Abstract
BackgroundPracticing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum.MethodsWe searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE.ResultsOf 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95 % confidence interval [CI] 0.40–0.75; P < 0.001; very low quality evidence), more knowledge (4 studies, SMD 0.76;95 % CI 0.40–1.12; p < 0.001; low quality evidence), and improvements in communication scores (8 studies, SMD 0.69; 95 % CI 0.41–0.96; p < 0.001; very low quality evidence). There was insufficient evidence to determine whether these educational interventions affect patient-level outcomes.ConclusionVery low to low quality evidence suggests that end-of-life communication training may improve healthcare professionals’ self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes.Trial registrationPROSPERO CRD42014012913Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0653-x) contains supplementary material, which is available to authorized users.
Highlights
Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families
We review only the studies of educational interventions directed to health care providers, whether trainees in a health professional training program, or practicing providers receiving continuing medical education
Study characteristics Study setting & populations Most of the studies were completed in the USA (80 %), and 17 (90 %) were aimed toward medical trainees (14 postgraduate level, 3 undergraduate medical school), one to postgraduate medical trainees and nurse practitioners in acute care programs, and two studies were open to all acute care health care professionals (HCP) (Table 1)
Summary
Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum. In a multicenter Canadian survey, internal medicine residents at five universities identified that EoL communication skills were a high learning priority [8] as resident physicians are often responsible for facilitating EoL discussions with hospitalized patients in academic centers [7, 9, 10] This need persists in even practicing HCPs such as physicians and nursing staff who continue to have discomfort in facilitating EoL discussions [11,12,13,14,15]. The effectiveness was measured based on the Kirkpatrick training evaluation model (Reaction, Learning, Behaviour and Results) [16] which was represented by outcomes of self-efficacy, knowledge, communication skills and patient-level effects
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