1
|
Swiderski D, Taniguchi RN, Chuang E. Are Safety-Net Primary Care Physicians Prepared to Engage in Serious Illness Conversations? Am J Hosp Palliat Care 2024; 41:486-491. [PMID: 37533362 DOI: 10.1177/10499091231190354] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Advance Care Planning (ACP) has not reliably improved care for patients at end-of-life. Serious Illness Conversations when patients are in the late stages of chronic illness might be more effective to address patients' goals. The Serious Illness Conversation (SIC) Guide has been helpful but was not developed for use in safety-net settings serving racial and ethnic minority populations. METHODS Physicians were recruited to complete a needs assessment survey prior to training in the use of the SIC Guide. RESULTS Of the 44 physician participants, most were female (82%) and white, non-Hispanic (62%). Less than half of respondents rated themselves as skilled or very skilled in basic serious illness communication related tasks such as setting up goals of care discussions (44%), assessing informational preferences (42%), sharing prognosis (38%), exploring goals for future care (49%) and managing family dynamics (44%). Respondents reported lower skill levels in conducting goals of care conversations via telehealth and establishing trust in racially discordant provider/patient pairs. CONCLUSIONS Most participants expressed the need for further training in critical end-of-life communications skills, including help with encounters with racial and/or language discordance. This may help to explain the failure of ACP discussions to reliably result in appropriate end-of-life care.
Collapse
Affiliation(s)
| | | | - Elizabeth Chuang
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
2
|
Wood GJ, Clepp RK, Lee J, Twaddle ML, Ogunseitan A, Neagle J, Szmuilowicz E. Outcomes of a Multisite Mentored Implementation Approach to Promoting Goals of Care Conversations. J Pain Symptom Manage 2024:S0885-3924(24)00744-9. [PMID: 38697406 DOI: 10.1016/j.jpainsymman.2024.04.024] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
CONTEXT The Preference-Aligned Communication and Treatment (PACT) Project is a multisite quality improvement effort that has been shown to increase the frequency of goals of care (GOC) conversations in hospitalized patients with serious illness. OBJECTIVES To evaluate the effect of PACT on goal-discordant care and resource utilization. METHODS Hospitals enrolled in a multiyear mentored implementation quality improvement initiative to facilitate GOC conversations for seriously ill hospitalized patients. The primary outcome was the percentage of patients with care discordant with stated preferences, assessed by comparing documented wishes to Medicare claims data for patients who were admitted to intervention units and died over the study period. Secondary outcomes evaluated end-of-life resource utilization by comparing Medicare claims data for intervention patients with propensity score-matched controls. RESULTS In the 9 hospitals included in the study, 1347 intervention group patients were compared to 4019 in the control group. Rates of discordance between wishes and care were generally low in the intervention group. Compared to the control group, patients in the intervention group had lower costs (-976.05 dollars, P = 0.010), were less likely to be admitted to the ICU (OR 0.9, P = 0.005), less likely to be on a ventilator or undergo CPR or cardioversion, more likely to enroll in hospice (OR 1.81, P < 0.001) and had a longer hospice stay (3.35 more days, P = 0.041). CONCLUSION A multisite mentored implementation quality improvement intervention for seriously ill hospitalized patients resulted in care aligned with goals and decreased resource utilization at the end of life.
Collapse
Affiliation(s)
- Gordon J Wood
- Division of Hospital Medicine (G.J.W., A.O., J.N., E.S.), Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education (G.J.W.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Rebecca K Clepp
- Division of Pulmonary and Critical Care (R.K.C.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jungwha Lee
- Department of Preventive Medicine (J.L.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martha L Twaddle
- Northwestern Lake Forest Hospital (M.L.T), Palliative Medicine and Supportive Care, Lake Forest, Illinois, USA
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (G.J.W., A.O., J.N., E.S.), Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jayson Neagle
- Division of Hospital Medicine (G.J.W., A.O., J.N., E.S.), Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eytan Szmuilowicz
- Division of Hospital Medicine (G.J.W., A.O., J.N., E.S.), Section of Palliative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
3
|
Szmuilowicz E, Clepp RK, Neagle J, Ogunseitan A, Twaddle M, Wood GJ. The PACT Project: Feasibility of a Multidisciplinary, Multi-Faceted Intervention to Promote Goals of Care Conversations. Am J Hosp Palliat Care 2024; 41:355-362. [PMID: 37272769 DOI: 10.1177/10499091231181557] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Patients living with serious illness generally want their physicians to facilitate Goals of Care conversations (GoCc), yet physicians may lack time and skills to engage in these conversations in the outpatient setting. The problem may be addressed by supporting multiple members of the clinical team to facilitate GoCc with the patient while admitted to the hospital. METHODS A multi-modal training and mentored implementation program was developed. A group of 10 hospitals were recruited to participate. Each hospital selected a primary inpatient unit on which to start the intervention, then expanded to a secondary unit later in the project. The number of trained facilitators (champions) and the number of documented GoCc were tracked over time. RESULTS Nine of 10 hospitals completed the 3-year project. Most of the units were general medical-surgical units. Forty-eight champions were trained at the kick-off conference, attended primarily by nurses, physicians, and social workers. By the end of the project, 153 champions had been trained. A total of 51 087 patients were admitted to PACT units with 85.4% being screened for eligibility. Of the patients who were eligible, over 68% had documented GoCc. CONCLUSION A multifaceted quality improvement intervention focused on serious illness communication skills can support a diverse clinical workforce to facilitate inpatient GoCc over time.
Collapse
Affiliation(s)
- Eytan Szmuilowicz
- Department of Medicine, Northwestern Medicine, Chicago, IL, USA
- Section of Palliative Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Rebecca K Clepp
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jayson Neagle
- Department of Medicine, Northwestern Medicine, Chicago, IL, USA
- Section of Palliative Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Adeboye Ogunseitan
- Department of Medicine, Northwestern Medicine, Chicago, IL, USA
- Section of Palliative Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Martha Twaddle
- Department of Medicine, Northwestern Medicine, Chicago, IL, USA
- Palliative Medicine and Supportive Care, Northwestern Lake Forest Hospital, Lake Forest, IL, USA
| | - Gordon J Wood
- Department of Medicine, Northwestern Medicine, Chicago, IL, USA
- Section of Palliative Medicine, Northwestern Memorial Hospital, Chicago, IL, USA
| |
Collapse
|
4
|
Walter JM, Smith MM, Einstein N, Cohen ER, Wood GJ, Vermylen JH. Development of a Simulation-Based Mastery Learning Curriculum for Late Goals of Care Discussions. J Pain Symptom Manage 2024:S0885-3924(24)00675-4. [PMID: 38527655 DOI: 10.1016/j.jpainsymman.2024.03.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Fellows in critical care medicine (CCM) routinely help patients and families navigate complex decisions near the end of life. These "late goals of care" (LGOC) discussions require rigorous skills training and impact patient care. Innovation is needed to ensure that fellow training in leading these discussions is centered on reproducible competency-based standards. The aims of this study were to (1) describe the development of a simulation-based mastery learning (SBML) curriculum for LGOC discussions and (2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. INNOVATION We developed an SBML curriculum for CCM fellows structured around REMAP, a mnemonic outlining foundational components of effective communication around serious illness. A multidisciplinary expert panel iteratively created an LGOC discussion assessment tool. Pilot testing was completed to refine the checklist, set the MPS, and assess skill acquisition. OUTCOMES The LGOC discussion assessment tool included an 18-item checklist and 6 scaled items. The tool produced reliable data (k ≥ 0.7 and ICC of ≥ 0.7). Using the Mastery Angoff method, the panel set the MPS at 87%. Ten CCM fellows participated in the pilot study. Performance on the checklist significantly improved from a median score of 52% (IQR 44%-72%) at pretest to 96% (IQR 82%-97%) at post-test (P = 0.005). The number of learners who met the MPS similarly improved from 10% during pre-testing to 70% during post-testing (P = 0.02). COMMENT We describe the development of a LGOC SBML curriculum for CCM fellows which includes a robust communication skills assessment and the delineation of a defensible MPS.
Collapse
Affiliation(s)
- James M Walter
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Melanie M Smith
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Noah Einstein
- Department of Emergency Medicine (N.E.), Advocate Health Care, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gordon J Wood
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julia H Vermylen
- Department of Medicine (J.M.W., M.M.S., E.R.C., G.J.W., J.H.V.), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
5
|
Pilnick A, O'Brien R, Beeke S, Goldberg S, Murray M, Harwood RH. Conversation Analysis Based Simulation (CABS): A method for improving communication skills training for healthcare practitioners. Health Expect 2023; 26:2461-2474. [PMID: 37589441 PMCID: PMC10632656 DOI: 10.1111/hex.13834] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation-based training because of the opportunity to think and react in real time, which alternatives cannot provide. OBJECTIVE To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication. DESIGN Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns. SETTINGS AND PARTICIPANTS Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands. OUTCOME MEASURES One month later HCPs reported using the skills learned in clinical practice. Masked-ratings of before and after simulated patient encounters confirmed these self-reports in relation to one key area of training. RESULTS The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others. DISCUSSION/CONCLUSION While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity. PATIENT AND PUBLIC CONTRIBUTION The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments.
Collapse
Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of NottinghamNottinghamUK
| | - Rebecca O'Brien
- School of Health Sciences, University of NottinghamUK and Nottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | - Suzanne Beeke
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Sarah Goldberg
- School of Health SciencesUniversity of NottinghamNottinghamUK
| | | | - Rowan H. Harwood
- School of Health Sciences, University of NottinghamUK and Nottingham University Hospitals NHS TrustNottinghamUK
| |
Collapse
|
6
|
Yang C, Feng X, Li J, Jiang Y, Zhang H, Gao Y, Tan J, Ran B. Clinical Knowledge, Perceptions, and Communication Confidence Regarding the Development of Thyroid Cancer --A Cross-Sectional Study of Clinical Medical Students in Chongqing, Southwest China. Risk Manag Healthc Policy 2023; 16:2101-2111. [PMID: 37849656 PMCID: PMC10577241 DOI: 10.2147/rmhp.s424052] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose Medical students play an essential role in providing disease consultation for patients. Despite the rapid increase in thyroid disease, there are few data on how well Chinese medical students master the knowledge of thyroid diseases. This study aims to evaluate the clinical knowledge, perception, and clinical communication confidence of medical students on thyroid cancer (TC). Patients and Methods This cross-sectional study was carried out among medical students of Chongqing Medical University. An anonymous, self-administered questionnaire distributed from December 2022 to February 2023 included items on demographics and other information, the warning signs of cancer, perception regarding a person's chance of developing cancer, and clinical communication confidence. Descriptive analysis, difference analysis, and correlation analysis were carried out. Results A total of 226 medical students participated in the survey. Most students (n=191, 84.5%) had heard of TC, while only a few (n=10, 4.4%) regularly performed thyroid self-examination. One hundred and eighty-four students (81.4%) agreed that an unexplained lump or swelling could be a sign of cancer. There were significant differences in thyroid clinical knowledge in relation to gender (P<0.001), major (P=0.026), and thyroid disease (P=0.030). Clinical communication confidence showed significant differences in year of study (P=0.002), major (P=0.048), and graduate major (P<0.001). There was a correlation between clinical confidence and year of study (r=0.261, P<0.001). Conclusion Most medical students have sufficient clinical knowledge on TC prevention, but there are still misconceptions related to TC screening. In addition, medical students lack confidence in communicating with patients. Comprehensive communication training should be integrated into the medical curriculum and clinical activities should be initiated earlier.
Collapse
Affiliation(s)
- Chuang Yang
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xing Feng
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Hepatobiliary, Breast and Thyroid Surgery, the People’s Hospital of Liangping District, Chongqing, 405200, People’s Republic of China
| | - Junfeng Li
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yuchan Jiang
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Huan Zhang
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yidan Gao
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jinxiang Tan
- Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Bolin Ran
- Department of Medical Laboratory Science, Laboratory of Traditional Chinese Medicine Hospital of Shizhu County, Chongqing, 409100, People’s Republic of China
| |
Collapse
|
7
|
Onishi E, Ishikawa H, Ito K, Nakagawa S, Shiozawa Y, Uemura T, Yuasa M, Ouchi K. Culturally Acceptable Emotional Expressions Perceived by Non-U.S. Physicians Undergoing U.S.-Based Serious Illness Communication Skills Training: A Cross-Sectional Study. Am J Hosp Palliat Care 2023; 40:1114-1123. [PMID: 36574477 PMCID: PMC10293470 DOI: 10.1177/10499091221148151] [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] [Indexed: 12/28/2022] Open
Abstract
CONTEXT Responding to emotions is a key feature of U.S.-based serious illness communication skills training, VitalTalk®, of which trained actors portraying seriously ill patients is a component. The cultural appropriateness and perceived utility of the actors' emotional expressions remain to be empirically evaluated outside of the U.S. OBJECTIVES To determine the cultural appropriateness and educational utility of VitalTalk® actors' emotional expressions, as perceived by clinicians. METHODS From January 2021-April 2022, we conducted a cross-sectional study of physicians in Japan attending virtual VitalTalk® training in Japanese, each session focusing on: responding to emotions (#1) and discussing goals of care (#2), respectively. We examined their perceived authenticity and utility of the actively and passively intense emotional expressions portrayed by actors in VitalTalk® role-plays. RESULTS Physicians (N = 100, 94% response rate) from across Japan voluntarily attended two-session workshops and completed post-session surveys. Eighty-eight participants (88%) responded that both actively and passively intense emotions portrayed by the actors provided useful learning experiences. For session #1, the participants found actively intense emotional expressions to be more clinically authentic, compared to passively intense ones (4.21 vs 4.06 out of a 5-point Likert scale, PP= .02). For session #2, no such difference was observed (4.16 vs 4.08 of a 5-point Likert scale, P = .24). CONCLUSIONS Even in a culture where patients may express emotions passively, any intense and authentic emotional expressions by actors can be perceived as facilitating learning. Most participants perceived both the Name, Understand, Respect, Support, and Explore '(NURSE)' statements and Reframe, Expect emotion, Map out patient goals Align with goals and Propose a plan '(REMAP)' frameworks as useful in routine clinical practice in Japan.
Collapse
Affiliation(s)
- Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Itabashi-ku, Japan
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, Teikyo University School of Medicine, Itabashi-ku, Japan
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Takeshi Uemura
- Division of Gerontology, Geriatrics and Palliative Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Misuzu Yuasa
- Hospice Division, Seirei Mikatahara Genaral Hospital, Tsu, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
| |
Collapse
|
8
|
Okamura M, Fujimori M, Saito E, Osugi Y, Akizuki N, Uchitomi Y. Development of an Online Communication Skills Training Program for Oncologists Working with Adolescents and Young Adults. J Adolesc Young Adult Oncol 2023; 12:433-439. [PMID: 36971619 PMCID: PMC10282788 DOI: 10.1089/jayao.2022.0102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
There are two purposes to this study. The first purpose was to develop a communication skills training (CST) program for oncologists working with adolescents and young adults (AYA-CST). The second purpose was to evaluate the program's feasibility. The online AYA-CST program was a half-day workshop including a didactic lecture, role-playing with simulated patients and discussions in a small group. All six oncologists who participated in the program satisfactorily completed it. Our AYA-CST program seems feasible and will be tested further in a randomized control study.
Collapse
Affiliation(s)
- Masako Okamura
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Eiichi Saito
- Department of Palliative Care, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuko Osugi
- Department of Hematology, Hyogo Medical University Hospital, Hyogo, Japan
| | - Nobuya Akizuki
- Department of Psycho-Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| |
Collapse
|
9
|
Frydman JL, Dow LA, Smith CB, Kelley AS, Lindenberger EC, Gelfman LP. Virtual Geritalk: Does Intensive Virtual Communication Skills Training Improve Use of Serious Illness Communication Skills? Am J Hosp Palliat Care 2023; 40:620-623. [PMID: 35857414 PMCID: PMC9979275 DOI: 10.1177/10499091221116078] [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] [Indexed: 01/27/2023] Open
Abstract
Background: The COVID-19 pandemic presented a unique opportunity to adapt in-person communication skills training to a virtual format. Objective: Examine use of serious illness communication skills by learners after participating in an intensive virtual communication skills training. Design: Prospective cohort study. Setting/Subjects: Icahn School of Medicine at Mount Sinai, Clinical Fellows. Measurements: Family Meeting Communication Assessment Tool (FAMCAT) assessed fundamental and advanced communication skills. Results: As compared to a historical benchmark obtained after a prior in-person course, the virtual course showed equivalent or better use of communication skills across fundamental skills and advanced skills. Conclusions: Our findings suggest that a virtual communication skills training is associated with the use of serious illness communication skills in the clinical setting by learners.
Collapse
Affiliation(s)
- Julia L. Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lindsay A. Dow
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cardinale B. Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S. Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth C. Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
| |
Collapse
|
10
|
Funding E, Viftrup DT, Knudsen MB, Haunstrup LM, Tolver A, Clemmensen SN. Impact of Training in Serious Illness Communication and Work Life Balance on Physicians' Self-Efficacy, Clinical Practice and Perception of Roles. Adv Med Educ Pract 2023; 14:547-555. [PMID: 37283658 PMCID: PMC10239622 DOI: 10.2147/amep.s406570] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
Purpose Serious illness communication is a core task in hemato-oncology that require advanced communication skills and can be emotionally demanding. A 2-day course was implemented as a mandatory part of the 5-year hematology specialist training program in Denmark in 2021. The aim of this study was to assess the quantitative and qualitative effect of course participation on self-efficacy in serious illness communication and measure the prevalence of burnout among physicians in hematology specialist training. Methods For quantitative assessment course participants answered three questionnaires: Self-efficacy Advance care planning (ACP), Self-efficacy Existential communication (EC) and the Copenhagen Burnout Inventory at baseline, 4 and 12 weeks after the course. The control group answered the questionnaires once. Qualitative assessment was performed as structured group interviews with course participants 4 weeks after the course, transcribed, coded, and transformed into themes. Results All self-efficacy EC scores and 12 out of 17 self-efficacy ACP scores improved after the course, though mostly non-significant. Course participants reported altered clinical practice and perception of role as a physician. The physicians' confidence that they could find the time to discuss ACP were low and remained low. The prevalence of burnout was high. Burnout levels were non-significantly lower after the course. Conclusion A mandatory course of formal training can increase physician self-efficacy in serious illness communication and alter clinical practice and perception of roles. The high level of burnout among physicians in hemato-oncology calls for institutional interventions in addition to training.
Collapse
Affiliation(s)
- Eva Funding
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Mark Bech Knudsen
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
11
|
Harnischfeger N, Rath H, Alt-Epping B, Brand H, Haller K, Letsch A, Rieder N, Thuss-Patience P, Bokemeyer C, Bergelt C, Oechsle K. Effects of a communication training for oncologists on early addressing palliative and end-of-life care in advanced cancer care (PALLI-COM): a randomized, controlled trial. ESMO Open 2022; 7:100623. [PMID: 36356411 PMCID: PMC9808464 DOI: 10.1016/j.esmoop.2022.100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION In advanced cancer care, early communication about palliative care (PC) and end-of-life (EoL)-related issues is recommended, but is often impeded by physicians' communication insecurities. We investigated the effect of a newly developed compact communication skills training 'PALLI-COM' on oncologists' competencies to early address PC/EoL-related issues. MATERIALS AND METHODS We conducted a randomized, controlled trial (RCT) with an intervention group (IG; 2 × 90 min training) and a wait list control group (CG) at five sites. At two assessment points, participating oncologists led videotaped medical consultations with simulated patients (SPs) via a privacy compliant video conference platform. SPs were represented by trained actors. The taped conversations were rated for primary outcome (communication skills assessed by adapted COM-ON-checklist and COM-ON-coaching rating scales) by raters blinded for study group. Secondary outcomes included oncologists' self-reported communication skills (Self-Efficacy in Palliative Care Scale, Thanatophobia-Scale, Communication about End of Life Survey, study-specific items) as well as external rating of the SPs. Univariate analyses of covariance with baseline adjustment were used to analyze intervention effects. RESULTS A total of 141 oncologists [age: mean (standard deviation) = 32.7 (6.3) years, 60% female (nIG = 73, nCG = 68)] participated. Following intervention, the IG showed significantly more improvement in four out of five assessed communication skills: 'reacting to emotions and showing empathy', 'pointing out opportunities and giving hope', 'addressing the EoL' and 'explaining the concept of PC'. IG participants also improved more than CG participants in almost all secondary outcomes assessed by participants and SPs: oncologists' self-efficacy, attitudes towards caring for terminally ill patients, communication strategies and confidence in dealing with PC/EoL-related issues as well as communication quality from the SPs' perspective. CONCLUSION Findings indicate that the compact communication skills training PALLI-COM increases oncologists' competencies in early addressing PC/EoL-related issues from different perspectives. Implementation in routine oncology residency might improve advanced cancer care by strengthening these communication skills.
Collapse
Affiliation(s)
- N. Harnischfeger
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Correspondence to: Nele Harnischfeger, Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - H.M. Rath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B. Alt-Epping
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - H. Brand
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - K. Haller
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - A. Letsch
- Department of Hematology, Oncology and Tumor Immunology, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany,Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité – University Medicine Berlin, Berlin, Germany
| | - N. Rieder
- Department of Palliative Medicine, Heidelberg University Hospital, Heidelberg, Germany,Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - P. Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - C. Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - K. Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
12
|
Engel KG, Pedersen K, Johansen MD, Schoennemann KR, Kjaer LB, Nayahangan LJ. Consensus on communication curriculum content in Danish undergraduate medical education: A Delphi study. Med Teach 2022; 44:1221-1227. [PMID: 35649701 DOI: 10.1080/0142159x.2022.2072280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The acquisition of skills in patient-centered communication is a critical aspect of medical education which demands both resource-intensive instruction and longitudinal opportunities for learning. Significant variation currently exists in the content and timing of communication education. The aim of this study was to establish consensus regarding communication curriculum content for undergraduate medical education (UME) within the country of Denmark. METHODS This study employed a Delphi process which is a widely accepted method for establishing consensus among experts and can be utilized to guide planning and decision-making in education. For this study, consensus was based on greater than 60% agreement between participants. Diverse stakeholders, representing all four universities with medical schools in Denmark, participated in an iterative three-round Delphi process which involved: (1) identifying key curricular elements for medical student education, (2) rating the importance of each item, and (3) prioritizing items relative to one another and rating each item based on the level of mastery that was expected for each skill (i.e. knowledge, performance with supervision, or performance independently). RESULTS A national sample of 149 stakeholders participated with a 70% response rate for round 1, 81% for round 2, and 86% for round 3. The completed Delphi process yielded 56 content items which were prioritized in rank order lists within five categories: (1) establishing rapport, engaging patient perspectives and responding to needs; (2) basic communication skills and techniques; (3) phases and structure of the encounter; (4) personal characteristics and skills of the student; (5) specific challenging patient groups and context-dependent situations. DISCUSSION Using a Delphi process, it was possible to achieve consensus regarding communication curriculum content for UME. These findings provide an important foundation for ensuring greater uniformity in UME, as well as supporting the important longitudinal goals of communication skill development across medical training.
Collapse
Affiliation(s)
- Kirsten Greineder Engel
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education and the University of Copenhagen, Copenhagen, Denmark
- Massachusetts General Hospital, Boston, MA, USA
| | - Kamilla Pedersen
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
| | - Mette Dencker Johansen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Katrine Rahbek Schoennemann
- Department of Oncology, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Louise Binow Kjaer
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
- Health, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR and Education and the University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
Nassar AK, Sasnal M, Miller-Kuhlmann RK, Jensen RM, Blankenburg RL, Rassbach CE, Smith-Bentley M, Vyas A, Korndorffer JR, Gold CA. Developing a multi-departmental residency communication coaching program. Educ Health (Abingdon) 2022; 35:98-104. [PMID: 37313890 DOI: 10.4103/efh.efh_357_22] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs. Innovation Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support. Evaluation A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies. Discussion and Implications Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.
Collapse
Affiliation(s)
- Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Marzena Sasnal
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca K Miller-Kuhlmann
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel M Jensen
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Alpa Vyas
- Stanford Health Care, Stanford, California, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
14
|
Ditton-Phare P, Sandhu H, Kelly B, Loughland C. ComPsych communication skills training: Applicability of simulated patients in psychiatry communication skills training. Australas Psychiatry 2022; 30:552-555. [PMID: 35138955 DOI: 10.1177/10398562211067199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Communication skills training (CST) programs within postgraduate psychiatry training are rare. ComPsych CST utilises simulated patients (SPs) for trainees to practice communication skills for discussing severe mental illness with patients and their families/carers. This study examined the applicability of using SPs in a psychiatry-specific CST. METHODS A total of 41 postgraduate psychiatry trainees attended at least one of four modules of training in their cohort year and completed a questionnaire after each module presenting eight questions rating the use of SPs and ratings of course deliverables. RESULTS Overall, trainees rated contact with SPs very highly across all modules, with a mean rating of 9.11 out of 10 (SD = 0.97). Trainees agreed that SPs appeared authentic, that their reactions showed they listened to the trainee. CONCLUSIONS Trainees valued training with SPs, providing evidence that using SPs for psychiatry-specific CST is feasible. Despite subjectivity, this is valuable to course providers as it highlights benefits perceived by trainees to be useful and provides further evidence for the program's feasibility and utility.
Collapse
Affiliation(s)
- Philippa Ditton-Phare
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Harsimrat Sandhu
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Brian Kelly
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Carmel Loughland
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| |
Collapse
|
15
|
Schultz MA, Morrisey JK, Kaplan LK, Colón JL, McVety-Leinen DG, Hinckley-Boltax AL. A Scalable and Effective Course Design for Teaching Competency-Based Euthanasia Communication Skills in Veterinary Curricula. J Vet Med Educ 2022; 49:484-491. [PMID: 34102093 DOI: 10.3138/jvme-2020-0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Veterinary staff must be able to navigate end-of-life care with sensitivity and skill to create the best possible outcome for the patient, client, and veterinary team collectively. Despite the clear importance of euthanasia communication and procedural skills in veterinary practice, recent graduates of veterinary programs identified gaps between skills deemed important in clinical practice and skills emphasized in the curriculum. Little time is allocated to euthanasia procedural or communication training across the board in US veterinary programs. Thus, it is of paramount importance to establish intentional and well-designed instruction and assessment of euthanasia communication skills for veterinary trainees. A course on veterinary euthanasia communication skills was designed to emphasize themes and topics essential for a competent veterinarian. Through course evaluations, students expressed the sentiments that this course improved their euthanasia communication skills, that euthanasia communication skills are essential for their careers, and that the course content should be integrated into the core curriculum. This article presents a scaffold for the instruction and assessment of veterinary euthanasia communication skills in alignment with a competency-based veterinary education (CBVE) framework and outlines specific learning interventions used in the course that are scalable and may be extracted and incorporated into existing courses.
Collapse
|
16
|
Murthy V, Sethuraman KR, Choudhury S, Shakila R. Application of Practice Oriented-Peer Review for Prosthodontics (PRO-PReP)-A Qualitative Study. Int J Psychiatry Med 2022; 57:117-133. [PMID: 33472469 DOI: 10.1177/0091217421990142] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Communication skills diminish with time and must be applied and updated frequently. Due to various professional constraints, the dentists may not be able to attend training programs to sharpen their skills. During patient interactions, dentists may face difficult situations which they may be unable to handle and, consequently, make them overreact. Therefore, there is a need to provide a platform to freely discuss their feelings, ideas, and take opinion from peers. METHODS Training in communication skills customized for dealing with complete denture patients was conducted for the prosthodontic postgraduates. Based on feedback obtained, it was decided to have periodic meetings and the concept of Practice-Oriented-Peer Review for Prosthodontics (PrO-PReP) was introduced. This novel concept is a combination of the Relationship building, exploring Reactions, exploring Content, and Coaching (R2C2) model of residency education and the Balint method. The meetings were scheduled every one or two months based on the available caseload of the patients treated by the postgraduates. RESULTS The thematic analysis of the postgraduates' self-reflection during the sessions and the video recorded observations (assessed using the Kalamazoo scale) revealed that these sessions were effective in positively engaging the postgraduates to discuss their experiences, reflect on their performances, practice their newly gained skills, and learn from peer sharing. CONCLUSION The postgraduates felt that they have changed in their working style and were more confident to manage patients. They found such sessions very useful for being updated with the already-learned skills.
Collapse
Affiliation(s)
- Varsha Murthy
- Department of Prosthodontics and Implantology, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - K R Sethuraman
- Faculty of Medicine, 60605AIMST University, Bedong, Malaysia
| | - Sunayana Choudhury
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pilliyarkuppam, Pondicherry, India
| | - R Shakila
- Department of Prosthodontics and Crown & Bridge, 179249Mahatma Gandhi Postgraduate Institute of Dental Sciences, Gorimedu, Pondicherry, India
| |
Collapse
|
17
|
Levy DC, Naehrig D, Sullivan L, Chin YS. Communication and collaboration skills training in Radiation Oncology in Australia and New Zealand: A qualitative study. Asia Pac J Clin Oncol 2022; 18:e356-e362. [PMID: 35043566 DOI: 10.1111/ajco.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods. MATERIALS AND METHODS Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent. RESULTS After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub-themes. CONCLUSIONS There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work-based assessments. CCST templates are recommended.
Collapse
Affiliation(s)
- David C Levy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Diana Naehrig Coaching & Communication, Sydney, Australia
| | - Lisa Sullivan
- The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Icon Cancer Centre, Bruce, Australian Capital Territory, Australia.,School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yaw S Chin
- Department of Radiation Oncology, St. George Hospital, Kogarah, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
MacDonald-Phillips KA, McKenna SLB, Shaw DH, Keefe GP, VanLeeuwen J, Artemiou E, Adams CL. Communication skills training and assessment of food animal production medicine veterinarians: A component of a voluntary Johne's disease control program. J Dairy Sci 2022; 105:2487-2498. [PMID: 34998564 DOI: 10.3168/jds.2021-20677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Abstract
In food animal production medicine (FAPM), the success of control programs for infectious diseases that have serious animal health and economic consequences frequently rely on the veterinarian's effective communication and producer adherence to veterinary recommendations. However, little research has been conducted on communication skills of practicing FAPM veterinarians. During this study, we developed a communication training workshop intervention to support the Atlantic Johne's Disease Initiative. Seventeen FAPM veterinarians across 10 clinics practicing within Maritime Canada participated in a pre-post intervention study design. Communication skills were evaluated utilizing 3 assessment tools; an objective structured clinical exam (OSCE), standardized client feedback, and an instrument designed for veterinary participants to assess their self-efficacy. Study results showed that before training, communication skills of participating veterinarians had limitations, including skill deficits in communication tasks strongly associated with increased adherence to veterinary recommendations. Based on the 3 assessment tools, communication skills of participating veterinarians improved with the training provided. Significant increases were detected in pre- to postintervention self-efficacy percentage scores, OSCE percentage and global scores from expert raters, and OSCE percentage and global scores from standardized client feedback. These improvements emphasize the importance of communication skills training specific to FAPM.
Collapse
Affiliation(s)
- Karen A MacDonald-Phillips
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3.
| | - Shawn L B McKenna
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - Darcy H Shaw
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - Greg P Keefe
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - John VanLeeuwen
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, Canada C1A 4P3
| | - Elpida Artemiou
- Ross University School of Veterinary Medicine, West Farm, Basseterre, PO Box 334, St. Kitts and Nevis
| | - Cindy L Adams
- Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Veterinary Medicine, 11877 85 St. NW, Calgary, AB, Canada T3R 1J3
| |
Collapse
|
19
|
Topoll AB, Wagner JK, Salem KM, Levenson JE, Makaroun MS, Arnold RM. Improving Code Status Documentation Rates Using Communication Skills Training in Vascular Surgery: A Quality Improvement Initiative. J Palliat Med 2022; 25:628-635. [PMID: 34990280 DOI: 10.1089/jpm.2021.0364] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Code status discussions are poorly understood by patients and variably performed by admitting providers, yet they are used as a quality metric. Surgical specialties, such as Vascular Surgery, admit patients with urgent and life-threatening illness. Surgical trainees are less likely to receive communication skills interventions when compared with nonsurgical specialties. Without a documented code status, nurses and physicians lack guidance on patient preference in the case of cardiopulmonary arrest and may deliver unwanted measures, which may also result in poor outcomes. Methods: We conducted a before-after Plan-Do-Study-Act quality improvement project between May 2018 and May 2019. A needs assessment included baseline code status documentation rates for the Vascular Surgery department admissions. A communication skills training (CST) and documentation intervention was provided to all Vascular Surgery trainees and advance practice providers (APPs). Departmental e-mails were sent over the 12-month intervention period, which demonstrated the code status documentation rates and served as reminders to document code status. Results: A total of 29 vascular surgery trainees and APPs received the intervention. At completion of the intervention, learners reported increased comfort initiating a code status discussion, making a recommendation for cardiopulmonary resuscitation (CPR) status, and having a strategy to discuss code status. A total of 2762 patient admissions were reviewed, with 1562 patient admissions occurring during the 12-month intervention period. The average code status documentation rate for the three months before the intervention was 7.8%. At the end of the 12-month intervention, documentation rates were 44.9% and 6 months after completion of the study period, average rates remained 45.2%. There was no change in admission rates during the study period. Discussion: CST and regular reminders increased vascular surgery residents' and APPs' comfort in engaging in code status discussions. After intervention, documentation of code status discussions increased with persistence up to six months after the intervention.
Collapse
Affiliation(s)
- Alicia B Topoll
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason K Wagner
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karim M Salem
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joshua E Levenson
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michel S Makaroun
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
20
|
Iversen ED, Wolderslund M, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S, Ammentorp J. Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice. J Patient Cent Res Rev 2021; 8:307-314. [PMID: 34722798 DOI: 10.17294/2330-0698.1782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. Methods This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Results Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Conclusions Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.
Collapse
Affiliation(s)
- Else Dalsgaard Iversen
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Helle Poulsen
- Department of Gastrointestinal Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
| |
Collapse
|
21
|
Ito K, Uemura T, Yuasa M, Onishi E, Shiozawa Y, Ishikawa H, Ouchi K, Nakagawa S. The Feasibility of Virtual VitalTalk Workshops in Japanese: Can Faculty Members in the US Effectively Teach Communication Skills Virtually to Learners in Japan? Am J Hosp Palliat Care 2021; 39:785-790. [PMID: 34493061 DOI: 10.1177/10499091211044477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. OBJECTIVES To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. SETTING/SUBJECTS We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. MEASUREMENTS To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. RESULTS All learners (n = 48, male 79%) participated in the survey. The mean score of the learners' satisfaction was 4.69 or higher in all questions. The mean score of the virtual format's satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). CONCLUSION Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.
Collapse
Affiliation(s)
- Kaori Ito
- Division of Acute Care Surgery, Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takeshi Uemura
- Department of Geriatric Medicine, John A. Burns School of Medicine at the University of Hawai'i at Manoa, Honolulu, HI, USA
| | | | - Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.,Serious Illness Care Program, Ariadne Labs, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Columbia University, New York, NY, USA
| |
Collapse
|
22
|
Frydman JL, Gelfman LP, Lindenberger EC, Smith CB, Berns S, Kelley AS, Dow LA. Virtual Geritalk: Improving Serious Illness Communication of Clinicians Who Care for Older Adults. J Pain Symptom Manage 2021; 62:e206-e212. [PMID: 33631324 PMCID: PMC8380266 DOI: 10.1016/j.jpainsymman.2021.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
CONTEXT High quality communication is essential to older adults' medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (four days, 10 hours total). OBJECTIVES Our study evaluated the change in participants' self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course. METHODS Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed five-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication. RESULTS Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5-point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (P < 0.01) improvements in mean self-reported preparedness across all surveyed communication skills. CONCLUSION We show that a virtual communication skills training is feasible and effective. Our findings suggest that the innovative virtual Geritalk course has the potential to increase access to communication skills training, improve serious illness communication skills, and in improve the quality of care received by older adults with serious illness.
Collapse
Affiliation(s)
- Julia L Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education & Clinical Center, James J. Peters Veterans' Affairs Medical Center, Bronx, New York, USA
| | - Elizabeth C Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research, Education & Clinical Center, James J. Peters Veterans' Affairs Medical Center, Bronx, New York, USA
| | - Cardinale B Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Berns
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lindsay A Dow
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
23
|
van de Water LF, van den Boorn HG, Hoxha F, Henselmans I, Calff MM, Sprangers MAG, Abu-Hanna A, Smets EMA, van Laarhoven HWM. Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study. J Med Internet Res 2021; 23:e27824. [PMID: 34448703 PMCID: PMC8433928 DOI: 10.2196/27824] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods We designed a web-based, physician-assisted prediction tool—Source—to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds—a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making.
Collapse
Affiliation(s)
- Loïs F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Héctor G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Florian Hoxha
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mart M Calff
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
24
|
Onishi E, Uemura T, Nakagawa S, Yuasa M, Ito K, Ouchi K. Bringing VitalTalk to Japan-Assessing Clinicians' Needs in Serious Illness Communication Skills Training and Adaptation. Igaku kyoiku 2021; 52:345-347. [PMID: 34690414 PMCID: PMC8532538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Shunichi Nakagawa
- Adult Palliative Care Services, Columbia University, New York, NY, USA
| | | | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Serious Illness Care Program, Ariadne Labs, Boston, MA, USA
| |
Collapse
|
25
|
Onishi E, Nakagawa S, Uemura T, Shiozawa Y, Yuasa M, Ito K, Kobayashi Y, Ishikawa H, Ouchi K. Physicians' Perceptions and Suggestions for the Adaptation of a US-Based Serious Illness Communication Training in a Non-US Culture: A Qualitative Study. J Pain Symptom Manage 2021; 62:400-409.e3. [PMID: 33290856 PMCID: PMC8244824 DOI: 10.1016/j.jpainsymman.2020.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 01/08/2023]
Abstract
CONTEXT US-based serious illness communication training pedagogy has not been well studied outside of the United States. OBJECTIVES To explore the perception of a US-based, serious illness communication training pedagogy in a non-US culture and to identify aspects requiring cultural adaptations. METHODS In September 2019, we conducted a qualitative study using convenient sampling at two urban, academic medical centers in Tokyo, Japan. Semistructured interviews were conducted to Japanese physicians who participated in the four-hour VitalTalk training in Japanese. We explored six majored themes: 1) global impression of the training; 2) main goals from participation; 3) appropriateness of didactics; 4) role play experiences; 5) take away points from the training; and 6) changes in their own communication practice after the training. Interviews were transcribed, coded, and analyzed using phenomenological approach. RESULTS All 24 participants found the VitalTalk pedagogy novel and beneficial, stressing the importance of demonstrating empathy, reflecting on own skills, and recognizing the importance of feedback that emphasizes the use of specific words. Participants also pointed out that Japanese patients generally do not express their strong emotions explicitly. CONCLUSION Our study found empirical evidence that the VitalTalk pedagogy is perceived to be novel and beneficial in a non-US cultural setting. Cultural adaptations in expression and response to emotion may be required to maximize its efficacy in Japan. To meet the needs of clinical practice in Japan, further studies are needed to empirically test the suggested refinements for the VitalTalk pedagogy.
Collapse
Affiliation(s)
- Eriko Onishi
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.
| | - Shunichi Nakagawa
- Adult Palliative Care Services, Columbia University, New York, New York, USA
| | - Takeshi Uemura
- University Health Partners of Hawaii, Honolulu, Hawaii, USA
| | | | | | - Kaori Ito
- Division of Acute Care Surgery, Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuki Kobayashi
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hirono Ishikawa
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA; Serious illness care program, Ariadne Labs, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Wenham J, Best M, Kissane Ac DW. Systematic Review of Medical Education on Spirituality. Intern Med J 2021; 51:1781-1790. [PMID: 34142417 DOI: 10.1111/imj.15421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spirituality is a fundamental dimension of our human nature that impacts on medical care and yet is relatively neglected by medical education courses in Australia. AIM This systematic review was conducted to assess the curriculum content currently used to develop medical student understanding of, and engagement with, spirituality in the context of patient care. METHODS Studies published in English from 2010 to the review date were included in order to focus on the most recent curricula. Studies included medical students in undergraduate or postgraduate programs, doctors in resident training programs, and registrars. Interventions considered for inclusion were curriculum modules on communication skills in spirituality, spiritual needs assessments and holistic care planning. Six databases including PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched electronically using the following keywords and MeSH search terms:- 'medical students', 'doctor', 'physician', 'spirituality', 'spiritual care', 'religion', 'education', 'history taking' and 'communication skills training' from 2010 to 2020. RESULTS For 342 articles, three researchers screened the titles and abstracts; disagreements were resolved by discussion. Full-text articles were assessed for eligibility based on study and report characteristics: 17 papers were included in the analysis. Curriculum content of each study was reviewed. The following key features were employed frequently: chaplain shadowing, communications skills training, self-reflection, examining evidence and relationship building. CONCLUSION This review has determined the core content, aims and objectives to guide construction of spirituality curricula in Australian medical education. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- John Wenham
- Director, Clinical Medicine Stream, Broken Hill Department of Rural Health, Sydney Medical School, Corrindah Court, PO Box 457, Broken Hill, New South Wales, 2880, Australia
| | - Megan Best
- Associate Professor of Bioethics, Institute for Ethics and Society, The University of Notre Dame Australia, 104 Broadway, PO Box 944, BROADWAY, New South Wales, 2007
| | - David W Kissane Ac
- Chair of Palliative Medicine Research, The University of Notre Dame Australia, and, The Cunningham Centre for Palliative Care Research, St Vincent's Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
27
|
Banerjee SC, Haque N, Schofield EA, Williamson TJ, Martin CM, Bylund CL, Shen MJ, Rigney M, Hamann HA, Parker PA, McFarland DC, Park BJ, Molena D, Moreno A, Ostroff JS. Oncology Care Provider Training in Empathic Communication Skills to Reduce Lung Cancer Stigma. Chest 2021; 159:2040-2049. [PMID: 33338443 PMCID: PMC8129726 DOI: 10.1016/j.chest.2020.11.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 05/04/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication. RESEARCH QUESTION What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)? METHODS Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP. RESULTS OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P < .05], stigma-mitigating skills [t(28) = -3.88; P < .001], and breadth of communication skill use [t(28) = -2.91; P < .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy. INTERPRETATION Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.
Collapse
Affiliation(s)
- Smita C Banerjee
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY..
| | - Noshin Haque
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Schofield
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy J Williamson
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chloe M Martin
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carma L Bylund
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Megan J Shen
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maureen Rigney
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi A Hamann
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A Parker
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel C McFarland
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aimee Moreno
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie S Ostroff
- From the Department of Psychiatry and Behavioral Sciences (S. C. Banerjee, N. Haque, E. A. Schofield, T. J. Williamson, C. M. Martin, P. A. Parker, D. C. McFarland, A. Moreno, J. S. Ostroff), Memorial Sloan Kettering Cancer Center, New York, NY; Department of Public Relations (C. L. Bylund), Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL; Department of Medicine (M. J. Shen), Weill Cornell Medical College, New York, NY; Support Initiatives, GO2 Foundation for Lung Cancer (M. Rigney), Washington, DC; Department of Psychology and the Department of Family and Community Medicine (H. A. Hamann), University of Arizona, Tucson, AZ; and Department of Surgery (B. J. Park, D. Molena), Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
28
|
Pless A, Hari R, Brem B, Woermamm U, Schnabel KP. Using self and peer video annotations of simulated patient encounters in communication training to facilitate the reflection of communication skills: an implementation study. GMS J Med Educ 2021; 38:Doc55. [PMID: 33824891 PMCID: PMC7994885 DOI: 10.3205/zma001451] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/31/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Background: The mandatory communication skills course for fourth-year medical students at the University of Bern Medical School aims to prepare students for challenging communication situations. Students role-play four different scenarios with simulated patients (SPs) and receive feedback from the patient's perspective. The scenarios are video-recorded and uploaded onto the University's virtual learning environment. Students can watch and annotate their own videos and give others access to view them. Project description: Although the course is well liked by students, we identified three areas for improvement: lack of faculty feedback; little active use of the video-recordings;lack of opportunity for students to discuss their experiences with each other. We aimed to address these shortcomings by introducing an additional learning task: students are asked to annotate a section of the video in which they had performed well, and one in which they thought they could have done better, in both their own and a colleague's videos. These video clips and annotations served as the basis of a subsequent two-hour small-group seminar with a physician tutor. The course was evaluated by a mandatory online questionnaire. Results: All 247 students completed the questionnaire. The annotation tool and task were deemed to be comprehensible. Students believed they had learnt more from annotating a peers' video than from their own and most thought being assessed by peers was acceptable. The physician tutors' comments were largely deemed as helpful. The mean mark for the course given by students was 4.6 (median 5) (1=very poor, 6=very good). Conclusion: A communication skills course expanded by video-annotations and group discussions with a physician tutor was shown to be feasible and was well received by students and faculty.
Collapse
Affiliation(s)
- Anina Pless
- University of Bern, Institute of Primary Healthcare, Bern, Switzerland
| | - Roman Hari
- University of Bern, Institute of Primary Healthcare, Bern, Switzerland
| | - Beate Brem
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Ulrich Woermamm
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Kai P. Schnabel
- University of Bern, Institute for Medical Education, Bern, Switzerland
| |
Collapse
|
29
|
Brem BG, Schnabel KP, Woermann U, Hari R, Pless A. "Telephone consultation for medical emergencies" - development, implementation and evaluation of a course in identifying and handling medical emergencies via telephone for 5 th year medical students. GMS J Med Educ 2021; 38:Doc63. [PMID: 33824899 PMCID: PMC7994869 DOI: 10.3205/zma001459] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
Objectives: Advising patients seeking medical guidance while communicating with them via telephone is a highly relevant skill in clinical daily life. However, telephone consultations differ from face-to-face interactions: clinical examination is nearly impossible and visual signals cannot be observed. Thus, telephone consultations require specific skills training. This article describes the development, implementation and evaluation of a course, "Telephone Consultation for Medical Emergencies", for 5th year medical students at the University of Bern, Switzerland. Methods: Following the evidence in the literature for telephone consultations, we developed guidelines for effective communication via telephone. After self-study of preparatory material, learners engaged in telephone consultations with simulated patients (SP) at the simulation center. They received multi-dimensional feedback regarding the encounter. Results: The course was successfully implemented in 2012. Evaluations showed the course to be well-received by students. In a survey, students agreed that they had learned many new skills and that they considered this learning as being important in their future employment. They felt that the SP feedback was helpful and that being observed by peer-students during the encounter or filling in a checklist while observing peer-students in other encounters added to their learning. During the debriefing of the simulation with a clinical expert, students judged the scenarios as realistic and relevant, praised the SP performances and identified that the most instructive aspect of the training was the opportunity to practice and to get feedback. Conclusion: Telephone consultations require specific skills that should be trained. The current Covid-19 pandemic and the recommendations of government institutions for patients to contact healthcare professionals primarily via telephone stress the importance of adequately training these skills. In this publication we describe a feasible and viable format for implementing this process.
Collapse
Affiliation(s)
| | | | - Ulrich Woermann
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Roman Hari
- University of Bern, Institute of Primary Health Care, Bern, Switzerland
| | - Anina Pless
- University of Bern, Institute of Primary Health Care, Bern, Switzerland
| |
Collapse
|
30
|
Banerjee SC, Staley JM, Alexander K, Parker PA, Haviland KS, Moreno A, Walters CB. Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy. Ann LGBTQ Public Popul Health 2021; 2:35-52. [PMID: 37475763 PMCID: PMC10358276 DOI: 10.1891/lgbtq-2020-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs' skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients' healthcare experience.
Collapse
Affiliation(s)
| | | | | | | | | | - Aimee Moreno
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
31
|
Knie K, Schwarz L, Frehle C, Schulte H, Taetz-Harrer A, Kiessling C. To zoom or not to zoom - the training of communicative competencies in times of Covid 19 at Witten/Herdecke University illustrated by the example of "sharing information". GMS J Med Educ 2020; 37:Doc83. [PMID: 33364362 PMCID: PMC7740036 DOI: 10.3205/zma001376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 05/25/2023]
Abstract
Since October 2018, a longitudinal communication curriculum for medical students has been implemented at Witten/Herdecke University. In the summer semester 2020, the concept for the 4th preclinical semester included a practical training on "sharing information", which consisted of three two-hour face-to-face sessions with simulated patients (SP). Due to the Covid 19 pandemic, teaching was changed to an inverted classroom concept combining asynchronous and synchronous teaching. The students worked at the beginning of the semester on an e-learning module of the learning platform docCom.deutsch on the topic "sharing information" using reflection and processing tasks. In two digital sessions, the students then were able to practice discharge interviews and discussions about risk communication illustrated by the example of screening methods for cancer prevention. In the first zoom session, students practiced in role-plays among themselves. In the second zoom session, they practiced with SP. The evaluation results revealed that 76% of the responding students considered working with the e-learning module as a good preparation for the interviews. According to the evaluation results, satisfaction with the Zoom meeting including SP contact was slightly higher than those with role-plays among themselves. Although the group atmosphere was rated by all responding students as conducive to learning, almost half of them confirmed that using Zoom significantly impaired the atmosphere (47%). In retrospect, the conversion of the communication training to a digital format worked better than expected from both the perspective of teachers and students. The students explicitly appreciated working with SP. From the teachers' perspective, some specific aspects of successful communication were difficult to reflect on, e.g. non-verbal communication. The use of e-learning as a preparation for practical exercises has proven successful and will be continued in the future.
Collapse
Affiliation(s)
- Katharina Knie
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Laura Schwarz
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Clarissa Frehle
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Heike Schulte
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Angelika Taetz-Harrer
- Universität Witten/Herdecke, Fakultät für Gesundheit, Studiendekanat Humanmedizin, Witten, Germany
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Witten, Germany
| | - Claudia Kiessling
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| |
Collapse
|
32
|
Bylund CL, Adams KA, Sinha T, Afana A, Yassin MA, El Geziry A, Nauman A, Al-Romaihi S, Anand A. The Impact of a Communication Skills Workshop on Doctors' Behavior Over Time. Adv Med Educ Pract 2020; 11:289-294. [PMID: 32346319 PMCID: PMC7167260 DOI: 10.2147/amep.s216642] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Communication skills education is still relatively new in some non-Western countries. Further, most evaluation research on communication skills education examines only short-term results. In our communication skills program in Qatar, we aimed to: 1) assess the impact of the communication skills course on participant skills application; 2) assess the length of time since course completion associated with participant skills application; and 3) assess participant gender or clinical position associated with participant skills application. METHODS Seven hundred and thirty-eight physicians completed a seven-module communication skills course. Participants reflected on what they learned in the course and how the course had impacted their behavior through a nine-item online survey that included a four-item Communication Workshop Impact Scale (CWIS), three open questions, and two demographic questions. To assess the effect of time since workshop on outcomes, we stratified the respondents into five groups based on how long ago they had completed the course. RESULTS Three hundred and thirty-two physicians completed the survey. Participants reported agreement with the items on the CWIS: X=4.45 (range 1-5; SD=0.70). When asked which skill(s) they had been able to implement in their clinical practice, 235 gave a specific response, either a specific communication skill (eg, ask open questions), a higher-order category of skills (eg, questioning skills), or the name of one of the seven modules of the course. Only 28 participants listed the name of a skill or module name that they had not been able to implement. There was no evidence of difference in CWIS score based on time since course completion. There was no gender difference; however, residents had significantly lower CWIS scores than fellows (4.70 vs. 4.29, p<0.05). CONCLUSION Participants reported agreement with response items about the impact of the course on their skills application. Participant gender did not play a significant role, but residents had lower scores than did fellows. Furthermore, most physicians (92%) were able to name something specific that they had learned from the course and were currently implementing in their practice. Positive outcomes of the course did not seem to diminish over time. Future research should identify whether observable communication behavior matches the self-reported behavior.
Collapse
Affiliation(s)
- Carma L Bylund
- College of Journalism and Communications, College of Medicine, UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
- Department of Anesthesia, Sidra Medicine, Doha, Qatar
| | - Kelsy-Ann Adams
- College of Journalism and Communications, College of Medicine, UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Tripiti Sinha
- Department of Anesthesia, Sidra Medicine, Doha, Qatar
| | - Abdelhamid Afana
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology/Oncology, Hamad Medical Corporation, Doha, Qatar
| | | | - Awais Nauman
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ambika Anand
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
33
|
Hsu TH, Li IC, Fang CK, Tang WR, Lin CT. A preliminary study of the effectiveness of cancer communication skills training for interdisciplinary staff. Jpn J Clin Oncol 2020; 49:734-742. [PMID: 31063193 DOI: 10.1093/jjco/hyz065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies have emphasized that the disclosure of a diagnosis and prognosis is the doctor's responsibility, but little attention has been given to the importance of interdisciplinary cooperation. OBJECTIVE Therefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan. METHODS This study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated. RESULTS Significant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors' scores for 'disclosing information in a monotonous tone' showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales' scores. CONCLUSION The CST for interdisciplinary professionals improved their cooperation and communication skills.
Collapse
Affiliation(s)
- Tsui-Hsia Hsu
- School of Nursing, National Yang-Ming University, Taiwan.,Health Promotion Administration, Ministry of Health and Welfare
| | - I-Chuan Li
- School of Nursing, National Yang-Ming University, Taiwan
| | - Chun-Kai Fang
- Department of Psychiatry and Suicide Prevention Center.,Department of Medicine, Mackay Medical College, New Taipei.,Mackay Memorial Hospital, Taipei.,Taiwan Psycho-Oncology Society
| | - Woung-Ru Tang
- Taiwan Psycho-Oncology Society.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan
| | | |
Collapse
|
34
|
Mohiaddin H, Malik A, Murtagh GM. Maximizing the acquisition of core communication skills at the start of medical training. Adv Med Educ Pract 2019; 10:727-735. [PMID: 31695549 PMCID: PMC6717721 DOI: 10.2147/amep.s212727] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient (SP) contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the SP encounter. AIM To explore the impact of real patient contact on the experience of communication skills training and SP contact for first-year medical undergraduate students. METHODS As part of the 6-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a SP encounter. The performance of both groups was analyzed alongside follow-up focus group data from a sample of the study group. RESULTS Quantitative analysis revealed there was no significant difference in communication skills during a scored SP interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalize their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the SP setting. CONCLUSION Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation, there needs to be a clear curricular purpose at pedagogical, practical and organizational levels. Students' experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching.
Collapse
Affiliation(s)
- Hasan Mohiaddin
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Anam Malik
- Faculty of Medicine, Sir Alexander Fleming Building, South Kensington Campus, Imperial College London, LondonSW7 2AZ, UK
| | - Ged M Murtagh
- Division of Surgery, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, LondonW2 1BL, UK
| |
Collapse
|
35
|
Vermylen JH, Wood GJ, Cohen ER, Barsuk JH, McGaghie WC, Wayne DB. Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News. J Pain Symptom Manage 2019; 57:682-687. [PMID: 30472316 DOI: 10.1016/j.jpainsymman.2018.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Physician communication impacts patient outcomes. However, communication skills, especially around difficult conversations, remain suboptimal, and there is no clear way to determine the validity of entrustment decisions. The aims of this study were to 1) describe the development of a simulation-based mastery learning (SBML) curriculum for breaking bad news (BBN) conversation skills and 2) set a defensible minimum passing standard (MPS) to ensure uniform skill acquisition among learners. INNOVATION An SBML BBN curriculum was developed for fourth-year medical students. An assessment tool was created to evaluate the acquisition of skills involved in a BBN conversation. Pilot testing was completed to confirm improvement in skill acquisition and set the MPS. OUTCOMES A BBN assessment tool containing a 15-item checklist and six scaled items was developed. Students' checklist performance improved significantly at post-test compared to baseline (mean 65.33%, SD = 12.09% vs mean 88.67%, SD = 9.45%, P < 0.001). Students were also significantly more likely to have at least a score of 4 (on a five-point scale) for the six scaled questions at post-test. The MPS was set at 80%, requiring a score of 12 items on the checklist and at least 4 of 5 for each scaled item. Using the MPS, 30% of students would require additional training after post-testing. COMMENTS We developed a SBML curriculum with a comprehensive assessment of BBN skills and a defensible competency standard. Future efforts will expand the mastery model to larger cohorts and assess the impact of rigorous education on patient care outcomes.
Collapse
Affiliation(s)
- Julia H Vermylen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Gordon J Wood
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elaine R Cohen
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Diane B Wayne
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
36
|
Pers M, Górski S, Stalmach-Przygoda A, Balcerzak Ł, Szopa M, Karabinowska A, Świerszcz J, Perera I, Cebula G. Clinical communication course and other factors affecting patient-centered attitudes among medical students. Folia Med Cracov 2019; 59:81-92. [PMID: 31659352] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patient-centered care (PCC) is associated with better relationships, resulting in a decrease in symptoms, hospitalizations and health costs. However, studies analyzing factors influencing patient-centered attitudes show ambiguous results. The purpose was to assess the impact of the Clinical Communication Course (CCC) in Jagiellonian University, Cracow and other factors on Patient-Centered Attitudes (PCA) and Attitude toward Clinical Skills Learning (CSLA). METHODS We retrospectively compared Polish-speakers (CCC+, n = 160), English-speakers (CCCen+, n = 55) after the CCC and upperclassmen Polish-speakers without it (CCC-, n = 122). Validated questionnaires to measure PCA (Leeds Attitude Toward Concordance II and Patient-Practitioner Orientation Scale (PPOS)) and for CSLA (Communication Skills Attitude Scale with negative subscale (CSAS-N)) were used. The higher the scores, the more PCA, and negative CSLA respectively. Students completed questionnaires and answered questions regarding age, sex, motivation to study (coded as humanitarian - MotHUM, financial - MotFIN, combination - MotMIX) and considered specialization - coded as with more human contact (family medicine, psychiatry, pediatrics - SpecHUM) and others (SpecNHUM). Statistics were prepared in R. RESULTS CCC+ scored higher in PPOS (2.91 vs. 2.74; p = 0.003) than CCC- and higher in CSAS-N than CCCen+ (31.22 vs. 28.32; p = 0.004). In CCC+ SpecHUM scored lower than SpecNHUM in PPOS (2.65 vs. 2.94, p = 0.012). MotFIN scored higher then MotMIX in PPOS (3.01 vs. 2.7, p = 0.036). Correlations were statistically significant. CONCLUSION CCC improved PCA in CCC+. They showed more negative CSLA than CCCen+. Among CCC+, surprisingly, SpecNHUM presented more PCA than SpecHUM as well as MotFIN compared to MotMIX.
Collapse
Affiliation(s)
- Michał Pers
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Górski
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland.
| | | | - Łukasz Balcerzak
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Szopa
- Department of Medical Education, Jagiellonian University Medical College, Kraków; Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Alaksandra Karabinowska
- Students' Scientific Group of Medical Education, Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Jolanta Świerszcz
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Ian Perera
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Cebula
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
37
|
Collins K, Hopkins A, Shilkofski NA, Levine RB, Hernandez RG. Difficult Patient Encounters: Assessing Pediatric Residents' Communication Skills Training Needs. Cureus 2018; 10:e3340. [PMID: 30473973 PMCID: PMC6248659 DOI: 10.7759/cureus.3340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Difficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described. Materials and methods We used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents’ experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results. Results These survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as “fair” or “good” (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters. Discussion We found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors. Conclusions Next steps include creating a “Difficult Encounters” communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to promote resident growth.
Collapse
Affiliation(s)
- Kimberly Collins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Akshata Hopkins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Nicole A Shilkofski
- General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Rachel B Levine
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | | |
Collapse
|
38
|
Feraco AM, Brand SR, Gagne J, Sullivan A, Block SD, Wolfe J. Development of the "Day 100 Talk": Addressing existing communication gaps during the early cancer treatment period in childhood cancer. Pediatr Blood Cancer 2018; 65:e26972. [PMID: 29384265 PMCID: PMC5911188 DOI: 10.1002/pbc.26972] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Families' communication needs during the early cancer treatment period (ECTP) may not be optimally met by current practices. We sought to identify potential communication gaps and to ameliorate these by developing a novel in-depth conversation between families and their pediatric oncologists, the "Day 100 Talk" (D100), during the ECTP. PROCEDURE We conducted semistructured interviews with parents and patients undergoing childhood cancer treatment for < 7 months. Interviews sought to elicit perceived communication gaps regarding cancer care and inform D100 development. Following qualitative analysis of interview responses, we developed a three-part D100 conversation tool consisting of a preparatory family worksheet, a conversation guide, and a family summary sheet. We presented the tool during interviews and a focus group with pediatric oncology providers and revised it to incorporate provider input. RESULTS Twenty-two stakeholders (six parents, five adolescents, and 11 providers) participated in interviews or a focus group. Parents and patients perceived insufficient anticipatory guidance as the most important communication gap. They also reported sometimes withholding worries and cancer-related beliefs. Meanwhile, oncology providers worried about "opening Pandora's Box" and limited clinical time. Additionally, providers reported employing indirect methods such as surmising to determine families' needs and relying on psychosocial clinicians to engage families around potentially "taboo" issues of emotional coping and spirituality. CONCLUSION Creating a communication occasion (D100), ensuring complementary disciplinary expertise through joint participation by oncologists and psychosocial clinicians, and providing a conversation tool to prompt disclosure by families and facilitate anticipatory guidance may ameliorate existing communication gaps during the ECTP.
Collapse
Affiliation(s)
- Angela M. Feraco
- Dana-Farber Cancer Institute, Boston, MA,Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston MA
| | - Sarah R. Brand
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA
| | | | - Amy Sullivan
- Harvard Medical School, Boston, MA,Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan D. Block
- Dana-Farber Cancer Institute, Boston, MA,Harvard Medical School, Boston, MA,Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston MA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Boston, MA,Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| |
Collapse
|
39
|
Miller DC, Sullivan AM, Soffler M, Armstrong B, Anandaiah A, Rock L, McSparron JI, Schwartzstein RM, Hayes MM. Teaching Residents How to Talk About Death and Dying: A Mixed-Methods Analysis of Barriers and Randomized Educational Intervention. Am J Hosp Palliat Care 2018; 35:1221-1226. [PMID: 29642710 DOI: 10.1177/1049909118769674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We present a pilot study exploring the effects of a brief, 30-minute educational intervention targeting resident communication surrounding dying in the intensive care unit (ICU). We sought to determine whether simulation or didactic educational interventions improved resident-reported comfort, preparation, and skill acquisition. We also sought to identify resident barriers to using the word "dying." METHODS In this mixed-methods prospective study, second- and third-year medical residents were randomized to participate in a simulation-based communication training or a didactic session. Residents completed a pre-post survey after the sessions evaluating the sessions and reflecting on their use of the word "dying" in family meetings. RESULTS Forty-five residents participated in the study. Residents reported increases in comfort (Mean [M]-pre = 3.3 [standard deviation: 0.6], M-post = 3.7 [0.7]; P < .01, Cohen d = 0.75) and preparation (M-pre = 3.4 [0.7], M-post = 3.9 [0.6]; P < .01, d = 1.07) using the word "dying" after both the simulation and didactic versions. Residents randomized to the simulation reported they were more likely to have learned new skills as compared to residents in the didactic (M-simulation = 2.2 [0.4], M-didactic = 1.9 [0.3]; P = .015, d = 0.80). They estimated that they used the word "dying" in 50% of their end-of-life (EOL) conversations and identified uncertain prognosis as the main barrier to explicitly stating the word "dying." CONCLUSION A 30-minute educational intervention improves internal medicine residents' self-reported comfort and preparation in talking about death and dying in the ICU. Residents in simulation-based training were more likely to report they learned new skills as compared to the didactic session. Residents report multiple barriers to using the word "dying" EOL conversations.
Collapse
Affiliation(s)
- David C Miller
- 1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Amy M Sullivan
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,3 Carl J. Shapiro Center for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Morgan Soffler
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brett Armstrong
- 3 Carl J. Shapiro Center for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asha Anandaiah
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laura Rock
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jakob I McSparron
- 4 Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard M Schwartzstein
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,3 Carl J. Shapiro Center for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret M Hayes
- 2 Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,3 Carl J. Shapiro Center for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
40
|
Christie D, Glew S. A clinical review of communication training for haematologists and haemato-oncologists: a case of art versus science. Br J Haematol 2017; 178:11-19. [PMID: 28543173 DOI: 10.1111/bjh.14606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The art of communication at times seems at odds with the science of medicine. Poor communication is associated with risks for patient and physician. Communication skills are highly relevant for haematologists and are associated with increased physician and patient satisfaction, positive psychosocial outcomes and possible health outcomes. Medical communication training has recently become widespread but is largely restricted to junior medical professionals. In haematology, the proliferation of high quality communication skills is low and there are few interventions catering for the required skillset. A review identified five applicable interventions for haematologists. There is variation in intervention length and structure, and most studies measure targeted skill fidelity rather than patient outcomes. Work on motivation and empowerment holds potential for haematological conditions, but is largely absent from care. This review highlights the need for new interventions for haematologists which focus on producing and maintaining positive patient outcomes.
Collapse
Affiliation(s)
- Deborah Christie
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK.,UCL Institute of Epidemiology and Public Health, London, UK
| | - Sarah Glew
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK
| |
Collapse
|
41
|
Ayn C, Robinson L, Nason A, Lovas J. Determining Recommendations for Improvement of Communication Skills Training in Dental Education: A Scoping Review. J Dent Educ 2017; 81:479-488. [PMID: 28365612 DOI: 10.21815/jde.016.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/16/2016] [Indexed: 12/18/2022]
Abstract
Professional communication skills have a significant impact on dental patient satisfaction and health outcomes. Communication skills training has been shown to improve the communication skills of dental students. Therefore, strengthening communication skills training in dental education shows promise for improving dental patient satisfaction and outcomes. The aim of this study was to facilitate the development of dental communication skills training through a scoping review with compilation of a list of considerations, design of an example curriculum, and consideration of barriers and facilitators to adoption of such training. A search to identify studies of communication skills training interventions and programs was conducted. Search queries were run in three databases using both text strings and controlled terms (MeSH), yielding 1,833 unique articles. Of these, 35 were full-text reviewed, and 17 were included in the final synthesis. Considerations presented in the articles were compiled into 15 considerations. These considerations were grouped into four themes: the value of communication skills training, the role of instructors, the importance of accounting for diversity, and the structure of communication skills training. An example curriculum reflective of these considerations is presented, and consideration of potential barriers and facilitators to implementation are discussed. Application and evaluation of these considerations are recommended in order to support and inform future communication skills training development.
Collapse
Affiliation(s)
- Caitlyn Ayn
- Ms. Ayn is a Master of Arts student, School of Health and Human Performance, Dalhousie University; Dr. Robinson is Associate Professor, Health Promotion Division, School of Health and Human Performance, Dalhousie University; Dr. Nason is a former clinical instructor, Faculty of Dentistry, Dalhousie University, a Master of Education student, Mount Saint Vincent University, and a practicing dental professional; and Dr. Lovas is retired Associate Dean for Student Affairs, Faculty of Dentistry, Dalhousie University
| | - Lynne Robinson
- Ms. Ayn is a Master of Arts student, School of Health and Human Performance, Dalhousie University; Dr. Robinson is Associate Professor, Health Promotion Division, School of Health and Human Performance, Dalhousie University; Dr. Nason is a former clinical instructor, Faculty of Dentistry, Dalhousie University, a Master of Education student, Mount Saint Vincent University, and a practicing dental professional; and Dr. Lovas is retired Associate Dean for Student Affairs, Faculty of Dentistry, Dalhousie University.
| | - April Nason
- Ms. Ayn is a Master of Arts student, School of Health and Human Performance, Dalhousie University; Dr. Robinson is Associate Professor, Health Promotion Division, School of Health and Human Performance, Dalhousie University; Dr. Nason is a former clinical instructor, Faculty of Dentistry, Dalhousie University, a Master of Education student, Mount Saint Vincent University, and a practicing dental professional; and Dr. Lovas is retired Associate Dean for Student Affairs, Faculty of Dentistry, Dalhousie University
| | - John Lovas
- Ms. Ayn is a Master of Arts student, School of Health and Human Performance, Dalhousie University; Dr. Robinson is Associate Professor, Health Promotion Division, School of Health and Human Performance, Dalhousie University; Dr. Nason is a former clinical instructor, Faculty of Dentistry, Dalhousie University, a Master of Education student, Mount Saint Vincent University, and a practicing dental professional; and Dr. Lovas is retired Associate Dean for Student Affairs, Faculty of Dentistry, Dalhousie University
| |
Collapse
|
42
|
Bylund CL, Alyafei K, Anand A, Al Marri A, Omer W, Sinha T, Alam W, Abdelrahim H, Al-Khal A. Implementing and tailoring a western-developed communication skills training program for graduate medical trainees in Qatar. Int J Med Educ 2017; 8:16-18. [PMID: 28088778 PMCID: PMC5275747 DOI: 10.5116/ijme.5856.72b4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/18/2016] [Indexed: 05/29/2023]
Affiliation(s)
- Carma L. Bylund
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Alyafei
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Ambika Anand
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Walid Omer
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Tripiti Sinha
- Department of Anesthesia, Hamad Medical Corporation, Doha, Qatar
| | - Wahila Alam
- Department of Geriatrics, Hamad Medical Corporation, Doha, Qatar
| | - Huda Abdelrahim
- Center for Cultural Competence, Global and Public Health Division, Weill Cornell Medicine, Qatar, Doha, Qatar
| | | |
Collapse
|
43
|
Feraco AM, Brand SR, Mack JW, Kesselheim JC, Block SD, Wolfe J. Communication Skills Training in Pediatric Oncology: Moving Beyond Role Modeling. Pediatr Blood Cancer 2016; 63:966-72. [PMID: 26822066 PMCID: PMC5861499 DOI: 10.1002/pbc.25918] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/21/2015] [Accepted: 01/03/2016] [Indexed: 11/09/2022]
Abstract
Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatment-related or disease-related death. However, parents, patients, and providers report substantial communication deficits. Poor communication outcomes may stem, in part, from insufficient communication skills training, overreliance on role modeling, and failure to utilize best practices. This review summarizes evidence for existing methods to enhance communication skills and calls for revitalizing communication skills training within pediatric oncology.
Collapse
Affiliation(s)
- Angela M. Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Department of Medicine, Boston Children’s Hospital, Boston, MA,Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston MA
| | - Sarah R. Brand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Department of Medicine, Boston Children’s Hospital, Boston, MA,Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Jennifer C. Kesselheim
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA,Department of Medicine, Boston Children’s Hospital, Boston, MA,Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Susan D. Block
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Departments of Psychiatry and Medicine, Brigham and Women’s Hospital,Harvard Medical School Center for Palliative Care
| | - Joanne Wolfe
- Department of Medicine, Boston Children’s Hospital, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
44
|
Hilkert SM, Cebulla CM, Jain SG, Pfeil SA, Benes SC, Robbins SL. Breaking bad news: A communication competency for ophthalmology training programs. Surv Ophthalmol 2016; 61:791-798. [PMID: 27134009 DOI: 10.1016/j.survophthal.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
As the ophthalmology accreditation system undergoes major changes, training programs must evaluate residents in the 6 core competencies, including appropriately communicating bad news. Although the literature is replete with recommendations for breaking bad news across various non-ophthalmology specialties, no formal training programs exist for ophthalmology. There are many valuable lessons to be learned from our colleagues regarding this important skill. We examine the historic basis for breaking bad news, explore current recommendations among other specialties, and then evaluate a pilot study in breaking bad news for ophthalmology residents. The results of this study are limited by a small number of residents at a single academic center. Future studies from multiple training programs should be conducted to further evaluate the need and efficacy of formal communication skills training in this area, as well as the generalizability of our pilot training program. If validated, this work could serve as a template for future ophthalmology resident training and evaluation in this core competency.
Collapse
Affiliation(s)
- Sarah M Hilkert
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Ophthalmology, University of California San Diego/Ratner Children's Eye Center, La Jolla, California, USA
| | - Colleen M Cebulla
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shelly Gupta Jain
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Sheryl A Pfeil
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Susan C Benes
- Department of Ophthalmology and Visual Science, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shira L Robbins
- Department of Ophthalmology, University of California San Diego/Ratner Children's Eye Center, La Jolla, California, USA
| |
Collapse
|
45
|
Liu C, Scott KM, Lim RL, Taylor S, Calvo RA. EQClinic: a platform for learning communication skills in clinical consultations. Med Educ Online 2016; 21:31801. [PMID: 27476537 PMCID: PMC4967711 DOI: 10.3402/meo.v21.31801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Doctors' verbal and non-verbal communication skills have an impact on patients' health outcomes, so it is important for medical students to develop these skills. Traditional, non-verbal communication skills training can involve a tutor manually annotating a student's non-verbal behaviour during patient-doctor consultations, but this is very time-consuming. Tele-conference systems have been used in verbal communication skills training. METHODS We describe EQClinic, a system that enables verbal and non-verbal communication skills training during tele-consultations with simulated patients (SPs), with evaluation exercises promoting reflection. Students and SPs can have tele-consultations through the tele-consultation component. In this component, SPs can provide feedback to students through a thumbs-up/ thumbs-down tool and a comments box. EQClinic automatically analyses communication features in the recorded consultations, such as facial expressions, and provides graphical representations. Our 2015 pilot study investigated whether EQClinic helped students be aware of their non-verbal behaviour and improve their communication skills, and evaluated the usability of the platform. Students received automated feedback, and SP and tutor evaluations, and then completed self-assessment and reflection questionnaires. RESULTS Eight medical students and three SPs conducted 13 tele-consultations using EQClinic. More students paid attention to their non-verbal communication and students who were engaged in two consultations felt more confident in their second consultation. Students rated the system positively, felt comfortable using it (5.9/7), and reported that the structure (5.4/7) and information (5.8/7) were clear. This pilot provides evidence that EQClinic helps, and positively influences, medical students practise their communication skills with SPs using a tele-conference platform. DISCUSSION It is not easy to improve non-verbal communication skills in a short time period. Further evaluation of EQClinic with larger numbers will ascertain learning gains and application in health professional training. Developing a standard model for the assessment of non-verbal behaviour in tele-consultations and providing students with more valuable evaluation and suggestions are part of our future work.
Collapse
Affiliation(s)
- Chunfeng Liu
- School of Electrical and Information Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Karen M Scott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Renee L Lim
- School of Electrical and Information Engineering, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Silas Taylor
- Office of Medical Education, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Rafael A Calvo
- School of Electrical and Information Engineering, The University of Sydney, Sydney, NSW, Australia;
| |
Collapse
|
46
|
Abstract
This article highlights the importance of effective communication skills for nurses. It focuses on core communication skills, their definitions and the positive outcomes that result when applied to practice. Effective communication is central to the provision of compassionate, high-quality nursing care. The article aims to refresh and develop existing knowledge and understanding of effective communication skills. Nurses reading this article will be encouraged to develop a more conscious style of communicating with patients and carers, with the aim of improving health outcomes and patient satisfaction.
Collapse
|
47
|
Ditton-Phare P, Halpin S, Sandhu H, Kelly B, Vamos M, Outram S, Bylund CL, Levin T, Kissane D, Cohen M, Loughland C. Communication skills in psychiatry training. Australas Psychiatry 2015; 23:429-31. [PMID: 26104774 DOI: 10.1177/1039856215590026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature. CONCLUSIONS The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice.
Collapse
Affiliation(s)
- Philippa Ditton-Phare
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, and; School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Sean Halpin
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW, Australia
| | - Harsimrat Sandhu
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Brian Kelly
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Translational Neuroscience and Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Marina Vamos
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, and; School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Sue Outram
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation, Weill Cornell Medical College, Doha-Qatar
| | - Tomer Levin
- Department of Psychiatry and Behavioral Health, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, and; Schizophrenia Research Institute (SRI), Australia
| | - Martin Cohen
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Carmel Loughland
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Translational Neuroscience and Mental Health, Mater Hospital Campus, Newcastle, NSW, and; Schizophrenia Research Institute (SRI), Australia
| |
Collapse
|
48
|
Siminoff LA, Traino HM, Genderson MW. Communicating Effectively about Organ Donation: A Randomized Trial of a Behavioral Communication Intervention to Improve Discussions about Donation. Transplant Direct 2015; 1. [PMID: 26146659 DOI: 10.1097/TXD.0000000000000513] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Families' refusal to authorize solid organ donation contributes to the organ deficit in the United States. The importance of communication to reducing refusal to requests for solid organ donation at the bedside and thus increasing the supply of transplantable organs cannot be overstated. This research compares two versions of an innovative communication skills training program for Organ Procurement Organization (OPO) request staff, Communicating Effectively About Donation (CEaD), designed to improve the quantity and quality of organ donation discussions with family decision makers (FDM) of deceased patients. METHODS We conducted a parallel-group randomized controlled trial of the CEaD intervention, comparing an online only version of the training (CEaD1) with the online version bolstered with in-person practice and feedback (CEaD2). Survey and interview data were collected from 1,603 FDMs and 273 requesters to assess the impact of both versions of the CEaD on requesters' communication skills and behaviors; the rate of family authorization to solid organ donation were obtained from administrative data provided by 9 OPOs. RESULTS Results revealed higher rates of authorization for requesters with less tenure (78% to 89%, p < .03) for both versions; however, CEaD1 also increased authorization rates for requesters with three or more years of experience (89% to 92%, p < .03). Both conditions resulted in an improvement in overall communication quality. CONCLUSIONS We conclude that the CEaD was effective in improving requesters' communication skills, rates of family authorization to organ donation, and the overall quality of the donation experience.
Collapse
|
49
|
Abstract
The aim of these two PhD thesis are to develop a guideline on doctor-patient communication skills based on cultural characteristics of Southeast Asian context and to develop communication skills training for nurses to enhance their contribution to the informed consent and shared decision making process, in the same context. These studies started with qualitative methods; including grounded theory methodology, by exploring doctors', patients', medical students' and nurses' perceptions on the current and desired communication skills in which influenced by culture. Based on the results, we design communication skills training and evaluate the training with quantitative methods, using pre and post test studies. Southeast Asian desired ideal partnership style in communicating with their doctors. More emphasize on basic skills such as listening to subtle non-verbal cues are needed for doctors and nurses. A guideline on doctor-patient communication tailored to local culture was developed as well as training for nurses using 4CID design to enhance their contribution to the shared decision making process. To promote two-way interaction between doctors and patients and between health professionals require mastering basic skills in communicating with people, such as explorations on the unspoken concern. In a culturally hierarchical context of Indonesia, this two-way interaction is quite a challenge. To generalize our studies to other culture, more studies with rigorous methods should follow. To promote the use of basic skills in communicating with patients to approach the desired partnership communication style in Southeast Asian context, we need to use local evidences.
Collapse
Affiliation(s)
- Mora Claramita
- Department of Medical Education Faculty of Medicine, Gadjah Mada University, Radiopoetro Building 6th Floor, Jalan Farmako Sekip Utara, Yogyakarta, 55281 Indonesia
| | - Astrid Pratidina Susilo
- Faculty of Medicine, Mulawarman University, Jl. Kerayan, Kampus Gn. Kelua, Samarinda, 75119 East Kalimantan Indonesia
| |
Collapse
|
50
|
Meehan MP, Menniti MF. Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's Experiential Learning Theory. J Vet Med Educ 2014; 41:371-383. [PMID: 25148880 DOI: 10.3138/jvme.1213-162r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Veterinary graduates require effective communication skills training to successfully transition from university into practice. Although the literature has supported the need for veterinary student communication skills training programs, there is minimal research using learning theory to design programs and explore students' perceptions of such programs. This study investigated veterinary students' perceptions of (1) their communication skills and (2) the usefulness of a communication skills training program designed with Kolb's Experiential Learning Theory (ELT) as a framework and implemented in a primary care setting. Twenty-nine final-year veterinary students from the Ontario Veterinary College attended a 3-week communication skills training rotation. Pre- and post-training surveys explored their communication objectives, confidence in their communication skills, and the usefulness of specific communication training strategies. The results indicated that both before and after training, students were most confident in building rapport, displaying empathy, recognizing how bonded a client is with his or her pet, and listening. They were least confident in managing clients who were angry or not happy with the charges and who monopolized the appointment. Emotionally laden topics, such as breaking bad news and managing euthanasia discussions, were also identified as challenging and in need of improvement. Interactive small-group discussions and review of video-recorded authentic client appointments were most valuable for their learning and informed students' self-awareness of their non-verbal communication. These findings support the use of Kolb's ELT as a theoretical framework and of video review and reflection to guide veterinary students' learning of communication skills in a primary care setting.
Collapse
|