Effect of a Coaching Intervention to Improve Cardiologist Communication

Abstract

ImportanceCommunication between cardiologists and patients can significantly affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching intervention to improve cardiologist communication has not been tested.ObjectiveTo evaluate the effect of a communication coaching intervention to teach evidence-based communication skills to cardiologists.Design, Setting, and ParticipantsThis 2-arm randomized clinical trial was performed at outpatient cardiology clinics at an academic medical center and affiliated community clinics, and from February 2019 through March 2020 recruited 40 cardiologists and audio recorded 161 patients in the preintervention phase and 240 in the postintervention phase. Data analysis was performed from March 2022 to January 2023.InterventionsHalf of the cardiologists were randomized to receive a coaching intervention that involved three 1:1 sessions, 2 of which included feedback on their audio-recorded encounters. Communication coaches taught 5 skills derived from motivational interviewing: (1) sitting down and making eye contact with all in the room, (2) open-ended questions, (3) reflective statements, (4) empathic statements, and (5) “What questions do you have?”Main Outcomes and MeasuresCoders unaware of study arm coded these behaviors in the preintervention and postintervention audio-recorded encounters (objective communication). Patients completed a survey after the visit to report perceptions of communication quality (subjective communication).ResultsAnalysis included 40 cardiologists (mean [SD] age, 47 [9] years; 7 female and 33 male) and 240 patients in the postintervention phase (mean [SD] age, 58 [15] years; 122 female, 118 male). When controlling for preintervention behaviors, cardiologists in the intervention vs control arm were more likely to make empathic statements (intervention: 52 of 117 [44%] vs control: 31 of 113 [27%]; P = .05); to ask, “What questions do you have?” (26 of 117 [22%] vs 6 of 113 [5%]; P = .002); and to respond with empathy when patients expressed negative emotions (mean ratio of empathic responses to empathic opportunities, 0.50 vs 0.20; P = .004). These effects did not vary based on patient or cardiologist race or sex. We found no arm differences for open-ended questions or reflective statements and were unable to assess differences in patient ratings due to ceiling effects.Conclusions and RelevanceIn this randomized clinical trial, a communication coaching intervention improved 2 key communication behaviors: expressing empathy and eliciting questions. Empathic communication is a harder-level skill that may improve the patient experience and information comprehension. Future work should explore how best to assess the effect of communication coaching on patient perceptions of care and clinical outcomes and determine its effectiveness in larger, more diverse samples of cardiologists.Trial RegistrationClinicalTrials.gov Identifier: NCT03464110

Explicit Training in Systematic Communication Strategies: A Pilot Study Exploring the Incorporation of Communication Tools by First-Year Residents in Simulation and in Clinical Practice

“… 13 And a randomized trial that evaluated a coaching intervention in which coaches taught 5 different communication skills to cardiologists revealed that those who received coaching had improved their ability to express empathy and elicit questions from patients. 9 Overall, these studies and others illustrate that communication skills can be improved through explicit instruction. 14 But one scoping review that assessed 151 articles on communication skills training programs concluded that many programs lacked curriculum structure, focus, and standardization, and the authors recommended a more rigorous approach to program development.…”

“…Thus, a wide range of approaches, frameworks, and curriculums have been developed to help health care professionals at any career stage learn a range of communication strategies. 6 – 13 For instance, surgery residents who took an 8-module training that covered empathic communication, end-of-life conversations, bad news delivery, and medical error disclosure reported positive learning experiences and increased confidence—results that correlated with patient perceptions of improved surgeon communication. 13 And a randomized trial that evaluated a coaching intervention in which coaches taught 5 different communication skills to cardiologists revealed that those who received coaching had improved their ability to express empathy and elicit questions from patients.…”

Racial Differences in Shared Decision-Making About Critical Illness

“…Training programs that teach clinicians the language of empathy may be a solution . However, given that the detection of emotion in others and empathic reactions are racialized, it is necessary to confirm whether the benefits of such training programs are experienced by all patients and caregivers . Further, communication training typically only focuses on managing negative emotions, which may be preferentially responsive to one specific sociocultural norm of communication.…”

A qualitative analysis of trust and distrust within patient-clinician interactions

“…We randomly selected 35 recordings from a larger intervention, randomized control trial [ 20 ]. We qualitatively coded these audio recordings ( n = 20 female, 15 male; Mage = 59.27, SD = 15.97; 66% had a bachelor's degree or higher) and their corresponding transcriptions of both white patient ( n = 13), white cardiologist interactions and Black patient ( n = 22), white cardiologist interactions in an academic medical center.…”