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Rosburg T, von Allmen DY, Langewitz H, Weber H, Bunker EB, Langewitz W. Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates. PATIENT EDUCATION AND COUNSELING 2024; 119:108093. [PMID: 38061142 DOI: 10.1016/j.pec.2023.108093] [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: 07/10/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. METHODS In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. RESULTS Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. CONCLUSIONS Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. PRACTICE IMPLICATIONS Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.
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Affiliation(s)
- Timm Rosburg
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland.
| | - David Y von Allmen
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland
| | - Helena Langewitz
- Johannes Gutenberg University Mainz, Institute of Art History and Musicology, Mainz, Germany
| | - Heidemarie Weber
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | | | - Wolf Langewitz
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
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Lajante M, Del Prete M, Sasseville B, Rouleau G, Gagnon MP, Pelletier N. Empathy training for service employees: A mixed-methods systematic review. PLoS One 2023; 18:e0289793. [PMID: 37578963 PMCID: PMC10424876 DOI: 10.1371/journal.pone.0289793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
Following the surge for empathy training in service literature and its increasing demand in service industries, this study systematically reviews empirical papers implementing and testing empathy training programs in various service domains. A mixed-methods systematic review was performed to identify and describe empathy training programs and discuss their effectiveness in service quality, service employees' well-being, and service users' satisfaction. Included papers met those eligibility criteria: qualitative, quantitative, or mixed-methods study; one training in empathy is identifiable; described training(s) developed for or tested with service employees dealing with service users. We searched health, business, education, and psychology databases, such as CINAHL, Medline ABI/Inform Global, Business Source Premier, PsycINFO, and ERIC. We used the Mixed-Method Assessment Tool to appraise the quality of included papers. A data-based convergent synthesis design allowed for the analysis of the data. A total of 44 studies published between 2009 to 2022 were included. The narrative presentation of findings was regrouped into these six dimensions of empathy training programs: 1) why, 2) who, 3) what, 4) how, 5) where, and 6) when and how much. Close to 50% of studies did not include a definition of empathy. Four main empathic competencies developed through the training programs were identified: communication, relationship building, emotional resilience, and counseling skills. Face-to-face and group-setting interventions are widespread. Our systematic review shows that the 44 papers identified come only from health services with a predominant population of physicians and nurses. However, we show that the four empathic skills identified could be trained and developed in other sectors, such as business. This is the first mixed-methods, multi-disciplinary systematic review of empathy training programs in service research. The review integrates insights from health services, identifies research limitations and gaps in existing empirical research, and outlines a research agenda for future research and implications for service research.
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Affiliation(s)
- Mathieu Lajante
- The emoLab, Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Marzia Del Prete
- Department of Economic Sciences and Statistics, University of Salerno, Fisciano, Salerno, Italy
| | | | - Geneviève Rouleau
- Nursing Department, Université du Québec en Outaouais, Québec, Canada
| | | | - Normand Pelletier
- Business & Economics Librarian, Université Laval, Quebec City, Canada
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Bylund CL. Understanding and improving empathy and emotion handling skills among medical students. PATIENT EDUCATION AND COUNSELING 2022; 105:2803-2804. [PMID: 35811258 DOI: 10.1016/j.pec.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA.
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Scheel-Sailer A, Eich S, Jelmoni L, Lampart P, Schwitter M, Sigrist-Nix D, Langewitz W. Effect of an interprofessional small-group communication skills training incorporating critical incident approaches in an acute care and rehabilitation clinic specialized for spinal cord injury and disorder. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:883138. [PMID: 36188965 PMCID: PMC9397787 DOI: 10.3389/fresc.2022.883138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
AIM To investigate the impact of site-specific inter-professional small-group communication skills training (CST) that incorporates critical incident approaches to learning on patient satisfaction with communication. SETTING Rehabilitation clinic specialized for spinal cord injury/disorder (SCI/D). METHODS Retrospective observational cohort study design using patient and health-professional self-report data. Data for patient satisfaction with communication were collected in 2014 (existing records) and each year from 2015 to 2021 (post-program; volunteers) using the MECON survey. RESULTS Fifteen basic (n = 161 participants), 16 refresher (n = 84), and five short (n = 17) CST seminars were conducted. Overall, 262 employees (105 physicians, 63 nurses, 36 physio- and occupational therapists, and 58 others) participated; 92 participants (response rate 37.6%) responded to feedback surveys. They rated the seminars positive concerning the alternation between theory, discussion, and practical exercise in 91.3%, and rated the length of the training ideal in 80.2%. Post-program patient satisfaction overall increased from 83.1% (confidence interval (CI) 2.6%) to 90% (CI 0.8%; R2 = 0.776; p= 0.004). It was higher in specific communication-related topics: "receiving information" (81.1%, CI 3.1-90.2%, CI 1.0%; p = 0.003), "being able to bring in concerns" (83%, CI 1.0-90.8%; R2 = 0.707; p = 0.009) and "being treated with respect" (89.4%, CI 2.6-94.4%, CI 0.8%; R2 = 0.708; p = 0.004). PRACTICE IMPLICATIONS Inter-professional CST is feasible and well accepted by professionals from various professional groups. During seven years of continuous training, independent patient ratings of satisfaction with professional communication have improved significantly. Participants attest to the training's high credibility and usefulness in everyday life.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stephanie Eich
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Luca Jelmoni
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Patricia Lampart
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Diana Sigrist-Nix
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- MECON Measure & Consult GmbH, Zürich, Switzerland
| | - Wolf Langewitz
- Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
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Chen SH, Chen SY, Yang SC, Chien RN, Chen SH, Chu TP, Fujimori M, Tang WR. Effectiveness of communication skill training on cancer truth-telling for advanced practice nurses in Taiwan: A pilot study. Psychooncology 2021; 30:765-772. [PMID: 33427382 DOI: 10.1002/pon.5629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/28/2020] [Accepted: 01/01/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study. METHODS A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2). RESULTS APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (β = 1.65, p = 0.01). CONCLUSIONS SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.
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Affiliation(s)
- Shih-Hsiang Chen
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shih-Ying Chen
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Chun Yang
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Rong-Nan Chien
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Sue-Hsien Chen
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Tsuei-Ping Chu
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Maiko Fujimori
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Woung-Ru Tang
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC
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Abstract
Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between-subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care.
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Sisk BA, Schulz GL, Mack JW, Yaeger L, DuBois J. Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets. PLoS One 2019; 14:e0221536. [PMID: 31437262 PMCID: PMC6705762 DOI: 10.1371/journal.pone.0221536] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology. Methods Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000–October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework. Findings Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies. Conclusions Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ginny L. Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Lauren Yaeger
- Becker Library, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James DuBois
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of Ameica
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Li Y, Wang X, Zhu XR, Zhu YX, Sun J. Effectiveness of problem-based learning on the professional communication competencies of nursing students and nurses: A systematic review. Nurse Educ Pract 2019; 37:45-55. [PMID: 31082712 DOI: 10.1016/j.nepr.2019.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 04/21/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
The objective of this systematic review was to estimate the effectiveness of problem-based learning (PBL) in developing the professional communication competences of nursing students and nurses. We have searched PubMed, EMBASE, MEDLINE, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals to identify all the English and Chinese language studies that used PBL to determine the effectiveness of developing professional communication competences of nursing students and nurses. Then two reviewers independently assessed eligibility and extracted data. Quality assessment using the Cochrane Collaboration's risk of bias tool for randomized controlled trials and Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quasi-experimental studies. A total of 12 studies were included, all of which were inclined to low bias. Eleven articles showed that PBL developed the communication skills of nursing students or nurses, while only one article revealed no significant difference between PBL and the traditional method. Owing to differences in experimental design and the method and duration of intervention, some of these studies combined PBL with other methods, and the evaluation tools were different. This systematic review cautiously supports the outcomes of PBL compared with traditional learning.
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Affiliation(s)
- Yuan Li
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Xiu Wang
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Xuan-Rui Zhu
- First Hospital of Jilin University, Changchun, 130021, China.
| | - Yan-Xin Zhu
- Weifang Medical University, Weifang, Shandong, China.
| | - Jiao Sun
- First Hospital of Jilin University, Changchun, 130021, China; School of Nursing, Jilin University, 965 Xinjiang St., Chaoyang, Changchun, Jilin, China.
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Niglio de Figueiredo M, Krippeit L, Ihorst G, Sattel H, Bylund CL, Joos A, Bengel J, Lahmann C, Fritzsche K, Wuensch A. ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial. PLoS One 2018; 13:e0205315. [PMID: 30289905 PMCID: PMC6173449 DOI: 10.1371/journal.pone.0205315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/24/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate the effect of the number of coaching sessions after communication skills training on the medical communicative performance of oncologists in clinical practice. METHODS/DESIGN The training, consisting of a workshop and one (control group) vs. four (intervention group) sessions of individual coaching, was evaluated in a randomized controlled trial. Eligible participants included physicians working in any setting where patients with oncological diseases were treated. Real medical consultations were video recorded at three time points: before the workshop (t0), after the workshop (t1) and after completion of coaching (t2). The 1.5-day workshop was based on role-playing in small groups; in the coaching sessions, the videos recorded at t1 were analyzed in detail by both the trainer and the physician. The coaching sessions were manualized and based on the physician's learning goals. The primary hypothesis was that the intervention group would improve to a higher extent than the control group, as assessed by external raters using rating scales specially developed for this project. Physicians were stratified for sex and setting and randomized by an independent statistician. The group assignment was revealed for physicians and trainers at the end of the workshop, while the raters were blinded to group assignments and assessment points. RESULTS A total of 72 physicians participated in one of 8 workshops and could be allocated to either the control or intervention group. The intervention group showed a statistically significant improvement (ES d = 0.41, p<.01) in the All items domain of the rating scales between t1 and t2 and showed a significant advantage compared with the CG (ES = .41, p = .04). The impact on diverse specified skills was heterogeneous; a larger sample is necessary for more detailed analysis. CONCLUSIONS The training achieved some observable and significant changes in the communicative behavior of oncologists in clinical practice. The four coaching sessions showed some significant advantages compared to the single coaching session. Considerable effort is necessary to achieve sustained changes in communication in clinical every-day practice. Thus, our coaching concept is a promising method for this purpose.
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Affiliation(s)
- Marcelo Niglio de Figueiredo
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lorena Krippeit
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heribert Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carma L. Bylund
- College of Journalism and Communications, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Bengel
- Institute of Psychology, Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Bridges J, Pickering RM, Barker H, Chable R, Fuller A, Gould L, Libberton P, Mesa-Eguiagaray I, Raftery J, Sayer AA, Westwood G, Wigley W, Yao G, Zhu S, Griffiths P. Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06330] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundConcerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.ObjectivesTo assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.DesignPilot cluster randomised trial (CRT) and associated process and economic evaluations.SettingSix inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).ParticipantsPatients (n = 639), staff (n = 211) and visitors (n = 188).InterventionCLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.Main outcome measuresQuality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).Data sourcesStructured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.ResultsThe pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.LimitationsFindings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.ConclusionsUse of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.Trial registrationCurrent Controlled Trials ISRCTN16789770.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.
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Affiliation(s)
- Jackie Bridges
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK
| | - Ruth M Pickering
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Hannah Barker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Rosemary Chable
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK
- Training, Development & Workforce, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Fuller
- Institute of Education, University College London, London, UK
| | - Lisa Gould
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paula Libberton
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - James Raftery
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Avan Aihie Sayer
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle, UK
- Older People’s Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Greta Westwood
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK
- Research and Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Wendy Wigley
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, UK
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11
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Stiefel F, de Vries M, Bourquin C. Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations. Eur J Cancer Care (Engl) 2018; 27:e12859. [PMID: 29873149 DOI: 10.1111/ecc.12859] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 11/27/2022]
Abstract
This systematic review synthesises the literature on Communication Skills Training (CST) programmes for oncology professionals to identify their core components and compare them with the recommendations formulated in a position paper based on a European expert consensus meeting. A systematic literature search was conducted using MEDLINE (OVID and PUBMED), CINAHL, EMBASE, PSYCHINFO, Web of Science and the Cochrane Library. The analytic approach relied on an a priori framework based on the position paper's recommendations, generating several themes. Forty-nine articles were included. The CST programmes reported between 2010 and 2016 were heterogeneous. Some recommendations, especially those regarding content and pedagogic tools, were followed by most providers, while others, such as setting, objectives and participants, were not. This synthesis raises questions on how CST programmes are conceived and how they could or should be conceived in future. While medicine, especially clinical communication, is socially and culturally embedded, some recommendations regarding CST programmes seem to be universally valuable, contributing to ensure quality and enhanced credibility, and thus endorsement and sustained implementation, of CST programmes in the oncology setting.
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Affiliation(s)
- Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Mirjam de Vries
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
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Erb S, Letang E, Glass TR, Natamatungiro A, Mnzava D, Mapesi H, Haschke M, Duthaler U, Berger B, Muri L, Bader J, Marzolini C, Elzi L, Klimkait T, Langewitz W, Battegay M. Health care provider communication training in rural Tanzania empowers HIV-infected patients on antiretroviral therapy to discuss adherence problems. HIV Med 2017; 18:623-634. [PMID: 28296019 PMCID: PMC5599974 DOI: 10.1111/hiv.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Self-reported adherence assessment in HIV-infected patients on antiretroviral therapy (ART) is challenging and may overestimate adherence. The aim of this study was to improve the ability of health care providers to elicit patients' reports of nonadherence using a "patient-centred" approach in a rural sub-Saharan African setting. METHODS A prospective interventional cohort study of HIV-infected patients on ART for ≥ 6 months attending an HIV clinic in rural Tanzania was carried out. The intervention consisted of a 2-day workshop for health care providers on patient-centred communication and the provision of an adherence assessment checklist for use in the consultations. Patients' self-reports of nonadherence (≥ 1 missed ART dose/4 weeks), subtherapeutic plasma ART concentrations (< 2.5th percentile of published population-based pharmacokinetic models), and virological and immunological failure according to the World Health Organization definition were assessed before and after (1-3 and 6-9 months after) the intervention. RESULTS Before the intervention, only 3.3% of 299 patients included in the study reported nonadherence. Subtherapeutic plasma ART drug concentrations and virological and immunological failure were recorded in 6.5%, 7.7% and 14.5% of the patients, respectively. Two months after the intervention, health care providers detected significantly more patients reporting nonadherence compared with baseline (10.7 vs. 3.3%, respectively; P < 0.001), decreasing to 5.7% after 6-9 months. A time trend towards higher drug concentrations was observed for efavirenz but not for other drugs. The virological failure rate remained unchanged whereas the immunological failure rate decreased from 14.4 to 8.7% at the last visit (P = 0.002). CONCLUSIONS Patient-centred communication can successfully be implemented with a simple intervention in rural Africa. It increases the likelihood of HIV-infected patients reporting problems with adherence to ART; however, sustainability remains a challenge.
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Affiliation(s)
- S Erb
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - E Letang
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
- ISGlobal, Barcelona Centre for International Health Research (CRESIB)University Hospital Clínic de BarcelonaBarcelonaSpain
| | - TR Glass
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | | | - D Mnzava
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - H Mapesi
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - M Haschke
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - U Duthaler
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - B Berger
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Muri
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | - J Bader
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - C Marzolini
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Elzi
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Ospedale Regionale di Bellinzona e ValliBellinzonaSwitzerland
| | - T Klimkait
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - W Langewitz
- Institute of Psychosomatic MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
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Schmitz FM, Schnabel KP, Stricker D, Fischer MR, Guttormsen S. Learning communication from erroneous video-based examples: A double-blind randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:1203-1212. [PMID: 28179074 DOI: 10.1016/j.pec.2017.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/18/2017] [Accepted: 01/24/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Appropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills. METHODS First-year nursing students (N=36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example's correctness) and elaborated feedback (the true explanation). RESULTS Participants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group. CONCLUSION The worked example effect was successfully adapted for learning in the provider-patient communication domain. PRACTICE IMPLICATIONS Implementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.
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Affiliation(s)
| | | | - Daniel Stricker
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
| | - Martin Rudolf Fischer
- Institute for Medical Education, University Hospital, LMU Munich, 80336 Munich, Germany.
| | - Sissel Guttormsen
- Institute of Medical Education, University of Bern, 3010 Bern, Switzerland.
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Berney A, Carrard V, Schmid Mast M, Bonvin R, Stiefel F, Bourquin C. Individual training at the undergraduate level to promote competence in breaking bad news in oncology. Psychooncology 2017; 26:2232-2237. [DOI: 10.1002/pon.4452] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Alexandre Berney
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
| | - Valérie Carrard
- Faculty of Business and Economics; Lausanne University; Lausanne Switzerland
| | | | - Raphael Bonvin
- Medical Education Unit, Faculty of Biology and Medicine; Lausanne University; Lausanne Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service; Lausanne University Hospital; Lausanne Switzerland
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15
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Coyle N, Manna R, Shen M, Banerjee SC, Penn S, Pehrson C, Krueger CA, Maloney EK, Zaider T, Bylund CL. Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses. Clin J Oncol Nurs 2017; 19:697-702. [PMID: 26583634 DOI: 10.1188/15.cjon.697-702] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. OBJECTIVES The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. METHODS The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. FINDINGS Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.
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16
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Radziej K, Loechner J, Engerer C, Niglio de Figueiredo M, Freund J, Sattel H, Bachmann C, Berberat PO, Dinkel A, Wuensch A. How to assess communication skills? Development of the rating scale ComOn Check. MEDICAL EDUCATION ONLINE 2017; 22:1392823. [PMID: 29141516 PMCID: PMC7011842 DOI: 10.1080/10872981.2017.1392823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/09/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Good communication is a core competency for all physicians. Thus, medical students require adequate preparation in communication skills. For research purposes, as well as for evaluation in teaching, there is a clear need for reliable assessment tools. We analyzed the shortcomings of existing instruments and saw a need for a new rating scale. The aim of this publication is to describe the development process for, and evaluation of, a new rating scale. METHODS First, we developed the rating scale in 10 steps. Then, two raters evaluated the newly developed rating scale by rating 135 videotaped consultations of medical students with standardized patients. Additionally, standardized patients evaluated students' performance, which was used as an outside criterion to validate ratings. RESULTS Our rating scale comprises six domains with 13 specific items evaluated on a five-point Likert scale: initiating conversation, patient's perception, structure of conversation, patient's emotions, end of conversation, and general communication skills. Item-total correlation coefficients between the checklist items ranged from 0.15 to 0.78. Subscale consistency was calculated for domains comprised of more than one item and Cronbach's α ≥ 0.77, indicating acceptable consistency. Standardized patients' global evaluation correlated moderately with overall expert ratings (Spearman's ρ = .40, p < .001). CONCLUSION Our rating scale is a reliable and applicable assessment tool. The rating scale focuses on the evaluation of general communication skills and can be applied in research as well as in evaluations, such as objective structured clinical examinations (OSCE). ABBREVIATIONS CST: Communication skills training; ICC: Intra-class correlation coefficient; OSCE: Objective structured clinical examination; SP: Standardized patients; SD: Standard deviation; M: Mean.
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Affiliation(s)
- K. Radziej
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J. Loechner
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Ludwig-Maximilians-Universität, Munich, Germany
| | - C. Engerer
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Niglio de Figueiredo
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J. Freund
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H. Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C. Bachmann
- Institute of Medical Education, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P. O. Berberat
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Dinkel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Wuensch
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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MacLean S, Kelly M, Geddes F, Della P. Use of simulated patients to develop communication skills in nursing education: An integrative review. NURSE EDUCATION TODAY 2017; 48:90-98. [PMID: 27741440 DOI: 10.1016/j.nedt.2016.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/02/2016] [Accepted: 09/21/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. AIMS The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. DESIGN An Integrative review. DATA SOURCES A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. REVIEW METHODS The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. RESULTS Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. CONCLUSION The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased methodological rigor is recommended.
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Affiliation(s)
- Sharon MacLean
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Fiona Geddes
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Phillip Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
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Blomberg K, Griffiths P, Wengström Y, May C, Bridges J. Interventions for compassionate nursing care: A systematic review. Int J Nurs Stud 2016; 62:137-55. [PMID: 27494429 DOI: 10.1016/j.ijnurstu.2016.07.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/31/2016] [Accepted: 07/08/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Compassion has been identified as an essential element of nursing and is increasingly under public scrutiny in the context of demands for high quality health care. While primary research on effectiveness of interventions to support compassionate nursing care has been reported, no rigorous critical overview exists. OBJECTIVES To systematically identify, describe and analyse research studies that evaluate interventions for compassionate nursing care; assess the descriptions of the interventions for compassionate care, including design and delivery of the intervention and theoretical framework; and to evaluate evidence for the effectiveness of interventions. REVIEW METHODS Published international literature written in English up to June 2015 was identified from CINAHL, Medline and Cochrane Library databases. Primary research studies comparing outcomes of interventions to promote compassionate nursing care with a control condition were included. Studies were graded according to relative strength of methods and quality of description of intervention. Narrative description and analysis was undertaken supported by tabulation of key study data including study design, outcomes, intervention type and results. RESULTS 25 interventions reported in 24 studies were included in the review. Intervention types included staff training (n=10), care model (n=9) and staff support (n=6). Intervention description was generally weak, especially in relation to describing participants and facilitators, and the proposed mechanisms for change were often unclear. Most interventions were associated with improvements in patient-based, nurse-based and/or quality of care outcomes. However, overall methodological quality was low with most studies (n=16) conducted as uncontrolled before and after studies. The few higher quality studies were less likely to report positive results. No interventions were tested more than once. CONCLUSIONS None of the studies reviewed reported intervention description in sufficient detail or presented sufficiently strong evidence of effectiveness to merit routine implementation of any of these interventions into practice. The positive outcomes reported suggest that further investigation of some interventions may be merited, but high caution must be exercised. Preference should be shown for further investigating interventions reported as effective in studies with a stronger design such as randomised controlled trials.
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Affiliation(s)
- Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden; Faculty of Health Sciences, University of Southampton, UK.
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), UK
| | - Yvonne Wengström
- Faculty of Health Sciences, University of Southampton, UK; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden
| | - Carl May
- Faculty of Health Sciences, University of Southampton, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), UK
| | - Jackie Bridges
- Faculty of Health Sciences, University of Southampton, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), UK
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Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewitz W, Schultz JH, Jünger J. Improving patient-centered communication: Results of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:117-24. [PMID: 26490488 DOI: 10.1016/j.pec.2015.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Patient-centered communication is a key element for improving the quality of care in terms of therapeutic relationship, patient participation, and treatment process. Postgraduate trainings provide an essential way of promoting patient centeredness on the job where learning opportunities are often limited by time, patient volume, and economic pressure. In the present study, changes in patient centeredness during clinical routines of postgraduate physicians (internal medicine) after a three-day communication training were assessed. METHODS A randomized controlled trial was conducted in a primary care clinic. The intervention consisted of a communication training that aimed to enhance patient centeredness in postgraduate physicians. The training was based on a need assessment and the principles of deliberate practice. Workplace-based assessment of physicians' communication behavior was obtained using the Roter Interaction Analysis System. RESULTS Three months after the intervention, trained physicians showed significantly increased patient centeredness (F=5.36, p=.04; d=0.42). CONCLUSION The communication training significantly improved patient centeredness during routine clinical practice. Thus, this training provides a structured and theory-based concept to foster patient centeredness. PRACTICE IMPLICATIONS The results support the implementation of communication trainings as a part of faculty development and medical specialization training.
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Affiliation(s)
- Barbara Maatouk-Bürmann
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany.
| | - Nadja Ringel
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Spang
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Carmen Weiss
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Möltner
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Urs Riemann
- Department of Internal Medicine I, SLK Clinic Heilbronn, Germany
| | - Wolf Langewitz
- Division of Psychosomatic Medicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
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Niglio de Figueiredo M, Rudolph B, Rodolph B, Bylund CL, Goelz T, Heußner P, Sattel H, Fritzsche K, Wuensch A. ComOn Coaching: Study protocol of a randomized controlled trial to assess the effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training. BMC Cancer 2015; 15:503. [PMID: 26148681 PMCID: PMC4494160 DOI: 10.1186/s12885-015-1454-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Communication skills training has proven to be an effective means to enhance communication of health care professionals in oncology. These effects are well studied in standardized settings. The question of transferring these skills into clinical consultations remains open. We build up on a previous developed training concept consisting of a workshop and coaching. This training achieved a medium effect size in two studies with standardized patients. In the current study, we expanded and manualized the coaching concept, and we will evaluate effects of a varied number of coaching sessions on real clinical consultations. Our aim is to determine how much coaching oncologists need to transfer communication skills into clinical practice. Methods/design Physicians of two German medical centers will participate in a workshop for communication skills and will be randomized to either a group with one coaching session or a group with four coaching sessions following the workshop. The participation is voluntary and the physicians will receive medical education points. Consultations held by the participating physicians with actual patients who gave their informed consent will be filmed at three time points. These consultations will be evaluated by blinded raters using a checklist based on the training content (primary outcome). Secondary outcomes will be the self-evaluated communication competence by physicians and an evaluation of the consultations by both physicians and patients. Discussion We will evaluate our communication training concept on three levels – rater, physician and patient – and concentrate on the transfer of communication skills into real life situations. As we emphasize the external validity in this study design, limitations will be expected due to heterogeneity of data. With this study we aim to gain data on how to improve communication skills training that will result in better patient outcomes. Trial registration German Clinical Trials Register DRKS00004385. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1454-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcelo Niglio de Figueiredo
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany. .,Clinic of Dermatology and Venereology, Freiburg University Medical Center, Hauptstr. 7, D-79104, Freiburg, Germany.
| | | | - Bärbel Rodolph
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation; Doha-Qatar, Weill-Cornell Medical College - Qatar, Doha, Qatar.
| | - Tanja Goelz
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany. .,Center for Pediatrics, Freiburg University Medical Center, Mathildenstr. 6, D-79106, Freiburg, Germany.
| | - Pia Heußner
- Department of Haematology and Internal Oncology, Interdisciplinary Psycho-Oncology Center, University Clinic of Munich - Grosshadern, Marchioninistr. 15, D-81377, München, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany.
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
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Pires CM, Cavaco AM. Communication between health professionals and patients: review of studies using the RIAS (Roter Interaction Analysis System) method. Rev Assoc Med Bras (1992) 2015; 60:156-72. [PMID: 24919004 DOI: 10.1590/1806-9282.60.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 08/30/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Systematic review of studies that investigate the communication between patients and health professionals with the application of the RIAS methodology. METHODS Keyword Roter Interaction Analysis System was searched in the following bibliographic resources: Academic Search Complete, Current Contents, ISI Proceedings, PubMed, Elsevier, SpringerLink, Web of Science, RCAAP, Solo and the official RIAS site. Selection period: 2006 to 2011. Studies were selected using multicriteria dichotomous analysis and organized according to PRISMA. RESULTS Identification of 1,262 articles (455 unrepeated). 34 articles were selected for analysis, distributed by the following health professions: family medicine and general practitioners (14), pediatricians (5), nurses (4), geneticists (3), carers of patients with AIDS (2), oncologists (2), surgeons (2), anesthetists (1) and family planning specialists (1). The RIAS is scarcely used and publicized within the scope of healthcare in Portuguese speaking countries. DISCUSSION Main themes studied include the influence of tiredness, anxiety and professional burnout on communication and the impact of specific training actions on professional activities. The review enabled the identification of the main strengths and weaknesses of synchronous and dyadic verbal communication within the provision of healthcare. CONCLUSION Scientific investigation of the communication between health professionals and patients using RIAS has produced concrete results. An improvement is expected in health outcomes through the application of the RIAS.
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Groom JA, Henderson D, Sittner BJ. NLN/Jeffries Simulation Framework State of the Science Project: Simulation Design Characteristics. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2013.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Grenon NN. Managing toxicities associated with antiangiogenic biologic agents in combination with chemotherapy for metastatic colorectal cancer. Clin J Oncol Nurs 2014; 17:425-33. [PMID: 23899982 DOI: 10.1188/13.cjon.425-433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Toxicities commonly associated with antiangiogenic agents include hypertension, proteinuria, wound-healing complications, bleeding or hemorrhage, thromboembolic events, hypersensitivity reactions, and gastrointestinal perforation; however, toxicities most often attributed to chemotherapy include nausea, vomiting, diarrhea, constipation, fatigue, neuropathy, mucositis, hand-foot syndrome, hypersensitivity reactions, and myelosuppression. Patients with metastatic colorectal cancer (mCRC) who receive an antiangiogenic agent in combination with chemotherapy may experience toxicities related to both chemotherapy and the antiangiogenic agent. If possible, evidence-based interventions should be used for the management of toxicities. Patient education about expected toxicities and optimal toxicity management can promote the optimal use of therapy to improve survival and quality of life. Oncology nurses are well positioned to educate patients and their families on anticipated treatment and management of side effects. This article summarizes the incidence of toxicities associated with the antiangiogenic biologic agents aflibercept and bevacizumab, in combination with chemotherapy for patients with mCRC, and provides strategies for managing these toxicities based on clinical practice guidelines.
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Chen CH, Raingruber B. Educational Needs of Inpatient Oncology Nurses in Providing Psychosocial Care. Clin J Oncol Nurs 2014; 18:E1-5. [DOI: 10.1188/14.cjon.e1-e5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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O'Hagan S, Manias E, Elder C, Pill J, Woodward-Kron R, McNamara T, Webb G, McColl G. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. J Adv Nurs 2013; 70:1344-55. [PMID: 24224663 DOI: 10.1111/jan.12296] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/28/2022]
Abstract
AIM To examine the feedback given by nurse educators and clinicians on the quality of communication skills of nurses in interactions with simulated patients. BACKGROUND The quality of communication in interactions between nurses and patients has a major influence on patient outcomes. To support the development of effective nursing communication in clinical practice, a good understanding of what constitutes effective communication is helpful. DESIGN An exploratory design was used involving individual interviews, focus groups and written notes from participants and field notes from researchers to investigate perspectives on nurse-patient communication. METHODS Focus groups and individual interviews were held between August 2010-September 2011 with a purposive sample of 15 nurse educators and clinicians who observed videos of interactions between nurses and simulated patients. These participants were asked to give oral feedback on the quality and content of these interactions. Verbatim transcriptions were undertaken of all data collected. All written notes and field notes were also transcribed. Thematic analysis of the data was undertaken. FINDINGS Four major themes related to nurse-patient communication were derived from the educators' and clinicians' feedback: approach to patients and patient care, manner towards patients, techniques used for interacting with patients and generic aspects of communication. CONCLUSION This study has added to previous research by contributing grounded evidence from a group of nurse educators and clinicians on the aspects of communication that are relevant for effective nurse-patient interactions in clinical practice.
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Affiliation(s)
- Sally O'Hagan
- Language Testing Research Centre, The University of Melbourne, Australia
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26
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Baer L, Weinstein E. Improving Oncology Nurses' Communication Skills for Difficult Conversations. Clin J Oncol Nurs 2013; 17:E45-51. [DOI: 10.1188/13.cjon.e45-e51] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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López-Pérez B, Ambrona T, Gregory J, Stocks E, Oceja L. Feeling at hospitals: perspective-taking, empathy and personal distress among professional nurses and nursing students. NURSE EDUCATION TODAY 2013; 33:334-338. [PMID: 23428365 DOI: 10.1016/j.nedt.2013.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 01/03/2013] [Accepted: 01/15/2013] [Indexed: 06/01/2023]
Abstract
When facing a person in need, professional nurses will tend to adopt an objective perspective compared to nursing students who, instead, will tend to adopt an imagine-other perspective. Consequently, professional nurses will show lower vicarious emotional reaction such as empathy and distress. Using samples from Spain (Studies 1 and 2) and United states (Study 3), we compared perspective taking strategies and the emotional responses of nurses and nursing students when perceiving a sick child (Study 1) and a sick adult (Studies 2 and 3). Taken together, the results supported our hypotheses. We discuss the applied value of considering the relationship between perspective-taking and its emotional consequences for the nursing profession.
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Affiliation(s)
- Belén López-Pérez
- Departamento de Psicología Social y Metodología, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain.
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Stiefel F, Bourquin C, Layat C, Vadot S, Bonvin R, Berney A. Medical students' skills and needs for training in breaking bad news. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:187-191. [PMID: 23055132 DOI: 10.1007/s13187-012-0420-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study assessed medical students' perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)-where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty-or individual training (IT)-where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.
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Meystre C, Bourquin C, Despland JN, Stiefel F, de Roten Y. Working alliance in communication skills training for oncology clinicians: a controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 90:233-238. [PMID: 23158787 DOI: 10.1016/j.pec.2012.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance. METHODS Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N=56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N=57) who did not benefit from CST. The patient-clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory - Short Revised Form. RESULTS While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance. CONCLUSION Patient-clinician alliance is related to specific verbal communication behaviors. PRACTICE IMPLICATIONS Working alliance is a key element of patient-physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.
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Affiliation(s)
- Claudia Meystre
- Department of Psychiatry, Lausanne University Hospital, CH-1011 CHUV-Lausanne, Switzerland
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30
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Yörük E, Albayrak G. Genetic characterization of Fusarium graminearum and F. culmorum isolates from Turkey by using random-amplified polymorphic DNA. GENETICS AND MOLECULAR RESEARCH 2013; 12:1360-72. [DOI: 10.4238/2013.april.25.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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31
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Singy P, Bourquin C, Sulstarova B, Stiefel F. The impact of communication skills training in oncology: a linguistic analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:404-408. [PMID: 22714790 DOI: 10.1007/s13187-012-0385-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study aimed to investigate the impact of a communication skills training (CST) in oncology on clinicians' linguistic strategies. A verbal communication analysis software (Logiciel d'Analyse de la Communication Verbale) was used to compare simulated patients interviews with oncology clinicians who participated in CST (N=57) (pre/post with a 6-month interval) with a control group of oncology clinicians who did not (N=56) (T1/T2 with a 6-month interval). A significant improvement of linguistic strategies related to biomedical, psychological and social issues was observed. Analysis of linguistic aspects of videotaped interviews might become in the future a part of individualised feedback in CST and utilised as a marker for an evaluation of training.
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Affiliation(s)
- Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Les Allières, 1011, Lausanne-CHUV, Switzerland.
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