Communication Assessment Tool Research Articles

Reducing Preoperative Anxiety: The Role of Anesthesia Provider Communication and Empathy

Preoperative anxiety is a common and significant issue that can negatively impact patient outcomes. Effective communication and empathy from anesthesia providers have been suggested as crucial factors in mitigating this anxiety. This study aimed to investigate the relationship between anesthesia provider communication and empathy and preoperative anxiety levels in adult patients undergoing elective surgery. A prospective, observational study was conducted at a tertiary care hospital. Adult patients scheduled for elective surgery under general anesthesia were enrolled. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before the anesthesia provider's preoperative visit and again immediately before surgery. Anesthesia provider communication and empathy were evaluated using the CARE (Communication Assessment Tool for Anesthesia Providers) questionnaire and the Jefferson Scale of Empathy (JSE), respectively. A total of 200 patients were included in the study. The mean preoperative anxiety score decreased significantly from before the anesthesia provider's visit to immediately before surgery (p < 0.001). Higher scores on the CARE questionnaire and the JSE were associated with a greater reduction in preoperative anxiety (p < 0.05). Multivariable analysis revealed that both effective communication and empathy independently contributed to reducing preoperative anxiety. Anesthesia provider communication and empathy play a crucial role in reducing preoperative anxiety. Implementing communication and empathy training programs for anesthesia providers may improve patient experiences and surgical outcomes.

Assessment tool items for addressing physician-patient communication and reducing healthcare risk factors across multiple enterprise risk management domains.

Expertise in physician-patient communication is a primary outcome measure for physicians. We evaluated residents' communication behaviors with clinic patients following an educational intervention as measured by the Communication Assessment Tool (CAT). Thirty-five internal medicine residents were assessed by patients using the CAT for 3 months before and after the educational intervention. The intervention included a simulated, videotaped patient encounter, mock CAT, and preceptor coaching during video review. The primary outcome was the percentage of CAT items receiving an "excellent" rating from patients before and after the intervention. Research results were compared to previously published CAT studies. Within-resident improvement in the percentage of excellent ratings was small with median changes between 0 and 3 percentage points. Compared to previously published studies, similar results were found for the highest and lowest-scored communication items. Many clinical encounters are time-limited, and physicians do not pursue time-consuming conversations that could reduce health care risk. This data and other published studies suggest seven communication items taking the most time to complete (i.e., shared decision-making) were items demonstrating little or no improvement. This study identified clinical performance risk factors applicable to the Enterprise Risk Management Framework that could impact complication and readmission rates if addressed by changes in physician- patient communication.

Validation of a Cantonese Version of the Amsterdam-Nijmegen Everyday Language Test (CANELT): A functional approach.

The current study aimed to validate the Cantonese version of the Amsterdam-Nijmegen Everyday Language Test (CANELT), a functional communication assessment tool for Cantonese speakers with aphasia. A quantitative scoring method was adopted to examine the pragmatics and informativeness of the production of people with aphasia (PWA). CANELT was translated from its English version with cultural adaptations. The performance on the 20-item CANELT collected from 56 PWA and 100 neurologically healthy Cantonese-speaking controls aged 30 to 79 years was orthographically transcribed. Scoring was based on the completeness of the main concepts produced in the preamble and subsequent elaborations, defined as Opening (O) and New Information (NI). Measures examining the validity and reliability were conducted. An age effect was found in neurologically healthy controls, and therefore z scores were used for subsequent comparisons between neurologically healthy controls and PWA. The test showed strong evidence for known-group validity in both O [χ2 (2) = 95.2, p < .001] and NI [χ2 (2) = 100.4, p < .001]. A moderate to strong correlation was found between CANELT and standardized aphasia assessment tools, suggesting satisfactory concurrent validity. Reliability measures were excellent in terms of internal consistency (Cronbach's α of .95 for both 'O' and 'NI'), test-retest reliability (ICC = .96; p < .001), intra-rater reliability (ICC = 1.00; p < .001), and inter-rater reliability for O (ICC = .99; p < .001) and NI (ICC = .99; p < .001). Sensitivity and specificity for O are 97% and 76.8%, respectively, while for NI, a sensitivity of 95% and specificity of 91.1% were obtained. Measures on validity and reliability yielded promising results, suggesting CANELT as a useful and reliable functional communication assessment for PWA. Its application in managing PWA and potential areas for development are discussed.

Effects of on-site Supportive Communication Training (On-site SCT) on doctor-patient communication in oncology: Study protocol of a randomized, controlled mixed-methods trial

BackgroundThe quality of communication in oncology significantly impacts patients' health outcomes, as poor communication increases the risk of unnecessary treatment, inadequate pain relief, higher anxiety levels, and acute hospitalizations. Additionally, ineffective communication skills training (CST) is associated with stress, low job satisfaction, and burnout among doctors working in oncology. While acknowledging the importance of effective communication, the specific features of successful CST remain uncertain. Role-play and recorded consultations with direct feedback appear promising for CST but may be time-consuming and face challenges in transferring acquired skills to clinical contexts. Our aim is to bridge this gap by proposing a novel approach: On-site Supportive Communication Training (On-site SCT). The concept integrates knowledge from previous studies but represents the first randomized controlled trial employing actual doctor-patient interactions during CST.MethodsThis randomized multicenter trial is conducted at three departments of oncology in Denmark. Doctors are randomized 1:1 to the intervention and control groups. The intervention group involves participation in three full days of On-site SCT facilitated by a trained psychologist. On-site SCT focuses on imparting communication techniques, establishing a reflective learning environment, and offering emotional support with a compassionate mindset. The primary endpoint is the change in percentage of items rated “excellent” by the patients in the validated 15-item questionnaire Communication Assessment Tool. The secondary endpoints are changes in doctors’ ratings of self-efficacy in health communication, burnout, and job satisfaction measured by validated questionnaires. Qualitative interviews will be conducted with the doctors after the intervention to evaluate its relevance, feasibility, and working mechanisms. Doctors have been actively recruited during summer/autumn 2023. Baseline questionnaires from patients have been collected. Recruitment of new patients for evaluation questionnaires is scheduled for Q1-Q2 2024.DiscussionThis trial aims to quantify On-site SCT efficacy. If it significantly impacts patients/doctors, it can be a scalable CST concept for clinical practice. Additionally, qualitative interviews will reveal doctors' insight into the most comprehensible curriculum parts.Trial registrationApril 2023 – ClinicalTrials.gov (NCT05842083). April 2023 – The Research Ethics Committee at the University of Southern Denmark (23/19397).

Mediating role of physician's empathy between physician's communication and patient's satisfaction.

Physician communication is vital for an effective physician-patient relationship. Physician empathy is crucial to patient communication. The relationship between physician empathy, physician communication, and patient satisfaction is not very clear. This study aims to study the mediating role of physician's empathy between physician's communication, physician's empathy, and patient's satisfaction. A cross-sectional study was conducted at the National Institute of Psychology, Quaid-i-Azam University, during the time period of December 2018 to February 2019. Employing the technique of purposive convenience sampling, data were collected (N = 238) from psychiatric, cardiology, and dermatology wards of public and private sector hospitals of Islamabad and Rawalpindi. The Communication Assessment Tool, specifically the Patient's Perception of Physician's Empathy and Patient Satisfaction Scale, was used to assess study variables. The measures used in the research assess the patient's perception of the physician's communication, empathy, and patient's satisfaction. Formal permission for the research was taken from the hospital administration with approval from the institutional review boards. Participants were briefed about the purpose of the research. Both verbal and written informed consent was taken from them. The result shows that a physician's empathy plays a mediating role between the physician's communication skills and patient satisfaction. Moreover, Pearson product-moment correlation indicated a significant positive relationship between doctors' communication skills, doctors' empathy, and patients' satisfaction. Building a positive doctor-patient relationship would not only lead to improved patient satisfaction but also reduce the likelihood of medical malpractice. Therefore, steps should be taken to enforce trust, interaction, and empathy in doctor-patient relationships, with patient-centered services. Physician's empathy plays a mediating role between physician's communication skills and patient's satisfaction.

Language Disparities in Caregiver Satisfaction with Physician Communication at Well Visits from 0-2 Years

ObjectiveThis study aimed to describe caregiver satisfaction with physician communication over the first two years of life and examine differences by preferred language and the relationship to physician continuity. MethodsLongitudinal data were collected at well visits (2 months to 2 years) from participants in a randomized controlled trial to prevent childhood obesity. Satisfaction with communication was assessed using the validated Communication Assessment Tool (CAT) questionnaire. Changes in the odds of optimal scores were estimated in mixed-effects logistic regression models to evaluate the associations between satisfaction over time and language, interpreter use, and physician continuity. ResultsOf 865 caregivers, 35% were Spanish-speaking. Spanish-speaking caregivers without interpreters had lower odds of an optimal satisfaction score compared with English speakers during the first 2 years, beginning at 2 months [OR 0.64 (95% CI: 0.43, 0.95)]. There was no significant difference in satisfaction between English-speaking caregivers and Spanish-speaking caregivers with an interpreter. The odds of optimal satisfaction scores increased over time for both language groups. For both language groups, odds of an optimal satisfaction score decreased each time a new physician was seen for a visit [OR 0.82 (95% CI: 0.69, 0.97)]. ConclusionCaregiver satisfaction with physician communication improves over the first two years of well-child visits for both English- and Spanish-speakers. A loss of physician continuity over time was also associated with lower satisfaction. Future interventions to ameliorate communication disparities should ensure adequate interpreter use for primarily Spanish-speaking patients and address continuity issues to improve communication satisfaction.

Patient-centred pathology reporting improves patient experience and understanding of disease in prostate cancer care.

Patient-centred (PC) and holistic care improves patient satisfaction and health outcomes. We sought to investigate the benefit of utilising a PC pathology report in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). Our study aimed to evaluate and compare patient understanding of their PCa diagnosis after RP, upon receiving either a standard histopathology report or a personalised and PC report (PCR). Moreover, we evaluated knowledge retention at 4 weeks after the initial consultation. We invited patients undergoing RP at three metropolitan Urology clinics to participate in our randomised controlled study. Patients were randomised to receive either a PCR or standard pathology report. Patient satisfaction questionnaires (Perceived Efficacy in Patient-Physician Interactions [PEPPI], Consultation and Relational Empathy [CARE] and Communication Assessment Tool [CAT]) and a knowledge test were conducted within 72 h of the initial appointment and again at 4 weeks. Accurate recollection of Gleason grade group (GGG) and extracapsular extension (ECE) were classified as 'correct'. Baseline demographic data included age, education, marital and employment status, pre-op prostate specific antigen (PSA) and clinical stage. Baseline data were tested for differences between groups using the Student's t test, chi-squared test or Fisher's exact test depending on whether data were continuous, categorical or sparse. Comparison of correctly answered 'knowledge' questions was analysed using chi-squared test. A significance level of p ≤ 0.05 was used. Data from 62 patients were analysed (30 standard vs. 32 PCR). No significant differences in baseline demographics were found between groups. Both groups reported high levels of satisfaction with their healthcare experiences in all domains of patient-physician rapport, empathy and communication. There were no significant differences between groups in PEPPI (p = 0.68), CAT (p = 0.39) and CARE (p = 0.66) scores, at baseline and 4 weeks. Ninety-three per cent of patients who received the PCR understood the report while 90% felt the report added to their understanding of their PCa. Regarding patient knowledge, the PCR group had significantly more correct answers on GGG and ECE as compared with the standard report group at baseline and 4 weeks (p < 0.001 and 0.001, respectively). Our findings demonstrate that PC pathology reports improve patient knowledge and understanding of their PCa that is retained for at least 4 weeks after initial receipt of results.

Assessment of Therapeutic Communication Skills and Barriers Between Nursing Students and Patients

Introduction: The ability of the nurse to communicate with patients has been long recognized as an essential pillar of nursing care. This study aimed to assess the therapeutic communication skills and barriers among nursing students and patients. Methods: A cross-sectional descriptive research design based on a quantitative approach is used in this study. The participants of the study were selected purposively from level 4 to level 8 students in nursing program from Mohammed Al-Mana College for Medical Sciences. An observation checklist named Health Communication Assessment tool was used to assess the communication skills of nursing students. The second tool was a survey questionnaire-the barriers to nursing student-patient communication questionnaire which identified the barriers to therapeutic communication between the nursing students and the patients. Results: A total of one hundred six (N = 106) nursing students were involved in the study. The students’ mean score in the assessment of their communication skills showed average scores in therapeutic communication skills (M = 3.32, SD =0.69). The students’ opinions regarding the common communication barriers between them and their patients, were moderate, with an overall average of (M = 2.58, SD = 0.53). The average and middle scores for both communication skills (M = 6.65 ± 1.37, Md = 6.73) and communication barriers (M =6.37 ± 1.39, Md = 6.37) were almost equal. The Pearson correlation test revealed a statistically significant positive weak correlation (rs = 0.242, p = &lt; 0.012) between the students' scores in therapeutic communication skills and their scores in communication barriers. Conclusion: Recognizing the relationship between therapeutic communication skills and perceived communication barriers can inform targeted educational programs aimed at addressing both skill development and barrier reduction. It’s essential to acknowledge that while a statistically significant correlation was found, the strength of the correlation is weak. Further research, including longitudinal studies or qualitative interventions, may provide deeper insights into the nature of the relationship between therapeutic communication skills and perceived barriers among nursing students.

17 Studying the Use of Politeness in Employment Specific Scenarios in Youth with Autism Spectrum Disorder.

Objective:Employment is crucial in the lives of adults with Autism Spectrum Disorder (ASD) as gainful occupational activity creates opportunities to form meaningful social relationships, participate in community life, and become financially independent. Impairments in pragmatic language skills (i.e., use of language to achieve social goals) negatively impact the ability to make and maintain cooperative work relationships with employers and coworkers, which are critical aspects of employment. A specific pragmatic skill key to workplace communication includes using a suitable degree of politeness, loosely defined as demonstrating the appreciation of the thoughts and feelings of your listener. Politeness can be measured with politeness markers (PMs). Appropriate PM use promotes positive, cooperative relationships. There are two main categories of PMs: positive and negative PMs. Positive PMs express appreciation or praise to the listener. Negative PMs avoid conflict and marks consideration of the thoughts and feelings of the listener. Crucially, negative PMs require more monitoring of social boundaries as they require consideration of the conversational partner’s potential reactions to statements and their emotional states. This makes PMs a novel new approach to evaluating speech in persons with ASD. Because PMs serve a purely social function in language, they include non-tangible words, such as would, could, may, or might. The current study explores the utility of an employment-specific social communication assessment tool, the Voicemail Elicitation Task (VET), in persons with ASD. The VET has proven sensitive to identifying social communication deficits in persons with traumatic brain injury.Participants and Methods:The current cohort comparative study included a sample of young adults with ASD (n=22) and neurotypical controls (NTC; n=10). All participants were given the VET, which utilizes a standardized computerized language sampling procedure that assesses politeness markers (PMs) in work-related role-play scenarios. The outcome measure of the VET is PMs per minute (PMpM) which is obtained by dividing the sum of PMs by the speaking time (in minutes). Higher PMpM indicates higher PM use (more politeness), while lower PMpM indicates lower PM use (less politeness).Results:The preliminary results indicated a significantly lower total PMpM in ASD participants (mean: 13.68 SD: 6.28) compared to NTCs (mean 18.72, SD: 3.65), p = 0.026. Post hoc analysis indicated that the differences in groups were driven by significantly lower negative PMs rates used by the ASD group (mean 9.18, SD: 5.77) compared to NTCs (mean: 16.30, SD: 7.78), p = 0.002, while both groups were similar in their mean level of positive PMs use, p = 0.442.Conclusions:This study represents an important step toward validating the VET for use in ASD, which will improve the capacity of the field to address unemployment in this population. The results of the current study indicate that individuals with ASD show deficits in PM use which could impact their interpersonal relationships within the workplace environment. Designing interventions to target these deficits could help provide better employment outcomes for this population.

Procedural simulation in venipuncture for medical undergraduates and its transfer to the bedside: a cluster randomized study.

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BackgroundThe effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.MethodsA prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student’s communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).ResultsFifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].ConclusionSimulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

Parental communication satisfaction with the clinical team in the paediatric cardiac ICU.

Understanding parents' communication preferences and how parental and child characteristics impact satisfaction with communication is vital to mitigate communication challenges in the cardiac ICU. This cross-sectional survey was conducted from January 2019 to March 2020 in a paediatric cardiac ICU with parents of patients admitted for at least two weeks. Family satisfaction with communication with the medical team was measured using the Communication Assessment Tool for Team settings. Clinical characteristics were collected via Epic, Pediatric Cardiac Critical Care Consortium local entry and Society for Thoracic Surgeons Congenital Heart Surgery Databases. Associations between communication score and parental mood, stress, perceptions of clinical care, and demographic characteristics along with patient demographic and clinical characteristics were examined. Multivariable ordinal models were conducted with characteristics significant in bivariate analysis. In total, 93 parents of 84 patients (86% of approached) completed surveys. Parents were 63% female and 70% White. Seventy per cent of patients were <6 months old at admission, 25% had an extracardiac abnormality, and 80% had a cardiac surgery this admission. Parents of children with higher pre-surgical risk of mortality scores (OR 2.875; 95%CI 1.076-7.678), presence of surgical complications (72 [63.0, 75.0] vs. 64 [95%CI 54.6, 73] (p = 0.0247)), and greater satisfaction with care in the ICU (r = 0.93922; p < 0.0001) had significantly higher communication scores. These findings can prepare providers for scenarios with higher risk for communication challenges and demonstrate the need for further investigation into interventions that reduce parental anxiety and improve communication for patients with unexpected clinical trajectories.

Development and validation of the interpersonal communication assessment tool for assessing the interpersonal communication skills of public health midwives

BackgroundInterpersonal Communication Skills (IPCS) are one of the core clinical skills that should be developed by the Public Health Midwives (PHMs), who are grass-root level public healthcare providers in primary healthcare settings in Sri Lanka. This study aimed to develop and validate the Interpersonal Communication Assessment Tool (IPCAT), an observational rating scale, to assess the IPCS of PHMs.MethodsItem generation, item reduction, instrument drafting, and development of the tool’s rating guide were made by an expert panel. A cross-sectional study was conducted in five randomly selected Medical Officer of Health (MOH) areas, the smallest public health administrative division in the district of Colombo, Sri Lanka, to identify the factor structure, which is the correlational relationship between a number of variables in the tool. A sample of 164 PHMs was recruited. The data on IPCS were collected by video-recording the provider-client interaction using simulated clients. All recorded videos were rated by a rater using the drafted IPCAT, which included a Likert scale of 1(poor) to 5 (excellent). Exploratory factor analysis was conducted using the Principal Axis Factoring extraction method and the Varimax rotation technique to explore the factors. Three independent raters were used to rate ten randomly selected videos to assess the tool’s internal consistency and inter-rater reliability.ResultsThe IPCAT obtained a five-factor model with 22 items, and all five factors explained 65% of the total variance. The resulting factors were “Engaging” (six items on making rapport), “Delivering” (four items on paying respect), “Questioning” (four items on asking questions), “Responding” (four items on empathy), and “Ending” (four items to assess the skills of ending a conversation productively). The internal consistency, Cronbach’s Alpha value, for all five factors was above 0.8, and the inter-rater reliability (ICC) was excellent (0.95).ConclusionsThe Interpersonal Communication Assessment Tool is a valid and reliable tool for assessing the interpersonal communication skills of Public Health Midwives.Trial registrationClinical Trial Registry, Sri Lanka. Ref No, SLCTR/2020/006(February 4th,2020)

Quality of anesthetist communication with surgical patients in the perioperative setting: a survey at an academic tertiary referral hospital in Ethiopia

BackgroundEffective communication is a fundamental step in providing best medical care and recognized as vital component of clinical anesthesia practice. Poor communication adversely affects patients’ safety and outcome. The objective of this study was to investigate the quality of anesthetist communication from patients’ perspectives at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.MethodologyA descriptive cross-sectional study was conducted on 423 surgical patients from April 1, – May 30, 2021. Perioperative patient-anesthetist communication (PPAC) was measured by using 15-items Communication Assessment Tool graded by 5-points Likert scale. Data collection was executed during postoperative time as the patients were optimally recovered from anesthesia. The collected data were cleaned and descriptive analysis was performed.ResultsA total of 400 (94.6% response rate) patients included and 226 (56.7%) were female. The median (IQR) age was 30 (25 – 40) years. Three-hundreds and sixty-one (90.3%) patients had reported good PPAC and 39 (9.8%) reported poor PPAC. The median (IQR) of PPAC scores was 53.0 (48.0 – 57.0) and range from 27 to 69. Highest mean score was observed for the item “Talked in terms I could understand” (4.3 ± 0.7). Lowest mean scores were observed for the item “Checked to be sure I understood everything” (1.9 ± 0.9). Patients who had underwent emergency surgery, no previous anesthetic exposure, had significant preoperative anxiety, no history of previous hospital admission, and moderate-severe preoperative pain were found to have poor PPAC compared to their counterparts in the proportions of 82.1%, 79.5%, 69.2%, 64.1%, and 59.0% respectively.ConclusionsThere was good PPAC in our hospital from patients’ perspective. However, there should be improvements in checking the degree of understanding of the delivered information, encouraging to question, disclosing next steps and involving in decision-making. Patients who underwent emergency surgery, had no previous anesthetic exposure, had clinically significant level of preoperative anxiety, had no history of previous hospital admission, and had moderate-severe preoperative pain were found to have poor PPAC.

Factors influencing patients’ experience of communication with the medical team of the emergency department

The Emergency Department (ED) setting often presents situations where the doctor–patient relationship is fundamental and may be challenging. Thus, it is important to use effective communication to improve outcomes. This study explores patients’ experience of communication with the medical team aiming to discover whether there are some objective factors which may affect their perception. A prospective, cross-sectional study in two hospitals: an urban, academic trauma center and a small city hospital. Adult patients discharged from the ED in October 2021 were consecutively included. Patients filled out a validated questionnaire, the Communication Assessment Tool for Teams (CAT-T), assessing communication perception. Additional data about the participants were collected by the physician in a dedicated tab to assess whether there were objective factors influencing the patient’s perception of the medical team's communication skills. Statistical analysis was then performed. 394 questionnaires were analyzed. The average score for all items exceeded 4 (good). Younger patients and patients who were conveyed by ambulance attributed lower scores than other groups (p value < 0.05). A significant difference between the two hospitals was also observed in favour of the bigger hospital. In our study long waiting times did not generate less satisfied responses. The item which received the lowest scores was “the medical team encouraged me to ask questions”. Overall, patients were satisfied with doctor–patient communication. Age, setting, way of conveyance to the hospital are objective factors that may influence patients’ experience and satisfaction in the ED.

Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use

BackgroundThe introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability.MethodsUsing the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter.ResultsA total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter).ConclusionThis checklist is a reliable and valid instrument that combines basic and EMR-related communication skills.

A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills.

Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool

To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. Pre-and postintervention study. Acute-care teaching hospital in Sabadell, Barcelona (Spain). Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.

Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management andsocio-demographics.

To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes. A quantitative study with a cross-sectional survey design. Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N=145) participated in the study. The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.

The Performance of the Health Communication Assessment Tool© (HCAT-f) in Calibrating Different Levels of Nurse Communication Skills in a French-Speaking Context

Communication skills training is essential in nurse education. Miscommunication may lead to adverse events and unsafe healthcare. To date, valid and reliable instruments to serve both communication training and assessment purposes across different cultural contexts are scarce. The present study empirically tested a French-language version of the Health Communication Assessment Tool© (HCAT-f) across different levels of communication skills performance to establish its reliability and validity through a cognitive fluency framework. Ten experts in communication and 52 nurse educators rated three videos simulating conversations between a nurse and a patient scheduled for lumpectomy. Each video captured a different level of communication skills performed by the nurse: High, medium, and low. Three distinct constructs were identified, i.e., professional presentation, empathy, and trust building. At absolute single-measure, an ICC = .43 suggested adequate interrater reliability of the whole scale for the medium-performed scenario, which decreased in low-performed (ICC = .35) and high-performed (ICC = .18) scenarios. The HCAT-f fulfils the criteria of linguistic equivalence, contextual relevance, and demonstrates acceptable construct validity. It can be used as a summative assessment tool after prior training on scale calibration is in place because interrater agreement was difficult to be established in high and low performance scenarios.