Communication Skills Training Module Research Articles

Addressing violence against doctors: Using ADDIE framework for designing, implementation, and evaluation of the effectiveness of a therapeutic communication skills training module

Addressing violence against doctors: Using ADDIE framework for designing, implementation, and evaluation of the effectiveness of a therapeutic communication skills training module

Incorporating shared decision making into communication with older adults with cancer and their caregivers: Development and evaluation of a geriatric shared decision-making communication skills training module

ObjectiveThe purpose of this study was to evaluate a Communication Skills Training (CST) module for health care providers (HCPs) applying a shared decision-making approach to a meeting with an older adult with cancer and his/her family. MethodsNinety-nine HCPs from community-based centers, cancer centers, and hospitals in the Northeastern U.S. who worked primarily with older adult patients participated in a CST module entitled Geriatric Shared Decision Making. Participants completed pre- and post-training Standardized Patient Assessments (SPAs) and a survey on their confidence in and intent to utilize skills taught. ResultsResults indicated high HCP satisfaction with the module, with over 95 % of participants reporting high endorsement to all five evaluation items. HCPs’ self-efficacy in utilizing communication skills related to geriatric shared decision making significantly increased pre- to post-training. In standardized patient assessments among a subset of providers (n = 30), HCPs demonstrated improvements in three shared decision-making skills: declare agenda, invite agenda, and check preference. ConclusionA geriatric shared decision-making CST workshop for HCPs showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. Practice implicationsThis Geriatric Shared Decision-Making CST module provides an intervention for improving provider-patient-family member communication in the context of cancer care for older adults.

Addressing the quality of communication with older cancer patients with cognitive deficits: Development of a communication skills training module.

Effective communication is an essential part of patient-centered care. The complexity of cancer care in older adults makes communication challenging, particularly when older patients have cognitive deficits and lose their autonomy. This paper describes the development, implementation, and evaluation of a communication skills training module for health care providers (HCPs) who work with older adults with cancer, with or at risk of developing cognitive deficits. Using a pre-post single arm study design, 99 HCPs from a comprehensive cancer center in North-East USA, who worked primarily with geriatric patients, participated in the study. Participants included Advance Practice Providers (including Nurse Practitioners and Physician Assistants; n = 24, 24.2%); nurses (n = 23, 23.2%), social workers (n = 14, 14.1%), physicians (n = 13, 13.1%), and "other" HCPs (including occupational therapists, physical therapists, and psychologists; n = 20, 20.2%). The HCPs participated in a one-day geriatric communication skills training program in groups of 12-15 over a 2-year period. Participants complete pre-post surveys on module evaluation and perception of self-efficacy as well as pre-post video-recorded Standardized Patient Assessment (SPA) to evaluate communication skill uptake. Most participants evaluated the module positively; over 90% indicated that they agreed or strongly agreed with five of the six module evaluation items. HCPs' self-efficacy in communicating with cancer patients with cognitive deficits significantly increased from pre- to post-module training. There was a significant increase in the following communication skill use from pre- to post-training: checking patient preferences, declaring agenda, and inviting agenda. Results demonstrated a successful implementation of the program as evidenced through favorable program evaluation, significant gains in self-efficacy, as well as significant improvement in several communication skills.

Responding empathically to patients: a communication skills training module to reduce lung cancer stigma.

Most lung cancer patients report perceiving stigma surrounding their diagnosis, and routine clinical interactions with their health care providers (HCPs) are reported as a common source. The adverse effects of lung cancer stigma are associated with several adverse psychosocial and behavioral outcomes. One potential clinician-level intervention target is empathic communication because of its association with higher rates of patients' satisfaction, treatment adherence, and lower levels of psychological distress. This study describes the conceptual model and evaluation of clinician-targeted empathic communication skills training to reduce lung cancer patients' experience of stigma. The goal of the training module is to enhance clinician recognition and responsiveness to lung cancer patients' empathic opportunities by communicating understanding, reducing stigma and distress, and providing support. Thirty multidisciplinary HCPs working in thoracic oncology, thoracic surgery, or pulmonary medicine participated in 2.25 hr of didactic and experiential training on responding empathically to patients with lung cancer. Overall, participants reported highly favorable evaluations of the training, with at least 90% of participants agreeing or strongly agreeing to 11 of the 12 items assessing clinical relevance, novelty, clarity, and facilitator effectiveness. Participants' self-efficacy to communicate empathically with lung cancer patients increased significantly from pretraining to posttraining, t(29) = -4.58, p < .001. The empathic communication skills training module was feasible and well received by thoracic and pulmonary medicine HCPs and demonstrated improvements in self-efficacy in empathic communication from pretraining to posttraining. The examination of patient outcomes is warranted.

MA22.11 An Empathic Communication Skills Training Module to Reduce Lung Cancer Stigma in Patients with Lung Cancer: Pilot Results

MA22.11 An Empathic Communication Skills Training Module to Reduce Lung Cancer Stigma in Patients with Lung Cancer: Pilot Results

Addressing communication challenges in older patients with cancer and geriatric syndromes: a communication skills training module for health care providers.

Older adults frequently suffer from functional decline and sensory changes which, in turn, may trigger ageism, i.e., stereotyping and discriminating against individuals based on their age. Ageism commonly interferes with medical care. Communication strategies can be used to counteract ageism and to engage in optimal patient-centered care. This study describes the development, application, and evaluation of a communication skills training (CST) module (Geriatrics 101) designed to familiarize health care providers (HCPs) with the concept of ageism, and the frequent sensory and physical impairments in older patients with cancer, and to teach practical communication skills to effectively communicate with these patients. Geriatrics 101 is one of three modules in a 1-day CST program for HCPs, intended to improve the outcome of consultations through utilization of a set of clinically meaningful strategies. Study measures included post-training module evaluation, self-efficacy measured pre- and post-training, and communication skills uptake assessed pre- and post-training. 97 clinicians participated over 2years. Over 90% of participants rated the module favorably. Participants' self-efficacy to communicate efficiently with older patients with impairments improved significantly from pre- (M = 3.52, SD 0.85) to post-module training (M = 4.26, SD 0.50). Participants also demonstrated significant uptake of three skills-invite agenda, transition, and normalize. The successful development and application of our program paves the way for future research that focuses on the evaluation of such geriatric-focused communication training in clinical settings, assessing patient-reported outcomes.

Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

ObjectiveThis study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. MethodsThis randomized control study (N=66) compared intervention and control groups of students (n=28) and residents’ (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. ResultsFollow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=0.007, r=−0.47; breast cancer (BC), p=0.003, r=−0.53), attention to patient responses after BBN (CC, p<0.001, r=−0.74; BC, p=0.001, r=−0.65), and addressing feelings (BC, p=0.006, r=−0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r=−0.43), communication related to emotions (p=0.034, r=−0.30), determining patient’s readiness to proceed after BBN and communication preferences (p=0.041, r=−0.28), active listening (p=0.011, r=−0.37), addressing feelings (p<0.001, r=−0.65), and global interview performance (p=0.001, r=−0.51). ConclusionThis brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. Practice implicationsImplementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.

Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses

ObjectiveThe purpose of this paper is to report on the development, implementation, and evaluation of a Communication Skills Training (CST) module for inpatient oncology nurses on how to respond empathically to patients. Methods248 nurses from a USA cancer center participated in a CST module on responding empathically to patients. Nurses completed pre- and post-training Standardized Patient Assessments (SPAs), a survey on their confidence in and intent to utilize skills taught, and a six-month post-training survey of self-reported use of skills. ResultsResults indicate that nurses were satisfied with the module, reporting that agreement or strong agreement to 5 out of 6 items assessing satisfaction 96.7%–98.0% of the time. Nurses’ self-efficacy in responding empathically significantly increased pre- to post-training. Additionally, nurses showed empathy skill improvement in the post-SPAs. Finally, 88.2% of nurses reported feeling confident in using the skills they learned post-training and reported an increase of 42–63% in the use of specific empathic skills. ConclusionsA CST module for nurses in responding empathically to patients showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. Practice implicationsThis CST module provides an easily targeted intervention for improving nurse–patient communication and patient-centered care.

The development and preliminary testing of a multimedia patient–provider survivorship communication module for breast cancer survivors

ObjectiveThis paper describes the development of a theory-guided and evidence-based multimedia training module to facilitate breast cancer survivors’ preparedness for effective communication with their health care providers after active treatment. MethodsThe iterative developmental process used included: (1) theory and evidence-based content development and vetting; (2) user testing; (3) usability testing; and (4) participant module utilization. ResultsFormative evaluation of the training module prototype occurred through user testing (n=12), resulting in modification of the content and layout. Usability testing (n=10) was employed to improve module functionality. Preliminary web usage data (n=256, mean age=53, 94.5% White, 75% college graduate and above) showed that 59% of the participants accessed the communication module, for an average of 7min per login. ConclusionThe iterative developmental process was informative in enhancing the relevance of the communication module. Preliminary web usage results demonstrate the potential feasibility of such a program. Practice implicationsOur study demonstrates survivors’ openness to the use of a web-based communication skills training module and outlines a systematic iterative user and interface program development and testing process, which can serve as a prototype for others considering such an approach.

Benefits of communication skills training after real patient exposure

The established communication skills training (CST) curriculum consists of continuous education, frequent practice with real patients, supervision and feedback from medical teachers. The limitation of this curriculum is that students have to directly apply the theoretical basis they are provided with to real patients. To improve the existing CST curriculum a CST module involving simulated patients was introduced in order to develop more complex communication skills. A new CST module using simulated patients was developed and evaluated. The students assessed the module from their own perspective using a questionnaire, and compared it with other courses. In addition, the communication competencies of the students were assessed with a self-report questionnaire before and after the training. The overall rating for the course was 5.4 on a six-point Swiss school grade scale, with six being the best possible score. The self-assessment showed positive changes after the intervention and subjective improvement in knowledge, to varying extents. For the acquisition of more complex communication skills students value being able to practise their skills with simulated patients first, before practising with real patients.

Responding to patient anger: Development and evaluation of an oncology communication skills training module

The purpose of this study was to develop a communication skills training (CST) module for oncology healthcare professionals on how to more effectively respond to patient anger. We also sought to evaluate the module in terms of participant self-efficacy and satisfaction. The development of this module was based on a systematic review of the literature and followed the Comskil model previously used for other doctor-patient CST. Using an anonymous 5-point Likert scale, participants rated their pre-post self-efficacy in responding to patient anger as well as their satisfaction with the course. Data were analyzed using a paired sample t test. During the academic years 2006-2009, 275 oncology healthcare professionals participated in a CST that focused on responding to patient anger. Participants' confidence in responding to patient anger increased significantly (p < 0.001) after attending the workshop. They also agreed or strongly agreed to five out of six items assessing course satisfaction 92-97% of the time. We have developed a CST module on how to respond to patient anger, which is both effective and useful. Training healthcare professionals to respond more effectively to patient anger may have a positive impact on the patient-physician relationship.

Discussing prognosis in an oncology setting: initial evaluation of a communication skills training module

Although cancer patients from Western countries have high needs for prognostic information, the frequency of such discussions in oncology consultations is variable. Prognosis is a difficult discussion area for both physicians and patients. Physician focused Communication Skills Training (CST) has been suggested as a means to aid these discussions. We developed and tested a CST module about discussing prognosis. Training consisted of didactic teaching, exemplary video and role-play sessions. The study aim was to develop the module and evaluate the effectiveness of the training. One hundred and forty-two clinicians from Memorial Sloan-Kettering Cancer Center and the New York City area voluntarily participated in the training module over a two-year period. The module was based on current literature and followed the Comskil model previously utilized for other doctor-patient CSTs. Participants completed pre and post surveys to evaluate their own confidence as well as the helpfulness of the module. Based on a retrospective pre-post measure, participants reported an increase in their confidence about discussing prognosis (t(141)=-9.331, p<0.001). At least 92% of participants reported their satisfaction with components of the module by either agreeing or strongly agreeing with 5/6 different statements included in their evaluation forms. This short training program demonstrated success in improving physician confidence to discuss prognosis and self-efficacy. This result, coupled with the participant's intent to utilize new skills in clinical encounters, suggests that this is a useful module. Future research will target changes in patient outcomes as a result of the physician training.

Conducting family meetings in palliative care: Themes, techniques, and preliminary evaluation of a communication skills module

To develop a communication skills training module for health care professionals about how to conduct a family meeting in palliative care and to evaluate the module in terms of participant self-efficacy and satisfaction. Forty multispecialty health care professionals from the New York metropolitan area attended a communication skills training module at a Comprehensive Cancer Center about how to conduct a family meeting in oncology. The modular content was based on the Comskil model and current literature in the field. Based on a retrospective pre-post measure, participants reported a significant increase in self-efficacy about their ability to conduct a family meeting. Furthermore, at least 93% of participants expressed their satisfaction with various aspects of the module by agreeing or strongly agreeing with statements on the course evaluation form. Family meetings play a significant role in the palliative care setting, where family support for planning and continuing care is vital to optimize patient care. Although these meetings can be challenging, this communication skills module is effective in increasing the confidence of participants in conducting a family meeting.