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Adeyemi O, Ginsburg AD, Kaur R, Cuthel AM, Zhao N, Siman N, Goldfeld KS, Emlet LL, DiMaggio C, Yamarik RL, Bouillon-Minois JB, Chodosh J, Grudzen CR. Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention. BMC Palliat Care 2024; 23:48. [PMID: 38378532 PMCID: PMC10880358 DOI: 10.1186/s12904-024-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. METHODS EM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. RESULTS A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice. CONCLUSION Our study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers' knowledge, attitude, and practice of SI communication skills. TRIAL REGISTRATION Clinicaltrials.gov: NCT03424109; Registered on January 30, 2018.
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Affiliation(s)
- Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
| | | | | | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA.
| | - Nicole Zhao
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, 227 East 30thStreet, New York, NY, 10016, USA
| | - Keith S Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lillian Liang Emlet
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles DiMaggio
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Joshua Chodosh
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Veteran's Affair, New York Harbor Healthcare System, New York, NY, USA
| | - Corita R Grudzen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Waughtal J, Luong P, Sandy L, Chavez C, Ho PM, Bull S. Nudge me: tailoring text messages for prescription adherence through N-of-1 interviews. Transl Behav Med 2021; 11:1832-1838. [PMID: 34080636 PMCID: PMC8686108 DOI: 10.1093/tbm/ibab056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Almost 50% of patients with cardiovascular diseases face challenges in taking medications and increased morbidity and mortality. Text messaging may impact medication refill behavior and can be delivered at scale to patients by texting mobile phones. To obtain feedback from persons with chronic conditions on the design of interactive text messages and determine language of message for making messages that can motivate patients to refill medications on time. We purposively sampled 35 English and Spanish speaking patients with at least one chronic condition from three large healthcare delivery systems to participate in N-of-1 video-based synchronous interviews. Research assistants shared ideas for theory-informed text messages with content intended to persuade patients to refill their medication. We transcribed recorded interviews and conducted a content analysis to identify strategies to employ generating a dynamic interactive text message library intended to increase medication refill. Those interviewed were of diverse age and race/ethnicity and typical of persons with multiple chronic conditions. Several participants emphasized that personally tailored and positively framed messages would be more persuasive than generic and/or negative messages. Some patients appreciated humor and messages that could evoke a sense of social support from their providers and rejected the use of emojis. Messages to remind patients to refill medications may facilitate improvements in adherence, which in turn can improve chronic care. Designing messages that are persuasive and can prompt action is feasible and should be considered given the ease with which such messages can be delivered automatically at scale.
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Affiliation(s)
- Joy Waughtal
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Phat Luong
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Lisa Sandy
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - Catia Chavez
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
| | - P Michael Ho
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
- Veteran Affairs Eastern Colorado Health Care System,
Aurora, CO, USA
| | - Sheana Bull
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA
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