Exploring End-of-Life Care Team Communication: An Interprofessional Simulation Study

Abstract

Effective team communication is necessary for the provision of high-quality health care. Yet, recent graduates from diverse health-care disciplines report inadequate training in communication skills and end-of-life care. This study explored the impact of a withdrawal of life-sustaining measures interprofessional simulation on team communication skills of students representing medicine, nursing, and social work. The 3-phase simulation required teams to communicate with the patient, family, and one another in the care of a seriously ill patient at the end of life. Team communication in the filmed simulations was analyzed via the Gap-Kalamazoo Communication Checklist. Results revealed fair to good communication across the 9 communication domains. Overall team communication was strongest in “shares information” and lowest in “understands the patient’s and family’s perspective” domains. Field notes revealed 5 primary themes— Team Dynamics, Awkwardness, Empathy is Everything, Build a Relationship, and Communicating Knowledge When You Have It—in the course of the data analysis. Logistical challenges encountered in simulation development and implementation are presented, along with proposed solutions that were effective for this study. This simulation provided an opportunity for interprofessional health-care provider students to learn team communication skills within an end-of-life care context.

Nursing Student Perceptions of End-of-Life Communication Competence

“…Over the past few decades, the provision of communication-focused education interventions, frequently simulation, has consistently led to enhanced knowledge, attitudes, and abilities 6-9 . However, some of the most difficult aspects of communicating with patients with serious illness continue to be conducting difficult conversations, or “breaking bad news,” and managing conflict 4,10-12 .…”

“…Over the past few decades, the provision of communicationfocused education interventions, frequently simulation, has consistently led to enhanced knowledge, attitudes, and abilities. [6][7][8][9] However, some of the most difficult aspects of communicating with patients with serious illness continue to be conducting difficult conversations, or "breaking bad news," and managing conflict. 4,[10][11][12] Given the importance of effective, transparent, and honest communication in palliative and end-of-life care, nurses must be adequately prepared to conduct all types of conversations, including difficult ones.…”

Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil

“…17,18 It is essential to listen to them, answer their questions, and understand their preferences in order to make them feel safer and help them maintain some sense of control and autonomy, which decreases stress and anxiety and increases satisfaction with healthcare. 3,19,20 Another demanding context involves communication with patients and families regarding diseases without therapeutic perspectives and/or end-of-life. 21 In these situations, care should aim to mitigate pain; include patients in present and future decision-making processes; encourage them to talk about important aspects of their lives, such as spirituality and preferences; and share information about dying and death, if they wish.…”

“…17,18 It is essential to listen to them, answer their questions, and understand their preferences in order to make them feel safer and help them maintain some sense of control and autonomy, which decreases stress and anxiety and increases satisfaction with healthcare. 3,19,20…”

Interdisciplinary simulation for nursing and medical students about final conversations: Catalyzing relationships at the end of life (CAREol)

“…Interprofessional patient and family-centered care at the end of life (EOL) aims to identify the needs and abilities of families to care for their loved ones, but also serves as a catalyst for communication among family members. While one might expect families to make decisions and form emotional bonds during an EOL experience, often the opposite occurs (Lippe et al, 2019;Hamano et al, 2021). Conversations about death and dying are difficult, uncomfortable, and frequently avoided due to cultural, spiritual, and family norms (Keeley, 2007;Sallnow et al, 2022).…”