Training Nonpalliative Care Clinicians in Serious Illness Communication: Results of a Train-the-Trainer Model in Three Health Systems (SA511D)

Abstract

•List the steps of a structured approach to training clinicians in serious illness communication using the Serious Illness Conversation Guide.•Evaluate clinician-reported outcomes of serious illness communication training, including self-assessment of change in skills.•Categorize and reflect on clinician takeaways from training that they will apply in practice as well as trainer perceptions of common barriers. Failure to initiate discussions about values and goals in serious illness (‘serious illness communication’) remains a common problem. Insufficient training leaves clinicians unsure of what to say or how/when to approach these conversations. Given the shortage of palliative care clinicians, evidence is needed to guide the development and implementation of consistent high-quality communication training for all clinicians. Evaluate the impact of clinician training as part of an organization-wide initiative and train-the-trainer program in three health systems. In partnership with the Serious Illness Care Program at Ariadne Labs (AL), 3 health systems identified champions to complete a novel train-the-trainer program. Subsequently, these trainers delivered skills-based trainings on the Serious Illness Conversation Guide (SICG) to nonpalliative-care clinicians in their own systems. After each training, clinician participants completed a survey, including self-assessment of change in skills and self-reported learnings. From 2016-2018, AL trained 22 trainers (18/22 were palliative care MDs) in three systems, who then trained 331 clinicians (48% MD; 32% APP; 20% RN, SW) in 53 sessions spanning subspecialties (67%); primary care (25%); other (8%). Upon completion, participants reported improvement in each of the communication tasks (e.g. assessing illness understanding, sharing prognosis, exploring goals/values); improvements between self-rating scores pre- and posttraining were all significant (p<0.0001). Participants rated the quality of the training highly (98% mostly/extremely effective) and shared a diverse array of personalized takeaways to apply in practice, including core skills learned (e.g. reflective listening) and the usefulness of a structure. Serious Illness Conversation Guide training, delivered through a train-the-trainer model and system-level program, was highly acceptable and resulted in significant measurable improvements in clinician self-reported skills. This is a viable and scalable method for health systems seeking to train their own workforce in serious illness communication.