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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Survivorship care planning after participation in communication skills training intervention for a consultation about lymphoma survivorship. Transl Behav Med 2015; 5:393-400. [PMID: 26622912 DOI: 10.1007/s13142-015-0326-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A survivorship care plan refers to a written summary of the treatment received and recommendations regarding surveillance and management of late effects. To provide evaluation of a communication skills training (CST) intervention to enhance the transition of lymphoma survivors to cancer survivorship. Nineteen oncologists specializing in lymphoma treatment were recruited and completed a survivorship CST workshop, and two standardized patient assessments (SPAs), one pretraining and one posttraining. Significant improvements in SPA scores were observed in six of the seven SPA assessment categories: use of survivorship care plan, review of disease and treatment details, long-term effects, potential late effects, specific physician recommendations, and additional health maintenance recommendations. The intervention had significant effects on physicians' uptake of new strategies and skills, as measured through pre- and posttraining SPAs, as well as on the physicians' self-efficacy about having these conversations.
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Bocquet C, Deruelle P. Quelles échelles psychométriques utiliser pour évaluer l’état psychologique de la femme enceinte ? ACTA ACUST UNITED AC 2014; 43:587-92. [DOI: 10.1016/j.jgyn.2014.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 06/05/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
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Udo C, Melin-Johansson C, Henoch I, Axelsson B, Danielson E. Surgical nurses’ attitudes towards caring for patients dying of cancer - a pilot study of an educational intervention on existential issues. Eur J Cancer Care (Engl) 2014; 23:426-40. [DOI: 10.1111/ecc.12142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 01/12/2023]
Affiliation(s)
- C. Udo
- Department of Health Sciences; Mid Sweden University; Östersund Sweden
- Health Care Sciences Post Graduate School; Karolinska Institute; Stockholm Sweden
| | | | - I. Henoch
- Institute of Health and Care Sciences; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Axelsson
- Department of General Surgery; Östersund Hospital; Östersund Sweden
| | - E. Danielson
- Department of Health Sciences; Mid Sweden University; Östersund Sweden
- Institute of Health and Care Sciences; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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Barth J, Lannen P. Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol 2011; 22:1030-1040. [DOI: 10.1093/annonc/mdq441] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Adriaansen M, van Achterberg T. The content and effects of palliative care courses for nurses: A literature review. Int J Nurs Stud 2008; 45:471-85. [PMID: 17509596 DOI: 10.1016/j.ijnurstu.2007.01.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Revised: 01/08/2007] [Accepted: 01/12/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The present literature review describes the literature (1990-2005) that concerns the effects of courses in palliative care at the pre- and postgraduate levels. DATA SOURCES A search was made for literature from the period between 1990 and 2005 using CINAHL, Pubmed and Psychlit, supplemented with a search for relevant systematic reviews from the Cochrane Library. DESIGN The research questions were directed on the areas of expertise and skills, the didactical methods, the effects of the courses and the standards to measure these effects. RESULTS The studies were all focused on general palliative care. Out of 27 studies 21 reported positive effects for communication, attitude, empathy and pain. Six of these 21 positive trails were studies with good quality designs, whereas 15 had moderate designs. The six studies with a lack of effects was one study with good quality and five studies with moderate quality designs. The effects on patients were described in only a few cases. There was still frequent use of self-constructed rating scales, where data about validity and reliability were lacking or where these aspects were not studied. CONCLUSIONS The most successful were integrated courses focused on several themes with a variety of didactical methods.
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Affiliation(s)
- Marian Adriaansen
- Department of Nursing, University of Professional Education at Nijmegen, The Netherlands.
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Butler L, Degner L, Baile W, Landry M. Developing communication competency in the context of cancer: a critical interpretive analysis of provider training programs. Psychooncology 2005; 14:861-72; discussion 873-4. [PMID: 16200525 DOI: 10.1002/pon.948] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We conducted a critical interpretive analysis of 47 studies from the Cochrane Review of the communications training literature to capture the empirical indicators used to judge provider communication competency and to describe how the indicators were characterized in the context of a cancer care system. Of the 47 studies reviewed, few showed any resemblance to recommendations from two international consensus conferences of experts in the communication research field. Some of the challenges in moving forward with cancer-related communication skills involve deciding what we want people to learn, providing learning across various experiences, identifying learning models, and finding alternate ways of motivating people to learn. Once core competencies are clearly articulated, we can determine the best approaches for developing cancer-specific training programs.
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Affiliation(s)
- Lorna Butler
- Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5.
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Delvaux N, Razavi D, Marchal S, Brédart A, Farvacques C, Slachmuylder JL. Effects of a 105 hours psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study. Br J Cancer 2004; 90:106-14. [PMID: 14710215 PMCID: PMC2395320 DOI: 10.1038/sj.bjc.6601459] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There is today a wide consensus regarding the need to improve communication skills (CS) of health-care professionals (HCPs) dealing with cancer patients. Psychological training programs (PTPs) may be useful to acquire the needed CS. Testing the efficacy of PTP will allow to define their optimal content. The present study was designed to assess the impact of a PTP on HCP stress, attitudes and CS, and on HCP and patients' satisfaction with HCP communication skills in a randomised study. A total of 115 oncology nurses were randomly assigned to a 105-h PTP or to a waiting list. Stress was assessed with the Nursing Stress Scale, attitudes with a Semantic Differential Questionnaire, CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual, and satisfaction with the nurses' CS with a questionnaire completed by the patients and the nurses. Trained (TG) and control (CG) groups were compared at baseline, after 3 months (just following training for TG) and after 6 months (3 months after the end of training for TG). Compared to controls, trained nurses reported positive changes on their stress levels (P⩽0.05) and on their attitudes (P⩽0.05). Positive training effects were found on CS used during the simulated interview: a significant increase in facilitative behaviours (open questions: P⩽0.001; evaluative functions: P⩽0.05) and a significant decrease in inhibitory behaviours (inappropriate information: P⩽0.01; false reassurance: P⩽0.05). Less positive training effects were found regarding interviews with a cancer patient: a significant increase in educated guesses (P⩽0.001) was noticed. No training effect was observed on nurses' satisfaction levels, but a positive training effect was found on patients' satisfaction levels (P⩽0.01). Although results outline PTP efficacy, they indicate the need to design PTP, amplifying the transfer of learned CS to clinical practice.
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Affiliation(s)
- N Delvaux
- Service de Psychologie, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, Bruxelles 1070, Belgium
| | - D Razavi
- Psychosomatic and Psycho-oncology Research Unit, Faculté des Sciences Psychologiques et de l'Education, Université Libre de Bruxelles, Avenue A. Depage 30, 1050 Bruxelles et Institut Jules Bordet, Rue Héger Bordet 1, Bruxelles 1000, Belgium
- CP 191, Université Libre de Bruxelles, Avenue Franklin Roosevelt 50, Bruxelles 1050, Belgium. E-mail:
| | - S Marchal
- CAM, Groupe de Recherche et de Formation, Boulevard de Waterloo 106, Bruxelles 1000, Belgium
| | - A Brédart
- Institut Curie, Unité de Psycho-oncologie, Rue d'Ulm 26, Paris Cedex 05 75246, France
| | - C Farvacques
- CAM, Groupe de Recherche et de Formation, Boulevard de Waterloo 106, Bruxelles 1000, Belgium
| | - J-L Slachmuylder
- CAM, Groupe de Recherche et de Formation, Boulevard de Waterloo 106, Bruxelles 1000, Belgium
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Fellowes D, Wilkinson S, Moore P. Communication skills training for health care professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev 2004:CD003751. [PMID: 15106217 DOI: 10.1002/14651858.cd003751.pub2] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests communication skills do not reliably improve with experience. Considerable effort is dedicated to courses improving communication skills for health professionals. Evaluation of such courses is important to enable evidence-based teaching and practice. OBJECTIVES To assess whether communication skills training is effective in changing health professionals' behaviour in cancer care with regard to communication/interaction with patients. SEARCH STRATEGY We searched CENTRAL (Cochrane Library Issue 3 2001), MEDLINE (1966 to November 2001), EMBASE (1980 to November 2001), PsycInfo (1887 to November 2001), CINAHL (1982 to November 2001), AMED (1985 - October 2001), Dissertation Abstracts International (1861 to March 2002) and EBM Reviews (1991 to March/April 2001). Reference lists of relevant articles were searched. Three further studies were detected in November 2003. SELECTION CRITERIA Randomized controlled trials or controlled before and after studies of communication skills training in cancer health professionals, measuring changes in behaviour/skills using objective and validated scales. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trials and extracted data. MAIN RESULTS Of 2824 references, 3 trials involving 347 health professionals were included. One provided an intensive 3 day course then assessed oncology doctors interacting with 640 patients; a second provided a modular course then assessed role plays with oncology nurses; the third was modular and assessed outcomes with clinical and simulated interviews and patient questionnaires. In one trial, course attendees used more focused questions (probability < 0.005), focused and open questions (p = 0.005), expressions of empathy (p < 0.005) and appropriate cue responses (p < 0.05) at follow up than non-attendees. No significant differences were found between attendees and non-attendees for leading questions. From baseline to follow up, attendees had significantly different changes in rates of leading questions (p < 0.05), focused questions (p < 0.005), open questions (p < 0.05) and empathy (p = 0.005). The only observed significant difference in the second trial was that trained doctors controlled the follow-up interview more than untrained doctors (p < 0.05). Neither studies found differences in summarising, interrupting and checking. The third trial found trained nurses used more emotional speech than untrained counterparts, particularly regarding anxiety and distress. Patients interviewed by trained nurses used more emotional terms, but no differences emerged in questionnaires. REVIEWERS' CONCLUSIONS Training programmes assessed by these trials appear to be effective in improving some areas of cancer care professionals communication skills. It is unknown whether this training would be effective if taught by others, nor the comparative efficacy of these programmes.
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Affiliation(s)
- D Fellowes
- Marie Curie Palliative Care Research and Development Unit, Marie Curie Cancer Care, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, London, UK, NW3 2PF
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Fellowes D, Wilkinson S, Moore P. Communication skills training for health care professionals working with cancer patients, their families and/or carers. Cochrane Database Syst Rev 2003:CD003751. [PMID: 12804489 DOI: 10.1002/14651858.cd003751] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests communication skills do not reliably improve with experience and considerable effort is dedicated to courses improving communication skills for health professionals. The evaluation of such courses is of importance to enable evidence-based teaching and practice. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of health professionals in cancer care with regard to communication/interaction with patients. SEARCH STRATEGY We searched CENTRAL (Cochrane Library Issue 3 2001), MEDLINE (1966 to November 2001), EMBASE (1980 to November 2001), PsycInfo (1887 to November 2001), CINAHL (1982 to November 2001), AMED (1985 - October 2001), Dissertation Abstracts International (1861 to March 2002) and EBM Reviews (1991 to March/April 2001). Reference lists of relevant articles were searched. SELECTION CRITERIA Randomized controlled trials or controlled before and after studies of communication skills training in cancer health professionals, measuring changes in behaviour/skills using objective and validated scales. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS Although 2822 references were considered, only two trials involving 232 health professionals were included. One provided an intensive three-day course then assessed oncology doctors interacting with a total of 640 patients; the other provided a modular course then used role plays with oncology nurses for skill assessment. In one trial, course attendees used more focused questions (34% increase, probability < 0.005), focused and open questions (27% increase, p = 0.005), expressions of empathy (69% increase, p < 0.005) and appropriate responses to cues (38% increase, p < 0.05) at follow up than non-attendees. No significant differences were found between attendees and non-attendees in use of leading questions. From baseline to follow up in the same study, attendees had significantly different changes in rates of leading questions (relative risk 0.72, p < 0.05), focused questions (Relative Risk 1.25, p < 0.005), open questions (RR 1.17, p < 0.05) and empathy (RR 1.50, p = 0.005). The only significant difference in observed communication skills in the second trial was that the trained group were more in control of the follow-up interview than the untrained group (p < 0.05). Both studies investigated differences in summarising, interrupting and checking but found none. REVIEWER'S CONCLUSIONS The training programmes assessed by these trials appear to be effective in improving cancer care professionals communication skills. It is not known whether the training would be effective if taught by other educators, nor has any trial compared the efficacy of both programmes.
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Affiliation(s)
- D Fellowes
- Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, London, UK, NW3 2PF.
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Thulesius H, Petersson C, Petersson K, Håkansson A. Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study. Palliat Med 2002; 16:347-54. [PMID: 12132548 DOI: 10.1191/0269216302pm568oa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test-retest reliability of the 20-item questionnaire was good (r=0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI = 2.1 -3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.
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Affiliation(s)
- Hans Thulesius
- Kronoberg County Research Centre and Department of Community Medicine, Malmö, Sweden.
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Razavi D, Delvaux N, Marchal S, Durieux JF, Farvacques C, Dubus L, Hogenraad R. Does training increase the use of more emotionally laden words by nurses when talking with cancer patients? A randomised study. Br J Cancer 2002; 87:1-7. [PMID: 12085247 PMCID: PMC2364281 DOI: 10.1038/sj.bjc.6600412] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2001] [Revised: 03/05/2002] [Accepted: 04/12/2002] [Indexed: 11/12/2022] Open
Abstract
The emotional content of health care professionals-cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy. One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods. Nurses randomly allocated to a control group arm (waiting list) were assessed a first time and then 3 and 6 months later. Nurses allocated to the training group were assessed before training workshop, just after and 3 months later. Each nurse completed a 20-min clinical and simulated interview. Each interview was analysed by three content analysis systems: two computer-supported content analysis of emotional words, the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level, the Cancer Research Campaign Workshop Evaluation Manual. The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained (P=0.056): training group subjects use 4.3 (std: 3.7) emotional words per 1000 used before training workshop, and 7.0 (std: 5.8) right after training workshop and 5.9 (std: 4.3) 3 months later compared to control group subjects which use 4.5 (std: 4.8) emotional words at the first assessment point, 4.3 (std: 4.1) at the second and 4.4 (std: 3.3) at the third. The same trend is noticeable for emotional words used by health care professionals in simulated interviews (P=0.000). The emotional words registry used by health care professionals however remains stable over time in clinical interviews (P=0.141) and is enlarged in simulated interviews (P=0.041). This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training (P=0.005). This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression.
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Affiliation(s)
- D Razavi
- CP191, Université Libre de Bruxelles, Faculté des Sciences Psychologiques et Pédagogiques, 50 av, Franklin Roosevelt, Brussels, 1050 Belgium.
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Hellbom M, Brandberg Y, Kurland J, Arving C, Thalén-Lindström A, Glimelius B, Sjödén PO. Assessment and treatment of psychosocial problems in cancer patients: an exploratory study of a course for nurses. PATIENT EDUCATION AND COUNSELING 2001; 45:101-106. [PMID: 11687322 DOI: 10.1016/s0738-3991(00)00198-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A course in psychosocial oncology for nurses was developed and evaluated within the framework of a prospective randomised study. Six nurses participated. Areas covered were basic techniques for assessment of psychosocial problems, for relieving anxiety and depression, solving problems in conjunction with treatment and disease, and improving communication. Participants met for four 3h weekly lessons. Between meetings, they met to train assessment and techniques. Follow-up discussions were held at termination and 5 months later. Participants reported that the new knowledge and skills had made them feel more confident when handling patients' psychosocial situation. However, treatment of psychological problems did not prove to be a predominant aspect of their patient work. The evaluation of the course suggests that participants improved their skills for assessment of patient problems and, therefore, felt more confident when handling psychosocial issues.
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Affiliation(s)
- M Hellbom
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Sweden.
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15
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De Valck C, Bensing J, Bruynooghe R. Medical students' attitudes towards breaking bad news: an empirical test of the World Health Organization model. Psychooncology 2001; 10:398-409. [PMID: 11536418 DOI: 10.1002/pon.520] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The literature regarding breaking bad news distinguishes three disclosure models: non-disclosure, full-disclosure and individualized disclosure. In this study, we investigated the relations between attitudes regarding disclosure of bad news and global professional attitudes regarding medical care in a sample of medical students (n=88). The Attitudes towards Breaking Bad News Questionnaire was developed and factor analysed to provide a valid and reliable instrument to measure attitudes regarding disclosure of bad news. The results indicate a preference for an individualized, patient-centred disclosure model in male and female students. Regarding the global professional attitudes, female students appear more humane-oriented than male students. Second, the relationship between global professional attitudes and attitudes regarding breaking bad news was examined by means of correlational and cluster analysis. The inter-relationship between global professional attitudes and attitudes regarding bad news is poor. Results of the cluster analysis, however, suggest that the sample can be divided into subsamples representing different disclosure clusters on the basis of specific combinations of global professional attitudes regarding medical care and attitudes regarding breaking bad news. The results are discussed in view of the theoretical framework proposed by the World Health Organization (WHO) in their training module on communication of bad news.
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Affiliation(s)
- C De Valck
- Health Psychology Department, Faculty of Medicine, Limburgs University Centre, Diepenbeek, Belgium.
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16
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Razavi D, Delvaux N, Marchal S, De Cock M, Farvacques C, Slachmuylder JL. Testing health care professionals' communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators. Psychooncology 2000; 9:293-302. [PMID: 10960927 DOI: 10.1002/1099-1611(200007/08)9:4<293::aid-pon461>3.0.co;2-j] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although standardized role-playing sessions (SRPS) with simulators are increasingly used to assess health care professionals' (HCPs) communication skills (CS) and the effectiveness of training workshops (TWs), nothing has been done to date to define the optimal emotional content of SRPS. Three emotionally different SRPS contexts-weakly emotional (WE-), moderately emotional (ME-), and highly emotional (HE-SRPS)-were, therefore, tested in order to assess induced CS and sensitivity to TW-related changes. The study included 25 HCPs. Tape-recorded SRPS, scheduled before and after the TW, were retranscribed, and assessed according to the Cancer Research Campaign Workshop Evaluation Manual (CRCWEM), which provides a rating of form, function and structure for each utterance. Results show that induced CS are different in WE-, ME-, and HE-SRPS, regarding form (HE-SRPS induced more 'directing', 'leading' or 'multiple' questions; WE: 20.7%; ME: 19.7%; HE: 33.7% (p<0.001)); function (HE-SRPS induced more 'inappropriate' information; WE: 6. 5%; ME: 8.2%; HE: 15.6% (p<0.001)); and blocking (HE-SRPS induced more 'blocking' utterances; WE: 7.2%; ME: 13.8%; HE: 30.2% (p<0. 0001)). Finally, CS changes induced by TWs are the highest in HE-SRPS (14.8% increase of 'open' questions for the HE- versus 1.0% for the WE-SRPS; 11.6% decrease of 'inappropriate' information for the HE- versus 3.3% for the WE-SRPS; and 17.5% decrease of 'blocking' for the HE- versus 2.6% for the WE-SRPS). In conclusion, SRPS, with a HE content, induce more inappropriate CS. Moreover, they are more sensitive to TW effects. SRPS with a HE content should, thus, be recommended for the assessment of TW effectiveness.
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Affiliation(s)
- D Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et del'Education, Brussels, Belgium.
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17
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Abstract
Preserving the best possible quality of life for cancer patients and their families has become a major goal in cancer care. However, the cumulative effect of stressors related to cancer care, many of which involve communicating with patients and relatives, may lead to the development of burnout in staff. Many health care professionals lack the psychosocial knowledge and communications skills needed to identify patients' problems because general professional training focuses on technical care. Teaching strategies known as psychological training programs (PTP) are therefore being developed to help improve health care professionals' sensitivity to communication problems with patients and relatives. Cognitive (e.g. theoretical information), experiential (e.g. case-history discussions), behavioural (e.g. role-playing exercise) and supportive (e.g. stressor identification) training techniques are used to teach the essential skills of good communication, i.e. listening, empathy, response to cues and appropriate use of reassurance. PTP range from one-day courses and residential workshops to full-time 1- or 2-year curricula. However, one of the main obstacles to implementing PTP is scepticism among health care professionals about its usefulness. Research on training effectiveness should therefore be developed to assess the impact of communication skills on quality of care and patients' quality of life.
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Affiliation(s)
- D Razavi
- Service Médico-Psychologique (Unité de Psycho-Oncologie), Hôpital Universitaire Saint-Pierre, Brussels, Belgium
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18
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Delvaux N, Razavi D. Psychological training for health-care professionals in oncology. A way to improve communication skills. Ann N Y Acad Sci 1997; 809:336-49. [PMID: 9103585 DOI: 10.1111/j.1749-6632.1997.tb48097.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N Delvaux
- Unité de Psycho-Oncologie, Institut Jules Bordet, Brussels, Belgium
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Kiss A. On organizing an international workshop on psychotherapeutic interventions in cancer patients. A virtual coffeebreak communication. Support Care Cancer 1995; 3:227-34. [PMID: 7551624 DOI: 10.1007/bf00335894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This paper is an unusual summary of my thoughts on the International Workshop on Psychotherapeutic Interventions in Cancer Patients in Flims, Switzerland, in 1995. Based upon virtual coffeebreak communications, I try to explain to my virtual partner how the idea of the workshop developed, how I came to select participants and experts, and why the workshop was structured in such a specific way. Concerning the workshop itself I shall quote personal feedback statements from participants, drawing upon the impressions they took with them from demonstration workshops prepared by the leading experts in the field. During the workshop the impact of psychosocial interventions upon survival was critically evaluated, whereas it was unanimously agreed that the most important target of psychosocial interventions in cancer patients is the improvement in quality of life. After the workshop I personally decided to enhance my professional engagement in the area of helping clinical oncologists and nurses to improve on the psychosocial skills they need in caring for cancer patients.
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Affiliation(s)
- A Kiss
- Department of Internal Medicine, University Hospital Basel, Switzerland
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Razavi D, Delvaux N. The psychiatrist's perspective on quality of life and quality of care in oncology: concepts, symptom management, communication issues. Eur J Cancer 1995; 31A Suppl 6:S25-9. [PMID: 8534528 DOI: 10.1016/0959-8049(95)00490-a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The important prevalence of psychosocial problems and psychiatric disturbances that have been reported in oncology, underlines the need for comprehensive psychosocial support for cancer patients and their families. Psychosocial support is designed to preserve, restore or enhance quality of life. Quality of life refers not only to psychosocial distress and adjustment-related problems but also to the management of cancer symptoms and treatment side-effects. Psychosocial interventions designed for this purpose should be divided into five categories: prevention, early detection, restoration, support and palliation. Firstly, preventive interventions are designed to avoid the development of predictable morbidity secondary to treatment and/or disease. Secondly, early detection of patients' needs or problems refers to the assumption that early interventions' could have therapeutic results superior to those of delayed support, both for quality of life and survival. Thirdly, restorative interventions refer to actions used when a cure is likely, the aim being the control or elimination of residual cancer disability. Fourthly, supportive rehabilitation is planned to lessen disability related to chronic disease, characterised by cancer illness remission and progression, and to active treatment. Fifthly, palliation is required when curative treatments are likely to no longer be effective, and when maintaining or improving comfort becomes the main goal. Psychological interventions are often multidisciplinary, with a variety of content. The type of psychological intervention ranges from information and education to more sophisticated support programmes including directive (behavioural or cognitive) therapies, or non-directive (dynamic or supportive) therapies. Social interventions usually include financial, household, equipment, and transport assistance depending on individual and family needs and resources. These interventions may be combined with the prescription of pharmacological (psychotropic, analgesic), physical, speech or occupational therapies, especially in rehabilitation programmes. Health care services devoted to delivery of these interventions are hospital, hospice or home-based and organised very differently depending on already available community resources and local practice.
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Affiliation(s)
- D Razavi
- Service de Médecine Interne et Laboratoire d'Investigation Clinique H.J. Tagnon (Unité de Psycho-Oncologie et de Réhabilitation), Institut Jules Border, Bruxelles, Belgium
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Razavi D, Stiefel F. Common psychiatric disorders in cancer patients. I. Adjustment disorders and depressive disorders. Support Care Cancer 1994; 2:223-32. [PMID: 8087440 DOI: 10.1007/bf00365726] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A high prevalence of adjustment and depressive disorders has been reported in oncology. These conditions are highly treatable, therefore the assumption that emotional distress is just a foreseeable and ordinary reaction to cancer had to be reviewed. Clinical presentation, etiology, assessment, and therapy of adjustment and depressive disorders are summarized in order to optimize supportive care.
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Affiliation(s)
- D Razavi
- Service de Médecine Interne et Laboratoire d'Investigation Clinique H. J. Tagnon, (Unité de Psycho-Oncologie, et de Réhabilitation, l'Université Libre de Bruxelles, Belgium
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Razavi D, Delvaux N, Marchal S, Bredart A, Farvacques C, Paesmans M. The effects of a 24-h psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study. Eur J Cancer 1993; 29A:1858-63. [PMID: 8260242 DOI: 10.1016/0959-8049(93)90538-q] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The usefulness of psychological training programs (P.T.P.) in health care settings devoted to cancer care is beginning to be recognised but their content, form and effectiveness need further investigation. Seventy-two oncology nurses were randomly assigned to a 24-h P.T.P. or to a waiting list period. Attitudes were assessed by a semantic differential questionnaire, occupational stress was assessed by the Nursing Stress Scale and communication skills were assessed by standardised videotaped role-playing exercises. These were used to compare trained (T.S.) and control subjects (C.S.). The results show a significant training effect on attitudes (P = 0.05), especially on those related to self concept (P = 0.004), and on the level of occupational stress related to inadequate preparation (P = 0.02). Limited changes were found regarding post-training communication skills. T.S. were significantly more in control of the interview than C.S. (P = 0.02). The results indicate that 24-h P.T.P. assessed here are effective. The data also demonstrate the need to consolidate the skills acquired by regular post-training sessions.
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Affiliation(s)
- D Razavi
- Service de Médecine et d'Investigation Clinique, H. J. Tagnon (Unité de Réhabilitation et de Psycho-Oncologie), Institut Jules Bordet, Université Libre de Bruxelles, Belgium
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