Improving Residents' End-of-Life Communication Skills with a Short Retreat: A Randomized Controlled Trial

Szmuilowicz, Eytan; El‐Jawahri, Areej; Chiappetta, Laurel; Kamdar, Mihir; Block, Susan D.

doi:10.1089/jpm.2009.0262

Cited by 113 publications

(118 citation statements)

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“…15,39 It may be particularly difficult for providers to discuss ACP with their heart failure patients for whom the trajectory of decline is highly variable and the timing and manner of death uncertain. 40 While efforts have been made to increase physician comfort with ACP conversations through communication trainings, 33,34,38,[41][42][43][44] medical education may need to incorporate updated illness models for non-malignant chronic diseases to help foster physician awareness of the relevance of ACP for patients with heart failure. 45 Even though patient openers were offered in just 13 of 71 consultations, the finding that some patients proactively and explicitly broach topics considered to be of a difficult and sensitive nature, such as prognosis, stands in stark contrast to findings from earlier studies characterizing a "conspiracy of silence" between patients, providers and family members over these topics.…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

et al. 2011

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BACKGROUND: Early provider-patient communication about future care is critical for patients with heart failure (HF); however, advance care planning (ACP) discussions are often avoided or occur too late to usefully inform care over the course of the disease. OBJECTIVE: To identify opportunities for physicians to engage in ACP discussions and to characterize physicians' responses to these opportunities. DESIGN: Qualitative study of audio-recorded outpatient clinic visits. PARTICIPANTS: Fifty-two patients≥65 years recently hospitalized for HF with one or more post-discharge follow-up outpatient visits, and their physicians (n=44), at two Veterans Affairs Medical Centers. APPROACH: Using content analysis methods, we analyzed and coded transcripts of outpatient follow-up visits for 1) patient statements pertaining to their future health or their future physical, psychosocial and spiritual/existential care needs, and 2) subsequent physician responses to patient statements, using an iterative consensus-based coding process. RESULTS: In 13 of 71 consultations, patients expressed concerns, questions, and thoughts regarding their future care that gave providers opportunities to engage in an ACP discussion. The majority of these opportunities (84%) were missed by physicians. Instead, physicians responded by terminating the conversation, hedging their responses, denying the patient's expressed emotion, or inadequately acknowledging the sentiment underlying the patient's statement. CONCLUSIONS: Physicians often missed the opportunity to engage in ACP despite openers patients provided that could have prompted such discussions. Communication training efforts should focus on helping physicians identify patient openers and providing a toolbox to encourage appropriate physician responses; in order to successfully leverage opportunities to engage in ACP discussions.KEY WORDS: qualitative research; advance care planning; heart failure; physician-patient communication.

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Section: Discussionmentioning

confidence: 99%

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

et al. 2011

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“…When proposing a training course on the disclosure of a bad news, the format is either classical classroom-training sessions on communication skills training courses [11,[40][41][42][43] or classical training plus standardized patient intervention [44][45][46][47][48]. Our approach lies in providing a distance-learning self-training tool that is not expensive and more manageable and less time-consuming for physicians with an often-overwhelming schedule.…”

Section: Discussionmentioning

confidence: 99%

Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) (Preprint)

Rat¹,

Ricci²,

Guillemin³

et al. 2017

Preprint

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Objective: Although most physicians in a medical setting have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and non-verbal skills, the ability to recognise and respond to patients' emotions and the importance of considering the patient environment such as culture and social level. How bad news is delivered can have consequences that may affect patients sometimes definitively.The goal of the project was to develop an online formative self-assessment tool for physicians to practice delivering bad news so as to minimize the deleterious effects of a poor way of disclosing bad news about a disease, whatever the disease.Methods: BReaking bAD NEws Tool (BRADNET) items were developed by using a review of the existing protocols and recommendations for delivering bad news and patient-physician communication assessment instruments and semi-structured interviews with patients and physicians. From this step, the themes were selected and then pooled before consensus on a good practices communication framework list. Items were then created from this list. To ensure that physicians found the BRADNET acceptable, understandable and relevant to their condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was then used to explore the impact of the items and messages and why and how these messages could change physicians' relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results:The good practices communication framework list consisted of 70 specific issues in breaking bad news pooled in 8 main domains: opening, preparing for the delivering bad news consultation, communication techniques, consultation content, attention, physician emotional management, shared decision making and relationship between the physician and the medical team. Following the construction of the items from this list, the items were extensively refined to make it more useful to the target audience.The BRADNET contains 71 items, each including a question, response options and a corresponding message. These 71 items were divided into 8 domains and assessed with 12 self-assessment sessions.2 Conclusion: The self-assessed training tool is Web-based. Its objective is to create a "space" for reflection. It contains items leading to self-reflection and messages introducing recommended communication behaviors. The interest in our approach lies in providing a distance-learning self-assessment tool that is not expensive and is more manageable and less time-consuming for physicians with often overwhelming schedules.

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“…1,2 This is despite the fact that competence in communication skills is required for residents and fellows in all disciplines. 3 Although baseline competence is not assured, studies show that educational interventions improve skills in areas such as communicating with patients with cancer 4 and patient-centered interviewing.…”

Section: Introductionmentioning

confidence: 99%

“…8 Earlier research demonstrates that focused interventions improve trainee skill in facilitating end-of-life conversations. 2,9,10 At Northwestern University, internal medicine residents completed a multimodality intervention in CSD skills including small group sessions, deliberate practice, and self-study. 9 Skill was significantly better in intervention group residents than controls, as assessed by performance on a simulated CSD with a standardized patient.…”

Section: Introductionmentioning

confidence: 99%

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Code Status Discussion Skill Retention in Internal Medicine Residents: One-Year Follow-Up

Wayne

Moazed

Cohen

et al. 2012

Journal of Palliative Medicine

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Background: Communicating with patients about goals of care is an important skill for internal medicine residents. However, many trainees are not competent to perform a code status discussion (CSD). A multimodality intervention improved skills in a group of first-year residents in 2011. How long these acquired CSD skills are retained is unknown. Objective: To study CSD skill retention one year after a multimodality intervention. Design: This was a longitudinal cohort study. Setting/Subjects: Thirty-eight second-year internal medicine residents in a university-affiliated internal medicine residency program participated in the study. Nineteen completed the intervention and 19 served as controls. Measurements: Mean CSD clinical skills examination (CSE) scores using an 18-item checklist were compared after the intervention (2011) and one year later (2012). Results: Intervention group residents performed significantly better than residents in the control group (71.9% (standard deviation [SD] = 16.0%) versus 54.7% (SD = 17.1%; p < 0.001) at one-year follow-up. Intervention group residents retained their CSD skills at one year as performance was 75.1% in 2011 and 71.9% in 2012 ( p = 0.46). Control group residents did not develop additional CSD skills as 2011 checklist performance was 53.2% and 2012 performance was 54.7% ( p = 0.78). Conclusions: CSD skills taught in a rigorous curriculum are retained at one-year follow-up. Residents in the control group did not acquire new CSD skills despite an additional year of training and clinical experience. Further study is needed to link improved CSD skills to better patient care quality.

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Improving Residents' End-of-Life Communication Skills with a Short Retreat: A Randomized Controlled Trial

Abstract: A short course for residents can significantly improve specific elements of resident EOL conversation performance, including the ability to respond to emotional cues.

Cited by 113 publications

References 40 publications

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

Missed Opportunities for Advance Care Planning Communication During Outpatient Clinic Visits

Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET) (Preprint)

Code Status Discussion Skill Retention in Internal Medicine Residents: One-Year Follow-Up

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