Serious Illness Communication Training for Heart Failure and Cardiology Fellows

Abstract

Introduction Integration of palliative care (PC) into management of patients with advanced heart disease (AHD) improves quality of life and is endorsed by consensus guidelines. Because of the limited availability of specialty PC providers, equipping cardiologists with communication skills for serious illness conversations is paramount to ensuring access to PC for all patients with AHD. Surveys have shown that fellows in training are frequently involved in late goals of care conversations with AHD patients, yet few receive training in communication skills. CardioTalk is a communication skills workshop created using the VitalTalk ( www.vitaltalk.org ) model, which has been shown to improve communication skills for oncology, nephrology, and geriatrics fellows. Hypothesis Adapting and implementing a serious illness communication skills curriculum for cardiology and heart failure fellows will be feasible, useful, and valued. Methods General cardiology and heart failure fellows participated in a communication skills workshop using a VitalTalk curriculum adapted for AHD. Sessions were taught by VitalTalk-trained educators, and were structured as a short didactic, including skills demonstration, followed by small-group practice with simulated patient actors. We used a structured “talking map” framework for late goals of care conversations, and specifically taught delivering serious news, responding to emotion, eliciting patient preferences and values, and making recommendations. A Likert scale-based questionnaire was used to assess fellows’ perceptions of the educational quality of the workshop, as well as the utility of skills learned. Results Twenty-three fellows participated. Overall educational quality of the workshop was rated highly, with an average score on the Likert scale of 4.8/5 (with 1 - “Poor” and 5 - “Excellent”). Likelihood of using the workshop skills in daily practice was also highly rated, with an average Likert score of 4.8/5 (with 1 - “Not likely at all” and 5 - “Very likely”). Likelihood of recommending this training to a colleague was rated on average 4.8/5 (1 - “Strongly disagree” and 5 - “Strongly Agree”). Qualitative responses suggested fellows took home the importance of responding to emotion rather than cognitive questions, and the utility of using a conversation framework. Fellows requested additional sessions, as well as training in even more complex cases. Conclusions Equipping cardiology and heart failure fellows with serious illness communication skills using the CardioTalk curriculum is feasible, effective and valued. Fellows were eager to learn, and felt their new skills would translate well into clinical practice.