five were randomised controlled trials, three were mixed-methods and one used repeated measurements. Four of the five different CST programmes managed to increase emotional communicative behaviour from the RT, and all studies measuring patient communicative behaviour found an improvement in at least one of the hypothesised outcomes. Two studies examining patient anxiety and concerns found a positive effect of the CST, although one found a negative effect; two other studies without a positive effect on mood made use of both empathic CST and tools. CONCLUSIONS There are promising indications that CST can be successfully introduced to improve emotional conversations between RT members and patients. With the right support, the RT can play an important role to help patients cope with their emotional concerns. Future work is necessary to confirm initial promising results and to ensure the learnt communication skills are sustained.
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Affiliation(s)
| | - Josie Cameron
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Carolyn Bedi
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Elspeth Banks
- Patient Representative, National Cancer Research Institute, London, UK
| | - Gerald Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
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Communication skills training for healthcare professionals in oncology over the past decade: a systematic review of reviews. Curr Opin Support Palliat Care 2019; 13:33-45. [DOI: 10.1097/spc.0000000000000409] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Engerer C, Berberat PO, Dinkel A, Rudolph B, Sattel H, Wuensch A. Specific feedback makes medical students better communicators. BMC MEDICAL EDUCATION 2019; 19:51. [PMID: 30736764 PMCID: PMC6368801 DOI: 10.1186/s12909-019-1470-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/21/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Feedback is regarded a key element in teaching communication skills. However, specific aspects of feedback have not been systematically investigated in this context. Therefore, the aim of this study was to investigate the effectiveness of communication skills training (CST) integrating specific, structured and behavioral feedback. METHODS We condensed best practice recommendations for feedback in a CST for undergraduate medical students and compared the effect of specific, structured and behavior-orientated feedback (intervention group CST-behav) to general, experience-orientated feedback (CST- exp. as our control group) in a randomized controlled trial (RCT). We investigated changes on communication skills evaluated by independent raters, and evaluated by standardized patients (SP). To do that, every student was video-recorded in a pre and post assessment. RESULTS Sixty-six undergraduate medical students participated voluntarily in our study. Randomization did not result in equally skilled groups at baseline, so valid inter-group comparisons were not possible. Therefore, we analyzed the results of 34 students of our intervention group (CST-behav). Five out of seven domains in communication skills as evaluated by independent raters improved significantly, and there was a significant change in the global evaluation by SP. CONCLUSIONS Although we were unable to make between-group comparisons, the results of the within group pre-post evaluation suggest that specific feedback helps improve communication skills.
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Affiliation(s)
- Cosima 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 of Heidelberg, Heidelberg, Germany
| | - Pascal O. Berberat
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bärbel Rudolph
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- CIP-Tagesklinik, Private Clinic for Psychotherapy, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Wuensch
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Clinic for Psychosomatic Medicine and Psychotherapy Medical Center Freiburg, Faculty of Medicine, University Freiburg, in cooperation with Outpatient Support for Cancer Patients Comprehensive Cancer Center Freiburg, Medical Center Freiburg, Freiburg, Germany
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Villalobos M, Siegle A, Hagelskamp L, Jung C, Thomas M. Communication along Milestones in Lung Cancer Patients with Advanced Disease. Oncol Res Treat 2019; 42:41-46. [DOI: 10.1159/000496407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
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Chéret A, Durier C, Noël N, Bourdic K, Legrand C, D'Andréa C, Hem E, Goujard C, Berthiaume P, Consoli SM. Motivational interviewing training for medical students: A pilot pre-post feasibility study. PATIENT EDUCATION AND COUNSELING 2018; 101:1934-1941. [PMID: 29958765 DOI: 10.1016/j.pec.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/05/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the impact of brief training in motivational interviewing (MI) from a non-specialist professional for medical students. METHODS Students (n = 20) received three four-hour sessions of MI training over one week. They interviewed caregivers acting as patients in two standardised medical situations, six weeks before and three weeks after training. Global scores from the MITI-3.1.1 code, including "MI- Spirit", were attributed to the audiotaped interviews by two independent coders, blind the pre- or post-training status of the interview. Secondary outcomes were: caregivers' perception of students' empathy (CARE questionnaire), students' evaluation of self-efficacy to engage in a patient-centred relationship (SEPCQ score), and students' satisfaction with their own performance (analogue scale). RESULTS MI-Spirit score increased significantly after training (p < 0.0001, effect size 1.5). Limited improvements in CARE score (p = 0.034, effect size 0.5) and one of the SEPCQ dimensions (sharing information and power with the patient; p = 0.047, effect size 0.5) were also noted. Students' satisfaction score was unaffected (p = 0.69). CONCLUSION These findings suggest that brief MI training can improve communication skills in medical students. PRACTICE IMPLICATIONS Such an intervention is feasible and could be generalised during medical studies.
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Affiliation(s)
- Antoine Chéret
- Internal Medicine Unit, Le Kremlin-Bicêtre Hospital, APHP, France.
| | | | - Nicolas Noël
- Internal Medicine Unit, Le Kremlin-Bicêtre Hospital, APHP, France
| | - Katia Bourdic
- Internal Medicine Unit, Le Kremlin-Bicêtre Hospital, APHP, France
| | - Chantal Legrand
- Direction of Care, Georges Pompidou Hospital, APHP, Paris, France
| | | | - Evelyne Hem
- Internal Medicine Unit, Le Kremlin-Bicêtre Hospital, APHP, France
| | - Cécile Goujard
- Internal Medicine Unit, Le Kremlin-Bicêtre Hospital, APHP, France
| | | | - Silla M Consoli
- Paris Descartes University, Sorbonne Paris Cité, Paris, France; Consultation-Liaison Psychiatry Unit, Department of Adult and Elderly Psychiatry, European Georges Pompidou Hospital, APHP, Paris, France
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Stiefel F, Kiss A, Salmon P, Peters S, Razavi D, Cervantes A, Margulies A, Bourquin C. Training in communication of oncology clinicians: a position paper based on the third consensus meeting among European experts in 2018. Ann Oncol 2018; 29:2033-2036. [PMID: 30412225 DOI: 10.1093/annonc/mdy343] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician's self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.
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Affiliation(s)
- F Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland.
| | - A Kiss
- Division of Psychosomatic Medicine, Basel University Hospital, Switzerland
| | - P Salmon
- Faculty of Humanities and Social Sciences, Liverpool University, UK
| | - S Peters
- Medical Oncology Service, Lausanne University Hospital, Switzerland
| | - D Razavi
- Jules Bordet Institute and Brussels University, Belgium
| | | | - A Margulies
- EONS Education Working Group, Zurich, Switzerland
| | - C Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Switzerland
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Siegle A, Villalobos M, Bossert J, Krug K, Hagelskamp L, Krisam J, Handtke V, Deis N, Jünger J, Wensing M, Thomas M. The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis <12 months: protocol for a mixed-methods study including a randomized controlled trial. Trials 2018; 19:438. [PMID: 30107809 PMCID: PMC6092809 DOI: 10.1186/s13063-018-2814-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background The care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory. This study aims to evaluate these aspects of MCA: (1) the training of healthcare professionals, (2) implementation context and outcomes, (3) patient outcomes, and (4) effects on interprofessional collaboration. Methods/design A multiphase mixed-methods design will be used for the study. A total of 100 patients and 120 healthcare professionals in a specialized oncology hospital will be involved. The training outcomes will be documented using a questionnaire. Implementation context and outcomes will be explored through semi-structured interviews and written questionnaires with healthcare professionals and with the training participants and through a content analysis of patient files. Patient outcomes will be assessed in a pragmatic non-blinded randomized controlled trial and in qualitative interviews with patients and caregivers. Trial outcomes are supportive care needs (SCNS-SF34-G), quality of life (SeiQol and Fact-L), depression and anxiety symptoms (PHQ-4), and distress (Distress Thermometer). Qualitative semi-structured interviews on patients’ views will focus on shared decision-making, communication needs, feeling empathy, and further utilization of healthcare services. Interprofessional collaboration will be explored using the UWE-IP-D before the implementation of MCA (t0) and after 3 (t1), 9 (t2), and 12 (t3) months. Discussion Using guideline-concordant early palliative care, MCA aims to foster patient-centered communication with shared decision-making and facilitation of advance care planning including end-of-life decisions, thus increasing patient quality of life and decreasing aggressive medical care at the end of life. It is assumed that the communication skills training and interprofessional coaching will improve the communication behavior of healthcare providers and influence team communications and team processes. Trial registration German Clinical Trials Register, DRKS00013649 and DRKS00013469. Registered on 22 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2814-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Siegle
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany. .,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Matthias Villalobos
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Laura Hagelskamp
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany.,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Violet Handtke
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Nicole Deis
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Jana Jünger
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
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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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Ellington L, Cloyes KG, Xu J, Bellury L, Berry PH, Reblin M, Clayton MF. Supporting home hospice family caregivers: Insights from different perspectives. Palliat Support Care 2018; 16:209-219. [PMID: 28464961 PMCID: PMC5670030 DOI: 10.1017/s1478951517000219] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. METHOD Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. RESULTS Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p < 0.05). SIGNIFICANCE OF RESULTS Our findings suggest differences in priorities for caregiver support across family caregivers, hospice nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lanell Bellury
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - Patricia H. Berry
- Hartford Center of Gerontological Excellence, Oregon Health & Science University, Portland, Oregon, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Henselmans I, Smets EMA, de Haes JCJM, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol. BMC Cancer 2018; 18:55. [PMID: 29310605 PMCID: PMC5759304 DOI: 10.1186/s12885-017-3838-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. DISCUSSION The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. TRIAL REGISTRATION Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).
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Affiliation(s)
- I. Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - E. M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - J. C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M. G. W. Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - F. Y. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Park E, Yoon J, Choi EK, Kim IR, Kang D, Lee SK, Lee JE, Nam SJ, Ahn JS, Visser A, Cho J. A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors. BMC Cancer 2018; 18:45. [PMID: 29306328 PMCID: PMC5756444 DOI: 10.1186/s12885-017-3965-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/11/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this study is to develop, implement, and evaluate a training program for healthcare providers to improve ability to provide psychosocial support to breast cancer survivors in Korea. METHODS Based on a needs assessment survey and in-depth interviews with breast cancer survivors, a multidisciplinary team developed two-day intensive training program as well as education materials and counseling notes. Participants' overall satisfaction was evaluated after the training. RESULTS The training program included a total of 16 lectures held over the course of seven sessions. Forty-one nurses and 3 social workers participated in the training program. Mean age was 37.5(± 6.4) years, and on average, they had 11.1 (± 5.6) years of experience. Participants' overall satisfaction was good as following: program contents (4.04), trainee guidebook (3.82), location and environment (4.10), and program organization (4.19). Among the participants, 31 (70.4%) received certification after submitting real consultation cases after the training. CONCLUSION Two day intensive training can provide a comprehensive and coordinated education to healthcare professionals for implementing survivorship care with an emphasis on psychosocial support. Furthermore, the program should resume as a periodic continuing education course for healthcare providers. Similar education for graduate students in oncology nursing would be beneficial.
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Affiliation(s)
- Eunyoung Park
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Junghee Yoon
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Eun-Kyung Choi
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Im Ryung Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam, Seoul, 06351, South Korea
| | - Se-Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Seok Ahn
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Juhee Cho
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea. .,Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam, Seoul, 06351, South Korea. .,Department of Epidemiology and Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Alzahrani AS, Alqahtani A, Alhazmi M, Gaafar R, Bajabir D, Alharbi IM, Alharbi AM, Kheshaifaty G, Alzahrani A. Attitudes of cancer patients and their families toward disclosure of cancer diagnosis in Saudi Arabia: a Middle Eastern population example. Patient Prefer Adherence 2018; 12:1659-1666. [PMID: 30214168 PMCID: PMC6126501 DOI: 10.2147/ppa.s176651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Particularly in the Middle East, few studies have explored the attitude of cancer patients and their families toward cancer diagnosis disclosure (CDD). This study was conducted to investigate the preference and attitude of a sample of cancer patients and their families in Saudi Arabia toward CDD. METHODS We constructed a questionnaire based on previous studies. The questionnaire assessed preference and attitude toward CDD. Participants were recruited from the King Abdullah Medical City, which has one of the largest cancer centers in Saudi Arabia. RESULTS Three hundred and four cancer patients and 277 of their family members participated in the study. The patient group preferred CDD more than the family group (82.6% vs 75.3%, P<0.05). This preference is especially more evident toward disclosure of detailed cancer information (status, prognosis, and treatment) (83.6% vs 59.9%, P<0.001). In a binary logistic regression, factors associated with preference toward CDD included having information about cancer (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.15-2.84) and being employed (OR, 1.77; 95% CI, 1-2.82) while being from the patient group was the only factor associated with preference toward detailed cancer information (OR, 3.25; 95% CI, 2.11-5.05). In terms of patient reaction after CDD, "fear" was the attitude expected by the family group more than the patient group (56.3% vs 70.4%, P<0.001) while "acceptance" was the attitude anticipated by the patient group more than the family group (38% vs 15.2%, P<0.001). CONCLUSION Patients preferred CDD and disclosure of related information, while their families were more inclined toward scarce disclosure. Family members seem to experience negative attitudes more than the patients themselves.
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Affiliation(s)
- Ahmad S Alzahrani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Abdullah Alqahtani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Maher Alhazmi
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | - Doaa Bajabir
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | | | - Ghufran Kheshaifaty
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Aamer Alzahrani
- College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Villalobos M, Coulibaly K, Krug K, Kamradt M, Wensing M, Siegle A, Kuon J, Eschbach C, Tessmer G, Winkler E, Szecsenyi J, Ose D, Thomas M. A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives. Eur J Cancer Care (Engl) 2017; 27:e12794. [PMID: 29168594 DOI: 10.1111/ecc.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.
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Affiliation(s)
- M Villalobos
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - K Coulibaly
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - A Siegle
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - J Kuon
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - C Eschbach
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - G Tessmer
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | - E Winkler
- National Center for Tumor Diseases, University Heidelberg, Heidelberg, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - D Ose
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M Thomas
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
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Dencker A, Kristiansen M, Rix BA, Bøge P, Tjørnhøj-Thomsen T. Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29114990 DOI: 10.1111/ecc.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication.
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Affiliation(s)
- A Dencker
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B A Rix
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - P Bøge
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - T Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting. Support Care Cancer 2017; 26:957-965. [DOI: 10.1007/s00520-017-3916-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Horlait M, Van Belle S, Leys M. Are future medical oncologists sufficiently trained to communicate about palliative care? The medical oncology curriculum in Flanders, Belgium. Acta Clin Belg 2017; 72:318-325. [PMID: 28050944 DOI: 10.1080/17843286.2016.1275377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Palliative care is considered an integral part of oncology and communicating this with patients is an unavoidable task for oncologists. This contribution investigated to what extent communication skills for communicating palliative care with patients are trained in the formal academic training program in medical oncology in Flanders, Belgium. The programme is based on the recommendations for a Global Core Curriculum in Medical Oncology, developed by The American Society of Clinical Oncology (ASCO) together with the European Society for Medical Oncology (ESMO). METHODS For this qualitative study, data were collected using document analysis from the ESMO/ASCO recommendations and the documents of the Flanders' medical oncology programme complemented with interviews with Flemish medical oncology trainees. RESULTS Few recommendations for training communication skills to communicate about palliative care were found in the ASMO/ASCO recommendations and even less in the Flanders' programme documents. Trainees are mainly exposed to palliative care communication during the clinical practice of their training. Only very few lectures or seminars are devoted to palliative care and even less on communication about palliative care. They reported several barriers to communicate about palliative care. CONCLUSIONS This study revealed promising developments for the training of Flemish medical oncologists to discuss palliative care. However, there is still a need for more theoretical training on palliative care complemented with communication skills trainings. Communication training in general needs to be fully integrated as a core skill within the medical curriculum at large and should be promoted as lifelong learning and competency development.
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Affiliation(s)
- M. Horlait
- Department of Health Sciences, Organisation, Policy and Social Inequalities in Health Care (OPIH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - S. Van Belle
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - M. Leys
- Department of Health Sciences, Organisation, Policy and Social Inequalities in Health Care (OPIH), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Aelbrecht K, De Maesschalck S, Willems S, Deveugele M, Pype P. How family physicians respond to unpleasant emotions of ethnic minority patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1867-1873. [PMID: 28535925 DOI: 10.1016/j.pec.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The diversity in our society makes patient-centered care more difficult. In this study, we aim to describe how family physicians respond to unpleasant emotions of ethnic minority patients. METHODS One hundred ninety one consultations of family physicians with ethnic minority patients were video-recorded and analyzed using the Verona Codes for Provider Responses (VR-CoDES-P) to describe physicians' responses to patients' expressed unpleasant emotions or cues (implicit) and concerns (explicit). RESULTS 42.4% (n=81) of all the consultations contained no cues or concerns, and thus no physician responses. Of the consultations containing at least one cue or concern, a mean of 3.45 cues and a mean of 1.82 concerns per consultation were found. Physicians are significantly (p≤0.001) more frequently stimulating further disclosure of patients' cues and concerns (providing space: n=339/494 or 68.6% versus reducing space: n=155/494 or 31.4%). However, these explorations are more often about the factual, medical content of the cue than about the emotion itself (n=110/494 or 22.3% versus n=79/494 or 16%). The inter-physician variation in response to patients' cues is larger than the variation in response to the patient's concerns. CONCLUSIONS Although family physicians are quite often providing room for patients' emotions, there is much room for improvement when it comes to explicitly talking about emotional issues with patients. PRACTICE IMPLICATIONS Further research should focus on a more qualitative in-depth analysis of the complex interplay between culture and language of ethnic minority patients in primary care and, consequently, create awareness among these healthcare providers about the importance of ethnic minority patients' emotions and how to respond accordingly.
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Affiliation(s)
- Karolien Aelbrecht
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium.
| | | | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
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