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Wu SI, Liu SI, Wu YJ, Huang LL, Liu TJ, Kao KL, Lee YH. The efficacy of applying the Interpersonal Effectiveness skills of dialectical behavior therapy into communication skills workshop for clinical nurses. Heliyon 2023; 9:e14066. [PMID: 36938426 PMCID: PMC10015201 DOI: 10.1016/j.heliyon.2023.e14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background We designed this open-pilot study to investigate the efficacy and feasibility of incorporating the Interpersonal Effectiveness skills from Dialectical Behavior Therapy (DBT-IE) into a 3-h clinical communication workshop for registered nurses. Method A convenience sample of registered nurses were invited. The Professional Fulfillment Index, Perceived Stress Scale, Empathy Index, the Interpersonal Reactivity Index, and measures regarding quality of life, anxiety, depression, and insomnia were completed. A subgroup of participants received the Objective Structured Teaching Examinations (OSTE). Pre- and post-workshop assessments were conducted to identify the most empathetic or validated responses from case scenarios and to assess the self-rated levels of confidence regarding the capability to select the best answer. The satisfaction of the participants with respect to the workshop content, process, and the lecturer were also collected. Paired t-test was used for statistical analysis. Results Among the 164 participants of the clinical communication workshop, 72 consented and their pre- and post-results were analyzed. Post-workshop assessment revealed significant improvement in professional fulfillment (p = 0.014), interpersonal coping ability (p = 0.038), and decrease in dysfunctional coping style (p < 0.001). The overall satisfaction score of participants was 4.68 (5-point Likert scale). In the subgroup that underwent pre- and post-workshop OSTE (n = 28), there was a significant improvement in total scores, pass rates, ratings from observational supervisors, simulated students, and simulated patients after the workshop (p < 0.001). Conclusion Our results demonstrated the effectiveness, acceptance, and feasibility of incorporating the DBT-IE skills into a clinical medical communication workshop through a teaching style comprising of rigorous interactions and hands-on practices.
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Affiliation(s)
- Shu-I Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Section of Psychiatry and Suicide Prevention Center, MacKay Memorial Hospital, Taipei, Taiwan
- Corresponding author. Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Shen-Ing Liu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Section of Psychiatry and Suicide Prevention Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ling-Lang Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Thih-ju Liu
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kai-Liang Kao
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Corresponding author.
| | - Yu-Hsia Lee
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan
- Corresponding author.
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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] [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.
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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
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Novais F, Ganança L, Barbosa M, Telles-Correia D. Communication skills in psychiatry for undergraduate students: A scoping review. Front Psychiatry 2022; 13:972703. [PMID: 36032255 PMCID: PMC9402997 DOI: 10.3389/fpsyt.2022.972703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Communication skills are paramount in all areas of medicine but particularly in psychiatry due to the challenges posed by mental health patients and the essential role of communication from diagnosis to treatment. Despite the prevalence of psychiatric disorders in different medical specialties, particularly in primary care settings, communication skills in psychiatry and their training are not well studied and are often not included in the undergraduate medical curriculum. Our paper explores the relevance of teaching communication competencies in psychiatry for undergraduate medical students. Our work focused on reviewing the methods for teaching communication skills to undergraduate students in Psychiatry. Eleven studies were selected to be included in this review. We found considerable heterogeneity among methods for teaching communication skills but also some common elements such as the use of simulated patients and providing feedback. This review has identified two models: the Calgary-Cambridge interview model and the Kolb cycle-based model. However, most studies still lack a theoretical background model. We believe that the inclusion of communication skills training in medical curricula is fundamental to teaching medical students general communication skills but also specific training on establishing adequate communication with psychiatric patients. However, more research is needed to determine the best method for training but also regarding its translation to patient care and cost-effectiveness.
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Affiliation(s)
- Filipa Novais
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Santa Maria Hospital, Lisbon, Portugal.,ISAMB - Instituto de Saúde Ambiental - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Licínia Ganança
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro Hospitalar Universitário Lisboa Norte, Santa Maria Hospital, Lisbon, Portugal
| | - Miguel Barbosa
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Diogo Telles-Correia
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,ISAMB - Instituto de Saúde Ambiental - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19. Behav Sci (Basel) 2021; 11:bs11060087. [PMID: 34198572 PMCID: PMC8231896 DOI: 10.3390/bs11060087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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Chen SH, Chen SY, Yang SC, Chien RN, Chen SH, Chu TP, Fujimori M, Tang WR. Effectiveness of communication skill training on cancer truth-telling for advanced practice nurses in Taiwan: A pilot study. Psychooncology 2021; 30:765-772. [PMID: 33427382 DOI: 10.1002/pon.5629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/28/2020] [Accepted: 01/01/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Advanced practice nurses (APNs) can best support physicians in improving the quality of truth-telling. However, the effectiveness of communication skill training (CST), based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs' and recipients' viewpoints, motivating the author to conduct the present study. METHODS A two-group before-after model design was adopted, and 61 APNs from two hospitals were randomly assigned to either an experimental group (EG; N = 28) or an control group (CG; N = 33). APNs in the EG received 6 h of CST under the guidance of qualified facilitators and simulated patients. This study used APNs' subjective assessment (N = 61) (self-confidence and perceptions on truth-telling) and recipients' opinions (N = 480) (cancer patients' and their caregivers' satisfaction with truth-telling and emotional status) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline, T0), immediately after (T1), and 2 weeks after (T2). RESULTS APNs in the EG had more confidence (p < 0.05) and better perceptions of cancer truth-telling (p < 0.01) than APNs in the CG at both T1 and T2. No group differences were found in patients' or their caregivers' satisfaction with truth-telling, emotional distress, and anxiety (p > 0.05). In addition, patients in the EG had higher depression than patients in the CG (β = 1.65, p = 0.01). CONCLUSIONS SHARE CST can improve APNs' confidence and perceptions of cancer truth-telling. However, more rigorous studies are required to test the effectiveness of CST from recipients' viewpoint.
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Affiliation(s)
- Shih-Hsiang Chen
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shih-Ying Chen
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Chun Yang
- School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Rong-Nan Chien
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Sue-Hsien Chen
- Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Tsuei-Ping Chu
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Maiko Fujimori
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Woung-Ru Tang
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.,School of Nursing, Chang Gung University, Taoyuan, Taiwan, ROC
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McGrath M, Low MA, Power E, McCluskey A, Lever S. Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge, Attitudes, and Practices of Health Care Professionals. Arch Phys Med Rehabil 2020; 102:999-1010. [PMID: 33045226 DOI: 10.1016/j.apmr.2020.09.379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically review health care professionals' practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability. DATA SOURCES Scopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched. STUDY SELECTION Eligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author. DATA SYNTHESIS A sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I2=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed. CONCLUSION Despite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals' knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.
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Affiliation(s)
- Margaret McGrath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Michelle Anne Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; The StrokeEd Collaboration, Sydney, Australia
| | - Sandra Lever
- Graythwaite Rehabilitation Centre, Ryde Hospital, Sydney, Australia; Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Kerr D, Ostaszkiewicz J, Dunning T, Martin P. The effectiveness of training interventions on nurses' communication skills: A systematic review. NURSE EDUCATION TODAY 2020; 89:104405. [PMID: 32244125 DOI: 10.1016/j.nedt.2020.104405] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/03/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice. DESIGN A systematic review of literature. DATA SOURCES Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures. REVIEW METHODS The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis. RESULTS Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills. CONCLUSIONS Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.
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Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia.
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
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Nixon J, Gray L, Turner J, Bernard A, Scaife J, Cartmill B. Communicating Actively Responding Empathically (CARE): Comparison of Communication Training Workshops for Health Professionals Working in Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:54-60. [PMID: 30386978 DOI: 10.1007/s13187-018-1439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Accessing full-day communication skills training can be challenging for health professionals working in cancer care. This study aimed to examine the effectiveness of Communicating Actively, Responding Empathically (CARE Express), a modified 2-h communication skills training course, across measures of health professional confidence, skills and attitudes. Cancer care health professionals (n = 147) were recruited from allied health, nursing and medical disciplines, using a partial randomisation to allocate to three arms: control, two-hour training (CARE Express) and 1-day training (CARE). Perceived confidence and skills were measured by self-report using a purpose-built scale, and written responses to a challenging clinical encounter were obtained at baseline, post-training and three-months post-training. Attitudes toward psychosocial issues were evaluated with the Physician Belief Scale at baseline and 3 months post-training. No changes were observed in the control group (n = 50) from baseline to 3 months follow-up. Participants in the CARE Express (n = 48) and CARE (n = 49) groups had significant improvement in confidence in identifying/responding to emotions between baseline and 3 months post-training (p < 0.001), as well as their attitude toward psychosocial care (p < 0.001). A significant increase in "acknowledging" responses from baseline to 3 months was also observed for CARE Express and CARE (p < 0.001), with no difference between groups. CARE Express and CARE resulted in changes in confidence in emotional identification/response, psychosocial focus and communication skills maintained at 3 months post-training. Whilst the 1-day workshop has been regarded as gold standard, this study has revealed positive outcomes with a modified 2-h version, thus offering a potential alternate training model.
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Affiliation(s)
- Jodie Nixon
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
| | - Lyndal Gray
- Occupational Therapy Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Jane Turner
- Faculty of Medicine, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, 4027, Australia
| | - Jessica Scaife
- Cancer Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
| | - Bena Cartmill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, 4102, Australia
- Centre for Functioning and Health Research, Princess Alexandra Hospital, Brisbane, Australia
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Sisk BA, Schulz GL, Mack JW, Yaeger L, DuBois J. Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets. PLoS One 2019; 14:e0221536. [PMID: 31437262 PMCID: PMC6705762 DOI: 10.1371/journal.pone.0221536] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology. Methods Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000–October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework. Findings Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies. Conclusions Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ginny L. Schulz
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Lauren Yaeger
- Becker Library, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James DuBois
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of Ameica
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Fischer F, Helmer S, Rogge A, Arraras JI, Buchholz A, Hannawa A, Horneber M, Kiss A, Rose M, Söllner W, Stein B, Weis J, Schofield P, Witt CM. Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research. BMC Cancer 2019; 19:808. [PMID: 31412805 PMCID: PMC6694634 DOI: 10.1186/s12885-019-6022-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.
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Affiliation(s)
- F. Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Helmer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A. Rogge
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J. I. Arraras
- Radiotherapeutic Oncology Department & Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - A. Buchholz
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre, Hamburg, Germany
| | - A. Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS), Faculty of Communication Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M. Horneber
- Department of Internal Medicine, Divisions of Pneumology and Oncology/Hematology, Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | - A. Kiss
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - M. Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, USA
| | - W. Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - B. Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - J. Weis
- Comprehensive Cancer Center, Department of Self-Help Research, Faculty of Medicine and Medical Center University of Freiburg, Freiburg, Germany
| | - P. Schofield
- Department of Psychology, Swinburne University, Melbourne, Victoria Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria Australia
| | - C. M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD USA
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Ahamad A, Wallner P, Salenius S, Ross R, Fernandez E. Information Needs Expressed During Patient-Oriented Oncology Consultations: Quantity, Variation, and Barriers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:488-497. [PMID: 29435742 DOI: 10.1007/s13187-018-1329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
High-quality oncology consultation includes patient-oriented communication tailored to patients' individualized needs. Common methods used in studies to increase question-asking are prompt lists and coaching pre-consultations. However, our patients were encouraged to ask questions by the physician during their visit. We aimed to estimate the quantity, nature, and variation of their questions when they were invited to ask by their oncologist. During radiotherapy consultations from 2012 to 2016, patient's questions were deliberately elicited and physician-transcribed. We derived mean and median number of questions per patient, variance by patient factors, and a taxonomy of subjects using thematic analysis. Three hundred ninety-six patients asked 2386 questions, median asked per patient = 6 (interquartile range = 4). We found significant variance with age (mean = 6.9 questions for < 60 years, 5.4 for ≥ 70 years) p = 0.018, insurance type (mean = 4.7 for Medicaid, 7.2 for private insurance) p = 0.0004, and tumor site (mean number of questions: skin = 4.6, lymphoma = 5.2, lung = 5.8, breast = 6.1, prostate = 6.3, rectum = 6.7 head and neck = 6.9, brain = 7.0, bladder = 7.2, anus = 8.8, others = 5.8) p = 0.0440. Of the diverse set of 57 topics, the commonest were 1. logistics, 2. radiotherapy details, 3. side effects, 4. diagnosis, and 5. stage and prognosis. Only 17 topics were asked by more > 10% of patients and 40 topics were asked by < 10% of patients. With median of 6 questions, it is practicable to routinely elicit and address individualized information needs. Potential barriers may be older and underinsured patients. The wide variety of topics, often pertaining to individuals' case, suggests that cancer clinicians should take time-out during consultation to elicit patients' questions to accomplish best-practice communication.
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Affiliation(s)
- Anesa Ahamad
- Department of Radiation Oncology, 21st Century Oncology, 3426 North Roosevelt Boulevard, Key West, FL, 33040, USA.
- University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Lennar Foundation Medical Center, 5555 Ponce de Leon Blvd. Suite 140, Coral Gables, FL, 33146, USA.
| | - Paul Wallner
- Department of Radiation Oncology, 21st Century Oncology, Inc. 146 Sarazen Drive, Moorestown, NJ, 08057, USA
| | - Sharon Salenius
- Department of Research and Education, 21st Century Oncology, 2234 Colonial Boulevard, Fort Myers, FL, 33907, USA
| | - Rudi Ross
- Department of Research and Education, 21st Century Oncology, 2234 Colonial Boulevard, Fort Myers, FL, 33907, USA
| | - Eduardo Fernandez
- Department of Radiation Oncology, 21st Century Oncology, 350 NW 84th Ave # 102, Plantation, FL, 33324, USA
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Abstract
OBJECTIVE The objective of this study was to determine if patient and family advisors' (PFAs) collaboration in an educational program could increase the empathy levels of intensive care unit (ICU) nurses. BACKGROUND Data suggest that nurse empathy is on the decline. Ensuring that nurses consistently empathize with patients and families helps create positive patient experiences. METHODS Thirty nurses participated in a PFA-designed educational intervention using simulation-based role playing. The Toronto Empathy Questionnaire (TEQ) was used to measure empathy before and after the intervention. RESULTS The TEQ empathy scores increased significantly after nurses completed the PFA-designed educational program. Younger nurses (<30 years) improved on average 3.03 ± 3.6 points compared with older nurses (>30 years), who improved, on average, only 0.43 ± 2.06 points (t24.4 = 2.46, P = .021). For the changes in TEQ scores from preintervention to postintervention, age was significantly associated with improvements in TEQ scores. CONCLUSIONS Patient and family advisors can positively impact empathy among ICU nurses.
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Niglio de Figueiredo M, Krippeit L, Ihorst G, Sattel H, Bylund CL, Joos A, Bengel J, Lahmann C, Fritzsche K, Wuensch A. ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial. PLoS One 2018; 13:e0205315. [PMID: 30289905 PMCID: PMC6173449 DOI: 10.1371/journal.pone.0205315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 09/24/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate the effect of the number of coaching sessions after communication skills training on the medical communicative performance of oncologists in clinical practice. METHODS/DESIGN The training, consisting of a workshop and one (control group) vs. four (intervention group) sessions of individual coaching, was evaluated in a randomized controlled trial. Eligible participants included physicians working in any setting where patients with oncological diseases were treated. Real medical consultations were video recorded at three time points: before the workshop (t0), after the workshop (t1) and after completion of coaching (t2). The 1.5-day workshop was based on role-playing in small groups; in the coaching sessions, the videos recorded at t1 were analyzed in detail by both the trainer and the physician. The coaching sessions were manualized and based on the physician's learning goals. The primary hypothesis was that the intervention group would improve to a higher extent than the control group, as assessed by external raters using rating scales specially developed for this project. Physicians were stratified for sex and setting and randomized by an independent statistician. The group assignment was revealed for physicians and trainers at the end of the workshop, while the raters were blinded to group assignments and assessment points. RESULTS A total of 72 physicians participated in one of 8 workshops and could be allocated to either the control or intervention group. The intervention group showed a statistically significant improvement (ES d = 0.41, p<.01) in the All items domain of the rating scales between t1 and t2 and showed a significant advantage compared with the CG (ES = .41, p = .04). The impact on diverse specified skills was heterogeneous; a larger sample is necessary for more detailed analysis. CONCLUSIONS The training achieved some observable and significant changes in the communicative behavior of oncologists in clinical practice. The four coaching sessions showed some significant advantages compared to the single coaching session. Considerable effort is necessary to achieve sustained changes in communication in clinical every-day practice. Thus, our coaching concept is a promising method for this purpose.
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Affiliation(s)
- Marcelo Niglio de Figueiredo
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lorena Krippeit
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heribert Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carma L. Bylund
- College of Journalism and Communications, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Bengel
- Institute of Psychology, Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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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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Turton BM, Williams S, Burton CR, Williams L. Arts-based palliative care training, education and staff development: A scoping review. Palliat Med 2018; 32:559-570. [PMID: 28604224 DOI: 10.1177/0269216317712189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The experience of art offers an emerging field in healthcare staff development, much of which is appropriate to the practice of palliative care. The workings of aesthetic learning interventions such as interactive theatre in relation to palliative and end-of-life care staff development programmes are widely uncharted. AIM To investigate the use of aesthetic learning interventions used in palliative and end-of-life care staff development programmes. DESIGN Scoping review. DATA SOURCES Published literature from 1997 to 2015, MEDLINE, CINAHL and Applied Social Sciences Index and Abstracts, key journals and citation tracking. RESULTS The review included 138 studies containing 60 types of art. Studies explored palliative care scenarios from a safe distance. Learning from art as experience involved the amalgamation of action, emotion and meaning. Art forms were used to transport healthcare professionals into an aesthetic learning experience that could be reflected in the lived experience of healthcare practice. The proposed learning included the development of practical and technical skills; empathy and compassion; awareness of self; awareness of others and the wider narrative of illness; and personal development. CONCLUSION Aesthetic learning interventions might be helpful in the delivery of palliative care staff development programmes by offering another dimension to the learning experience. As researchers continue to find solutions to understanding the efficacy of such interventions, we argue that evaluating the contextual factors, including the interplay between the experience of the programme and its impact on the healthcare professional, will help identify how the programmes work and thus how they can contribute to improvements in palliative care.
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Affiliation(s)
| | - Sion Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Lynne Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
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16
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Confidence in communicating with patients with cancer mediates the relationship between rehabilitation therapists' autistic-like traits and perceived difficulty in communication. Palliat Support Care 2018; 17:186-194. [PMID: 29352834 DOI: 10.1017/s147895151700116x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists' communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT. METHOD Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties. RESULTS Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001). SIGNIFICANCE OF RESULTS Communication difficulty was linked to rehabilitation therapists' ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.
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Development and inter-rater reliability of a tool assessing hypnotic communication behaviours adopted by nurses caring for children with cancer: The Sainte-Justine Hypnotic Communication Assessment Scale. Complement Ther Med 2017; 37:178-184. [PMID: 29609931 DOI: 10.1016/j.ctim.2017.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several studies in pediatric oncology have shown the successful effects of using hypnotic communication techniques (HCTech) during painful medical procedures. Since no studies assessed the precise use of these techniques with a validated tool, it is unsure that the observed relationships involve the use of HCTech. OBJECTIVES To develop a scale evaluating healthcare professionals' behaviours when using HCTech and to evaluate its inter-rater reliability. METHODS This study involved the preliminary steps of the Sainte-Justine Hypnotic Communication Assessment Scale (SJ-HCAS) development process. As part of a larger intervention study, the SJ-HCAS was developed in three steps by five experts and four lay raters using an iterative process applied to subsets of video-recorded nurse-patient interactions. The development aimed to maximize clarity and precision of items as well as minimize redundancy amongst items. Inter-rater reliability was assessed in a randomly selected sample of 1/3 of collected video-recorded interactions (n=42). RESULTS The final version of the scale is composed of 11 items categorized in two domains pertaining to Relationship and Technique. We found excellent inter-rater reliability for both subscores and total score in two independent inter-rater comparisons (median ICC=0.879), with most items showing very good to perfect inter-rater reliability (median Kappa=0.847). CONCLUSIONS The results support further work with the SJ-HCAS. The scale has the potential to help ensure the integrity of hypnotic communication training in children which could ultimately promote the dissemination of the practice of HCTech.
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Dencker A, Kristiansen M, Rix BA, Bøge P, Tjørnhøj-Thomsen T. Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29114990 DOI: 10.1111/ecc.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication.
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Affiliation(s)
- A Dencker
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B A Rix
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - P Bøge
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - T Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Selman LE, Brighton LJ, Hawkins A, McDonald C, O'Brien S, Robinson V, Khan SA, George R, Ramsenthaler C, Higginson IJ, Koffman J. The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis. J Pain Symptom Manage 2017; 54:404-416.e5. [PMID: 28778560 DOI: 10.1016/j.jpainsymman.2017.04.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/10/2017] [Indexed: 01/09/2023]
Abstract
CONTEXT As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. OBJECTIVES To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. METHODS Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. RESULTS Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I2 = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I2 = 44%; chi-square = 5.96, df = 3, P = 0.11; I2 = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. CONCLUSIONS The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient interactions may be beneficial. REGISTRATION NUMBER CRD42014014777.
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Affiliation(s)
- Lucy Ellen Selman
- King's College London, Cicely Saunders Institute, London, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Lisa J Brighton
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Amy Hawkins
- Phyllis Tuckwell Hospice, Farnham, United Kingdom; Frimley Park Hospital NHS Foundation Trust, Frimley, United Kingdom
| | - Christine McDonald
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Suzanne O'Brien
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Shaheen A Khan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rob George
- King's College London, Cicely Saunders Institute, London, United Kingdom; St Christopher's Hospice, London, United Kingdom
| | | | - Irene J Higginson
- King's College London, Cicely Saunders Institute, London, United Kingdom
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, London, United Kingdom
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Demoralization in medical illness: Feasibility and acceptability of a pilot educational intervention for inpatient oncology nurses. Palliat Support Care 2017; 16:503-510. [PMID: 28789725 DOI: 10.1017/s1478951517000657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjective:Demoralization is a common problem among medical inpatients with such serious health problems as cancer. An awareness of this syndrome, a knowledge of what defines it, and a plan for how to intervene are limited among nursing teams. Nurses are uniquely poised to efficiently provide brief interventions that address demoralization in their patients. To our knowledge, there are no interventions that train nurses to distinguish and treat demoralization in their patients. The objective of the present study was to determine the acceptability, feasibility, and impact of a novel educational intervention for nurses. METHOD An educational training video was created and delivered to staff nurses (N = 31) at oncology staff meetings to test the feasibility and acceptability of this intervention. Assessments of nurses' knowledge about demoralization and intervention methods were administered immediately before and after the training intervention and through a web-based survey 6 weeks post-intervention. McNemar's test for dependent categorical data was utilized to evaluate change in survey responses at the three timepoints. RESULTS Nurses' understanding of the concept of demoralization and appropriate interventions significantly improved by 30.3% from pre- to posttest (p ≤ 0.0001). These improvements persisted at 6 weeks post-intervention (p ≤ 0.0001). At 6-week follow-up, 74.2% of participants agreed or strongly agreed that the training had positively changed their nursing practice, 96.8% reported that this training benefited their patients, and 100% felt that this training was important for the professional development of nurses. SIGNIFICANCE OF RESULTS This pilot intervention appeared feasible and acceptable to nurses and resulted in increased understanding of demoralization, improved confidence to intervene in such cases, and an enhanced sense of professional satisfaction among inpatient oncology floor nurses.
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Libert Y, Peternelj L, Bragard I, Liénard A, Merckaert I, Reynaert C, Razavi D. Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients. BMC Cancer 2017; 17:476. [PMID: 28693515 PMCID: PMC5504708 DOI: 10.1186/s12885-017-3437-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. Methods/design Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. Discussion The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. Trial registration US Clinical Trials Register NCT02836197.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium. .,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Liège, Belgium
| | - Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Kiosses V, Symeonidou K, Alexiou C, Tatsioni A, Hyphantis T, Dimoliatis I. How medical students experience empathy training? An Interpretative Phenomenological Analysis. Results from the "Empathize with me, doctor!" project. MEDEDPUBLISH 2017; 6:111. [PMID: 38406408 PMCID: PMC10885267 DOI: 10.15694/mep.2017.000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. The aim of this study was to investigate how a detailed experiential empathy training program was experienced by medical undergraduates. Twelve medical undergraduates completed a 60-hour, experiential, person-centered training, aiming at improving their empathic performance. After the completion of the training they were interviewed, using semi-structured interviews with open questions, while Interpretative Phenomenological Analysis (IPA) was used to extract the emerged themes. IPA revealed one superordinate theme, i.e. the training as opportunity for actualization, and two subordinate themes, i.e. change in relating with others and self-concept reconstruction through introspection. The first subordinate theme had two components: change in relating with others regarding professional relationships and change related to personal relationships. IPA of students' transcripts revealed that the training was experienced by the students, as an opportunity to introspect, to deal with the obstacles occurring in their encounters with their patients, as a chance to eavesdrop to their inner needs and as a chance to actualize their potential.
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Gibon AS, Durieux JF, Merckaert I, Delvaux N, Farvacques C, Libert Y, Marchal S, Moucheux A, Slachmuylder JL, Razavi D. Development of the LaComm 1.0, A French medical communication analysis software: A study assessing its sensitivity to change. PATIENT EDUCATION AND COUNSELING 2017; 100:297-304. [PMID: 27593086 DOI: 10.1016/j.pec.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To test and compare the sensitivity to change of a communication analysis software, the LaComm 1.0, to the CRCWEM's using data from a randomized study assessing the efficacy of a communication skills training program designed for nurses. METHODS The program assessment included the recording of two-person simulated interviews at baseline and after training or 3 months later. Interview transcripts were analyzed using the CRCWEM and the LaComm 1.0 tools. RESULTS One hundred and nine oncology nurses (mainly graduated or certified) were included in the study. The CRCWEM detected 5 changes out of 13 expected changes (38%) (e.g., more open directive questions after training) and the LaComm 1.0, 4 changes out of 7 expected changes (57%) (e.g., more empathic statements after training). For open directive question, the effect sizes of the group-by-time changes were slightly different between tools (CRCWEM: Cohen's d=0.97; LaComm 1.0: Cohen's d=0.67). CONCLUSIONS This study shows that the LaComm 1.0 is sensitive to change. PRACTICE IMPLICATIONS The LaComm 1.0 is a valid method to assess training effectiveness in French. The use of the Lacomm 1.0 in future French communication skills training programs will allow comparisons of studies.
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Affiliation(s)
- Anne-Sophie Gibon
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | | | - Isabelle Merckaert
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | - Nicole Delvaux
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium
| | | | - Yves Libert
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | | | | | | | - Darius Razavi
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
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Hulley L, Cashell A, Feuz C, Jessop A, Sperduti A, Moyo E, Rosewall T. Communicating with Emotional Patients: Thoughts, Skills, and Influencing Factors for Ontario Radiation Therapists. J Med Imaging Radiat Sci 2016; 47:315-322. [DOI: 10.1016/j.jmir.2016.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
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Kiosses VN, Karathanos VT, Tatsioni A. Empathy promoting interventions for health professionals: a systematic review of RCTs. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40639-016-0024-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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26
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Di Mattei VE, Carnelli L, Mazzetti M, Bernardi M, Di Pierro R, Bergamini A, Mangili G, Candiani M, Sarno L. Mental Representations of Illness in Patients with Gestational Trophoblastic Disease: How Do Patients Perceive Their Condition? PLoS One 2016; 11:e0153869. [PMID: 27101144 PMCID: PMC4839755 DOI: 10.1371/journal.pone.0153869] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Gestational Trophoblastic Disease comprises a group of benign and malignant disorders that derive from the placenta. Using Leventhal's Common-Sense Model as a theoretical framework, this paper examines illness perception in women who have been diagnosed with this disease. METHODS Thirty-one women diagnosed with Gestational Trophoblastic Disease in a hospital in Italy were asked to complete the Illness Perception Questionnaire-Revised to measure the following: illness Identity, illness opinions and causes of Gestational Trophoblastic Disease. RESULTS High mean scores were observed in the Emotional representations and Treatment control subscales. A significant difference emerged between hydatidiform mole patients and those with gestational trophoblastic neoplasia on the Identity subscale. A significant correlation emerged between "time since diagnosis" and the Treatment control subscale. DISCUSSION This study is the first to investigate illness perception in Gestational Trophoblastic Disease. From a clinical perspective the results highlight the need for multidisciplinary support programs to promote a more realistic illness perception.
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Affiliation(s)
- Valentina E. Di Mattei
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Letizia Carnelli
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | | | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University, Milan, Italy
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lucio Sarno
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Health Psychology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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van Riet Paap J, Vernooij-Dassen M, Sommerbakk R, Moyle W, Hjermstad MJ, Leppert W, Vissers K, Engels Y. Implementation of improvement strategies in palliative care: an integrative review. Implement Sci 2015. [PMID: 26210499 PMCID: PMC4515317 DOI: 10.1186/s13012-015-0293-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia. Although a growing number of new insights and best practices in palliative care have been published, they are often not implemented in daily practice. The aim of this integrative review is to provide an overview of implementation strategies that have been used to improve the organisation of palliative care. Methods Using an integrative literature review, we evaluated publications with strategies to improve the organisation of palliative care. Qualitative analysis of the included studies involved categorisation of the implementation strategies into subgroups, according to the type of implementation strategy. Results From the 2379 publications identified, 68 studies with an experimental or quasi-experimental design were included. These studies described improvements using educational strategies (n = 14), process mapping (n = 1), feedback (n = 1), multidisciplinary meetings (n = 1) and multi-faceted implementation strategies (n = 51). Fifty-three studies reported positive outcomes, 11 studies reported mixed effects and four studies showed a limited effect (two educational and two multi-faceted strategies). Conclusions This review is one of the first to provide an overview of the available literature in relation to strategies used to improve the organisation of palliative care. Since most studies reported positive results, further research is needed to identify and improve the effects of strategies aiming to improve the organisation of palliative care. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0293-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasper van Riet Paap
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Nijmegen Alzheimer Centre, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Kalorama Foundation, Nijmegen, The Netherlands.
| | - Ragni Sommerbakk
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway.
| | - Wendy Moyle
- Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, 170 Kessels Road, Nathan, Brisbane, Australia.
| | - Marianne J Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, N-7491, Trondheim, Norway. .,Regional Centre for Excellence in Palliative Care Department of Oncology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland.
| | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Niglio de Figueiredo M, Rudolph B, Rodolph B, Bylund CL, Goelz T, Heußner P, Sattel H, Fritzsche K, Wuensch A. ComOn Coaching: Study protocol of a randomized controlled trial to assess the effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training. BMC Cancer 2015; 15:503. [PMID: 26148681 PMCID: PMC4494160 DOI: 10.1186/s12885-015-1454-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 05/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Communication skills training has proven to be an effective means to enhance communication of health care professionals in oncology. These effects are well studied in standardized settings. The question of transferring these skills into clinical consultations remains open. We build up on a previous developed training concept consisting of a workshop and coaching. This training achieved a medium effect size in two studies with standardized patients. In the current study, we expanded and manualized the coaching concept, and we will evaluate effects of a varied number of coaching sessions on real clinical consultations. Our aim is to determine how much coaching oncologists need to transfer communication skills into clinical practice. Methods/design Physicians of two German medical centers will participate in a workshop for communication skills and will be randomized to either a group with one coaching session or a group with four coaching sessions following the workshop. The participation is voluntary and the physicians will receive medical education points. Consultations held by the participating physicians with actual patients who gave their informed consent will be filmed at three time points. These consultations will be evaluated by blinded raters using a checklist based on the training content (primary outcome). Secondary outcomes will be the self-evaluated communication competence by physicians and an evaluation of the consultations by both physicians and patients. Discussion We will evaluate our communication training concept on three levels – rater, physician and patient – and concentrate on the transfer of communication skills into real life situations. As we emphasize the external validity in this study design, limitations will be expected due to heterogeneity of data. With this study we aim to gain data on how to improve communication skills training that will result in better patient outcomes. Trial registration German Clinical Trials Register DRKS00004385. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1454-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcelo Niglio de Figueiredo
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany. .,Clinic of Dermatology and Venereology, Freiburg University Medical Center, Hauptstr. 7, D-79104, Freiburg, Germany.
| | | | - Bärbel Rodolph
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation; Doha-Qatar, Weill-Cornell Medical College - Qatar, Doha, Qatar.
| | - Tanja Goelz
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany. .,Center for Pediatrics, Freiburg University Medical Center, Mathildenstr. 6, D-79106, Freiburg, Germany.
| | - Pia Heußner
- Department of Haematology and Internal Oncology, Interdisciplinary Psycho-Oncology Center, University Clinic of Munich - Grosshadern, Marchioninistr. 15, D-81377, München, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Hauptstr. 8, D-79104, Freiburg, Germany.
| | - Alexander Wuensch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Langerstr. 3, D-81675, München, Germany.
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Albarracin D, Jouffre S. L’annonce de mauvaises nouvelles : émotions et feed-back dans la formation des médecins. PSYCHO-ONCOLOGIE 2014. [DOI: 10.1007/s11839-014-0481-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Slort W, Blankenstein AH, Schweitzer BPM, Knol DL, van der Horst HE, Aaronson NK, Deliens L. Effectiveness of the palliative care 'Availability, Current issues and Anticipation' (ACA) communication training programme for general practitioners on patient outcomes: a controlled trial. Palliat Med 2014; 28:1036-45. [PMID: 24951633 PMCID: PMC4230538 DOI: 10.1177/0269216314538302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients' quality of life. Little is known about the effect of training general practitioners in palliative care-specific communication. We hypothesized that palliative care patients of general practitioners exposed to the 'Availability, Current issues and Anticipation' communication training programme would report better outcomes than patients of control general practitioners. AIM To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. DESIGN In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire-III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. TRIAL REGISTRATION ISRCTN56722368. SETTING/PARTICIPANTS General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. RESULTS Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire-III and Availability, Current issues and Anticipation Scale. CONCLUSION General practitioner participation in the Availability, Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated. Patients reported high levels of satisfaction with general practitioner care, regardless of group assignment. Future research might focus on general practitioners without special interest in palliative care.
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Affiliation(s)
- Willemjan Slort
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Annette H Blankenstein
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Canivet D, Delvaux N, Gibon AS, Brancart C, Slachmuylder JL, Razavi D. Improving communication in cancer pain management nursing: a randomized controlled study assessing the efficacy of a communication skills training program. Support Care Cancer 2014; 22:3311-20. [PMID: 25099306 DOI: 10.1007/s00520-014-2357-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/21/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Effective communication is needed for optimal cancer pain management. This study assessed the efficacy of a general communication skills training program for oncology nurses on communication about pain management. METHODS A total of 115 nurses were randomly assigned to a training group (TG) or control group (CG). The assessment included the recording of interviews with a simulated cancer patient at baseline for both groups and after training (TG) or 3 months after baseline (CG). Two psychologists rated the content of interview transcripts to assess cancer pain management communication. Group-by-time effects were measured using a generalized estimating equation. RESULTS Trained nurses asked the simulated patient more questions about emotions associated with pain (relative rate [RR] = 4.28, p = 0.049) and cognitions associated with pain treatment (RR = 3.23, p < 0.001) and used less paternalistic statements about cancer pain management (RR = 0.40, p = 0.006) compared with untrained nurses. CONCLUSIONS The general communication skills training program improved only a few of the communication strategies needed for optimal cancer pain management in nursing. General communication skills training programs should be consolidated using specific modules focusing on communication skills related to cancer pain management.
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Affiliation(s)
- Delphine Canivet
- Université Libre de Bruxelles, 50 Avenue F.D. Roosevelt, 1050, Brussels, Belgium
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Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, Wilson M, Bernhard J. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2014; 18:2570-83. [PMID: 24975503 DOI: 10.1111/hex.12229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Informed consent is required for both standard cancer treatments and experimental cancer treatments in a clinical trial. Effective and sensitive physician-patient communication about informed consent is difficult to achieve. Our aim was to train doctors in clear, collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour, stress and satisfaction. PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zealand (ANZ) centres and 41 oncologists from 10 Swiss/German/Austrian (SGA) centres. Oncologists were randomized to participate in a 1-day workshop or not. Patients were recruited before and after the training. Doctors were asked to submit 1-2 audiotaped consultations before and after training. Doctors completed outcome measures before and after completing the post-training cohort recruitment. RESULTS Ninety-five consultation interactions were audiotaped. Doctors strongly endorsed the training. ANZ intervention doctors demonstrated a significant increase in collaborative communication (P = 0.03). There was no effect of training on other doctor behaviours. Trained doctors did not demonstrate reduced stress and burnout. Patient outcomes are presented elsewhere. CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent. Methods to increase the impact of training are required and may include longer training and more intensive follow-up.
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Aldridge
- International Breast Cancer Study Group (IBCSG) Statistical Centre, Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - P Zoller
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Boyle
- Pam McLean Centre, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M Wilson
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Bernhard
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Formation au dépistage des difficultés psychosociales en cancérologie : apport d’un guide d’entretien (PO-Bado) sur la pratique des soignants du dispositif d’annonce. PSYCHO-ONCOLOGIE 2014. [DOI: 10.1007/s11839-014-0451-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Connolly M, Thomas JM, Orford JA, Schofield N, Whiteside S, Morris J, Heaven C. The impact of the SAGE & THYME foundation level workshop on factors influencing communication skills in health care professionals. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:37-46. [PMID: 24648362 DOI: 10.1002/chp.21214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The "SAGE & THYME Foundation Level Workshop" delivers evidence-based communication skills training to 30 health care workers in 3 hours. It teaches a structured approach (the SAGE & THYME model) to discuss patient/carer concerns. The aim of this study was to determine whether the workshop had a positive outcome on factors that influence communication skills. METHODS The study had a pragmatic, mixed methods design. Workshops were run in an acute hospital. One hundred seventy health care workers completed questionnaires pre- and post-workshop; 141 were sent follow-up questionnaires at 2 weeks and 2 months; and 9 were filmed talking to a simulated patient pre- and post-workshop. RESULTS From pre- to post-workshop, there was a significant increase in knowledge (p < 0.001), self-efficacy (p < 0.001), and outcome expectancy (p < 0.001). An expert's rating of behavior with the simulated patient also significantly increased after the training (p = 0.011). Motivation to use the training, and the perceived usefulness of the SAGE & THYME model, were high post-workshop. There was a poor response rate in the follow-up period; hence, the quantitative data are not reported. The qualitative data are described, however, as they give an insight into the impact of the training on staff and their patients. DISCUSSION The SAGE & THYME Foundation Level Workshop significantly increases communication skills knowledge, self-efficacy, and outcome expectancy of hospital health care workers who are predominantly white, female, nursing, or nonclinical staff. This suggests that the workshop may have a positive impact on some factors influencing communication skills in this group.
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Blackhall LJ, Erickson J, Brashers V, Owen J, Thomas S. Development and Validation of a Collaborative Behaviors Objective Assessment Tool for End-of-Life Communication. J Palliat Med 2014; 17:68-74. [DOI: 10.1089/jpm.2013.0262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - John Owen
- University of Virginia School of Medicine, Charlottesville, Virginia
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Bibila S, Rabiee F. Training the powerful: issues that emerged during the evaluation of a communication skills training programme for senior cancer care professionals. Eur J Cancer Care (Engl) 2013; 23:531-44. [PMID: 24373021 DOI: 10.1111/ecc.12167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2004] [Indexed: 11/28/2022]
Abstract
'Connected' is the name of the national advanced communication skills training programme developed in 2008 for cancer care professionals in the NHS. A 3-day training course combining didactic and experiential learning elements is run by two facilitators with course participants expected to engage fully in simulated consultations with trained actors. In 2011, and as a result of participant feedback on the length of the course and increasing pressures on budgets and clinical time, the Connected team developed and piloted an alternative 2-day training course. Before its roll-out in 2012, Birmingham City University was commissioned to evaluate the effectiveness and quality of the 2-day course vis-à-vis the 'traditional' 3-day one. This article is written by the two evaluators and it discusses some of the issues that emerged during the evaluation. We broadly grouped these issues into two overlapping categories: the mandatory nature of the course and the different professional background and seniority of participants. In our discussion we consider the implications these issues have for communication skills training policy and practice and put forward suggestions for further research.
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Affiliation(s)
- S Bibila
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Birmingham, UK
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Stadelmaier N, Duguey-Cachet O, Saada Y, Quintard B. The Basic Documentation for Psycho-Oncology (PO-Bado): An innovative tool to combine screening for psychological distress and patient support at cancer diagnosis. Psychooncology 2013; 23:307-14. [DOI: 10.1002/pon.3421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 01/22/2023]
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A pan-Canadian web-based education program to support screening for distress: Evaluation of outcomes. Palliat Support Care 2013; 12:15-23. [DOI: 10.1017/s1478951513000072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Cancer-related distress has been endorsed as the sixth vital sign by many international cancer organizations, and some countries such as Canada have implemented national screening for distress programs. The completion of a screening tool is an important first step in improving responsiveness to cancer-related distress, but screening must be followed with skilled supportive care to make a difference in patient-reported outcomes. Our objective was to create a web-based education program to support nurses and other frontline staff in providing an initial response to screening results.Method:To address screening and supportive care learning needs, the Canadian Association of Psychosocial Oncology (CAPO), with support from the Canadian Partnership Against Cancer, created a web-based education program as one component of the national screening for distress agenda. The program provides clinically grounded and interactive learning through the use of PowerPoint presentations, video clips of clinical interactions with patients and family members, and test questions. Presentation topics include, for example, strategies for dealing with screening results, managing referrals, and supportive counseling. We employed a matched pairs, pre-post survey design to assess the effect of the education program on confidence in screening and in providing initial supportive care.Results:Our analysis of the first 147 matched pairs to complete the course suggests that satisfaction with the course was high. Statistically significant increases in confidence in relation to screening for distress and assessing distress, and in providing initial supportive care, were evident.Significance of results:Our ongoing experience with CAPO's Interprofessional Psychosocial Oncology Distance Education (IPODE) project (www.ipode.ca) project suggests that healthcare professionals value web-based learning for its accessibility and convenience. Such programs appear to offer excellent opportunities for cost-effective education that supports practice change.
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Sheldon LK. Communication skills training: using evidence to develop programs that improve patient outcomes. J Adv Pract Oncol 2013; 4:172-5. [PMID: 25031997 PMCID: PMC4093425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Kennedy Sheldon
- University of Massachusetts Boston, College of Nursing and Health Sciences, Boston, Massachusetts
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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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Hallford DJ, McCabe MP, Mellor D, Davison TE, Goldhammer DL. Depression in palliative care settings: the need for training for nurses and other health professionals to improve patients' pathways to care. NURSE EDUCATION TODAY 2012; 32:556-560. [PMID: 21862185 DOI: 10.1016/j.nedt.2011.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
Depression is highly prevalent in patients receiving palliative care; however, detection rates are low, with many patients who suffer with depression continuing to go undetected and untreated. A number of factors unique to this setting, as well as issues relating to staff knowledge and self-efficacy working with depression, may impede the detection of patients who are depressed by professional health care staff. Although programmes aimed to train nurses and other allied health staff in depression may be an effective way to improve detection rates, there have been few studies investigating the efficacy of these interventions. This article draws upon recent literature to provide a narrative review of barriers to detection and factors relating to professional palliative care staffs' ability to provide pathways to care for patients who suffer with depression in this setting. Previously evaluated training programmes are reviewed and the argument is made that further development and empirical evaluation of depression training interventions for staff in this setting will provide services with evidence-based methods of training nurses and other professional care staff and improve the pathways to care for patients who suffer with depression.
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Szmuilowicz E, Neely KJ, Sharma RK, Cohen ER, McGaghie WC, Wayne DB. Improving residents' code status discussion skills: a randomized trial. J Palliat Med 2012; 15:768-74. [PMID: 22690890 DOI: 10.1089/jpm.2011.0446] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Inpatient Code Status Discussions (CSDs) are commonly facilitated by resident physicians, despite inadequate training. We studied the efficacy of a CSD communication skills training intervention for internal medicine residents. METHODS This was a prospective, randomized controlled trial of a multimodality communication skills educational intervention for postgraduate year (PGY) 1 residents. Intervention group residents completed a 2 hour teaching session with deliberate practice of communication skills, online modules, self-reflection, and a booster training session in addition to assigned clinical rotations. Control group residents completed clinical rotations alone. CSD skills of residents in both groups were assessed 2 months after the intervention using an 18 item behavioral checklist during a standardized patient encounter. Average scores for intervention and control group residents were calculated and between-group differences on the CSD skills assessment were evaluated using two-tailed independent sample t tests. RESULTS Intervention group residents displayed higher overall scores on the simulated CSD (75.1% versus 53.2%, p<0.0001) than control group residents. The intervention group also displayed a greater number of key CSD communication behaviors and facilitated significantly longer conversations. The training, evaluation, and feedback sessions were rated highly. CONCLUSION A focused, multimodality curriculum can improve resident performance of simulated CSDs. Skill improvement lasted for at least 2 months after the intervention. Further studies are needed to assess skill retention and to set minimum performance standards.
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Affiliation(s)
- Eytan Szmuilowicz
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Araújo MMTD, Silva MJPD. Estratégias de comunicação utilizadas por profissionais de saúde na atenção à pacientes sob cuidados paliativos. Rev Esc Enferm USP 2012; 46:626-32. [DOI: 10.1590/s0080-62342012000300014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 08/16/2011] [Indexed: 11/22/2022] Open
Abstract
O presente estudo objetivou verificar a relevância e a utilização de estratégias de comunicação em cuidados paliativos. Estudo quantitativo multicêntrico, realizado entre agosto/2008 e julho/2009, junto a 303 profissionais de saúde que trabalhavam com pacientes sob cuidados paliativos, por meio da aplicação de questionário. Os dados foram submetidos a tratamento estatístico descritivo. A maioria (57,7%) não foi capaz de citar ao menos uma estratégia de comunicação verbal e apenas 15,2% mencionaram cinco sinais ou estratégias não verbais. As estratégias verbais mais citadas foram as de cunho interrogativo sobre a doença/tratamento e, dentre as não verbais, destacaram-se o toque afetivo, olhar, sorriso, proximidade física e escuta ativa. Embora os profissionais tenham atribuído alto grau de relevância para a comunicação em cuidados paliativos, evidenciaram escasso conhecimento de estratégias de comunicação. Faz-se necessária a capacitação dos profissionais no que tange à comunicação em cuidados paliativos.
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Araújo MMTD, Silva MJPD. O conhecimento de estratégias de comunicação no atendimento à dimensão emocional em cuidados paliativos. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000100014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
O estudo objetivou investigar o conhecimento e a utilização de estratégias de comunicação no cuidado da dimensão emocional do paciente sob cuidados paliativos. Com abordagem quantitativa, foi realizado entre agosto/2008 e julho/2009, junto a 303 profissionais de saúde que trabalhavam ou tinham contato frequente com estes pacientes, por meio da aplicação de questionário. Os dados sofreram tratamento estatístico descritivo e analítico. Os profissionais denotaram desconhecimento de estratégias de comunicação, evidenciando-se diferença significativa (p-valor 0,0011) na comparação entre sujeitos com e sem formação prévia em cuidados paliativos, denotando que quem possui capacitação paliativista conhece/utiliza mais estratégias comunicacionais na atenção à dimensão emocional de seus pacientes. As estratégias mais citadas pelos sujeitos foram: escuta ativa, reafirmações verbais de solicitude, uso de perguntas abertas e toque afetivo. Conclui-se que há pouco conhecimento e utilização insatisfatória de estratégias de comunicação, pelos profissionais de saúde no cuidado à dimensão emocional de pacientes sob cuidados paliativos.
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Tay LH, Ang E, Hegney D. Nurses’ perceptions of the barriers in effective communication with inpatient cancer adults in Singapore. J Clin Nurs 2012; 21:2647-58. [DOI: 10.1111/j.1365-2702.2011.03977.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sajjadi S, Ahmadi M, Heidarpour M, Yakta AS, Khadembashi N, Rafatbakhsh M. The effect of in-service English education on medical professionals' language proficiency. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:190-6. [PMID: 23264797 PMCID: PMC3525041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 10/30/2011] [Accepted: 11/28/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite its inevitable significance, the effect of in-service English education on medical professionals has rarely been studied longitudinally. The reason can be issues such as physicians' heavy workload, commuting problems, inappropriate class times, and inexperienced teaching staff. MATERIALS AND METHODS A needs assessment worksheet was administered to faculty members of Shahid Beheshti University of Medical Sciences in Tehran and the responses were analyzed. A project for the promotion of faculty members' English proficiency was formulated. Then, following a placement test, 235 applicants from the university colleges and hospitals were classified into 28 homogeneous groups. After four terms of instruction, the participants' scores on the pre- and post- assessments were analyzed. RESULTS There was significant improvement in participants' total scores on different communicative skills (P<0.001). Regarding individual skills also, they achieved meaningful gains on listening (P<0.001), writing (P = 0.038), and grammar (P<0.001), but failed to progress significantly on reading comprehension (P = 0.523). CONCLUSION The administration of in-service education for skill-oriented courses, over a long period, can be quite encouraging and should be further strengthened. Regular instructions on each individual skill on the one hand and on their combination on the other are essential for success in such education.
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Affiliation(s)
- Samad Sajjadi
- Associate Professor, Department of Applied Linguistics at the English Language, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ahmadi
- Associate Professor, Department of Applied Linguistics at the English Language, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Address for correspondence: Mr. Majid Ahmadi, Department of English Language, College of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
| | - Maryam Heidarpour
- Instructor, Department of Medical and General English Courses at the English Language, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Salahi Yakta
- Instructor of Medical and General English Courses at the English Language Department, College of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghmeh Khadembashi
- Instructor, Department of Medical and General English Courses at the English Language, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rafatbakhsh
- Instructor, Department of Medical and General English Courses at the English, Paramedical College, Shiraz University of Medical Sciences, Shiraz, Iran
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Lelorain S, Brédart A, Dolbeault S, Sultan S. A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psychooncology 2012; 21:1255-64. [PMID: 22238060 DOI: 10.1002/pon.2115] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology. METHOD With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes. RESULTS Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping). CONCLUSION Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed.
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Affiliation(s)
- Sophie Lelorain
- Laboratoire de Psychopathologie et Processus de Santé (LPPS EA 4057), IUPDP, Université Paris Descartes, Boulogne-Billancourt, France.
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Slort W, Schweitzer BPM, Blankenstein AH, Abarshi EA, Riphagen II, Echteld MA, Aaronson NK, van der Horst H, Deliens L. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review. Palliat Med 2011; 25:613-29. [PMID: 21273221 DOI: 10.1177/0269216310395987] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While effective general practitioner (GP)-patient communication is required for the provision of good palliative care, barriers and facilitators for this communication are largely unknown. We aimed to identify barriers and facilitators for GP-patient communication in palliative care. In a systematic review seven computerized databases were searched to find empirical studies on GP-patient communication in palliative care. Fifteen qualitative studies and seven quantitative questionnaire studies were included. The main perceived barriers were GPs' lack of availability, and patients' and GPs' ambivalence to discuss 'bad prognosis'. Main perceived facilitators were GPs being available, initiating discussion about several end-of-life issues and anticipating various scenarios. Lack of availability and failure to discuss former mistakes appear to be blind spots of GPs. GPs should be more forthcoming to initiate discussions with palliative care patients about prognosis and end-of-life issues. Empirical studies are needed to investigate the effectiveness of the perceived barriers and facilitators.
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Affiliation(s)
- W Slort
- Department of General Practice, and EMGO+ Institute for Health and Care Research, VU University Medical Centre, The Netherlands.
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Berkhof M, van Rijssen HJ, Schellart AJM, Anema JR, van der Beek AJ. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. PATIENT EDUCATION AND COUNSELING 2011; 84:152-62. [PMID: 20673620 DOI: 10.1016/j.pec.2010.06.010] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 05/18/2010] [Accepted: 06/04/2010] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Physicians need good communication skills to communicate effectively with patients. The objective of this review was to identify effective training strategies for teaching communication skills to qualified physicians. METHODS PubMED, PsycINFO, CINAHL, and COCHRANE were searched in October 2008 and in March 2009. Two authors independently selected relevant reviews and assessed their methodological quality with AMSTAR. Summary tables were constructed for data-synthesis, and results were linked to outcome measures. As a result, conclusions about the effectiveness of communication skills training strategies for physicians could be drawn. RESULTS Twelve systematic reviews on communication skills training programmes for physicians were identified. Some focused on specific training strategies, whereas others emphasized a more general approach with mixed strategies. Training programmes were effective if they lasted for at least one day, were learner-centred, and focused on practising skills. The best training strategies within the programmes included role-play, feedback, and small group discussions. CONCLUSION Training programmes should include active, practice-oriented strategies. Oral presentations on communication skills, modelling, and written information should only be used as supportive strategies. PRACTICE IMPLICATIONS To be able to compare the effectiveness of training programmes more easily in the future, general agreement on outcome measures has to be established.
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Affiliation(s)
- Marianne Berkhof
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Walger O. Similitudes, différences, complémentarités entre médecins et infirmières en interaction avec le patient dans le cadre de programmes en éducation du patient diabétique : une revue de la littérature. ACTA ACUST UNITED AC 2011. [DOI: 10.1051/tpe/2011107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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