Communication skills training in end of life care – Short of the mark?

Abstract: Quality palliative care requires the integration of palliative care into standard oncological care, an educated workforce, and access to essential drugs. Referral criteria for specialist palliative care include time- and needs-based criteria. Prognostic scores have been constructed to assist in prognostic assessment but remain inaccurate in the individual patient. Patient–clinician communication is essential; guidelines for effective communication have been developed, and communication skills training and early exposure are important. Advanced care planning is of paramount importance for patients and families, since it can reduce aggressiveness of end-of-life care. Barriers to the development of palliative care need to be addressed; a resource-stratified practice guideline has been developed making recommendations for model of care, staffing requirements, roles, and training needs of members. Quality indicators have been developed as well, and these focus mainly on outcome indicators. The movement to legalize assisted dying has met with much controversy, yet this may also be an opportunity for communication, transparency, and accountability.

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The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review

Palliative & Supportive Care ◽

10.1017/s1478951515001108 ◽

2015 ◽

Vol 14 (4) ◽

pp. 433-444 ◽

Cited By ~ 15

Author(s):

Laura Lord ◽

David Clark-Carter ◽

Amy Grove

Keyword(s):

Systematic Review ◽

End Of Life ◽

Communication Skills ◽

Self Efficacy ◽

Skills Training ◽

Communication Skills Training ◽

Training Interventions ◽

Staff Behavior ◽

The Impact ◽

End Of Life Communication

AbstractObjective:A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff.Method:Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills.Results:Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills.Significance of results:Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.

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Improving and validating children’s nurses communication skills with standardized patients in end of life care

Journal of Child Health Care ◽

10.1177/1367493514555588 ◽

2014 ◽

Vol 20 (2) ◽

pp. 145-152 ◽

Cited By ~ 5

Author(s):

Gerard Kenny ◽

Jamie Cargil ◽

Catherine Hamilton ◽

Rachel Sales

Keyword(s):

End Of Life ◽

Communication Skills ◽

End Of Life Care ◽

Standardized Patients ◽

Life Care

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THE IMPACT OF AN INTERPROFESSIONAL SIMULATION ON TEAM COMMUNICATION AT THE END OF LIFE

Innovation in Aging ◽

10.1093/geroni/igz038.541 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S150-S151

Author(s):

Anne Halli-Tierney ◽

Megan E Lippe ◽

Alexandra Stanley ◽

Allison Ricamato ◽

Robert E McKinney

Keyword(s):

Social Work ◽

Nursing Students ◽

End Of Life ◽

Communication Skills ◽

End Of Life Care ◽

Accurate Information ◽

Life Care ◽

Team Communication ◽

Geriatric Population ◽

The Impact

Abstract It is increasingly important that healthcare professionals understand how to care for patients at the end of life, especially as 75% of hospital deaths occur in the geriatric population. Many new healthcare profession graduates feel under-prepared to provide end-of-life care. Healthcare education programs must provide education on interprofessional communication and end-of-life care. This study explored the effects of an interprofessional end-of-life simulation on medical, social work, and nursing students’ communication skills. Across three simulation phases, teams were required to communicate with the patient (high-fidelity manikin), family members (scripted actors), and team members about treatment option, change in patient’s condition, and withdrawal of life-sustaining measures. A total of 16 teams participated in the simulation, with each team comprised of nursing students (n=7-8), social work students (n=1), and medical students or residents (n=1). Team communication skills were assessed using the Gap Kalamazoo Communication Skills Assessment Form. The average communication score for teams reflected fair to good communication (M=28.81, SD=5.55). The best communication domains were “Shares information” (n=8), “Communicates accurate information” (n=6), and “Builds a relationship” (n=5). The worst domains were “Demonstrates empathy” (n=7), “Provides closure” (n=6), and “Builds a relationship” (n=5). This simulation provides an interactive educational mechanism by which to educate interprofessional healthcare students on communication and care of patients at the end of life.

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Exploring End-of-Life Care Team Communication: An Interprofessional Simulation Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119865862 ◽

2019 ◽

Vol 37 (1) ◽

pp. 65-71 ◽

Cited By ~ 1

Author(s):

Megan Lippe ◽

Alexandra Stanley ◽

Allison Ricamato ◽

Anne Halli-Tierney ◽

Robert McKinney

Keyword(s):

Health Care ◽

End Of Life ◽

Communication Skills ◽

End Of Life Care ◽

Life Care ◽

Team Communication ◽

Quality Health Care ◽

Good Communication ◽

Quality Health ◽

The Impact

Effective team communication is necessary for the provision of high-quality health care. Yet, recent graduates from diverse health-care disciplines report inadequate training in communication skills and end-of-life care. This study explored the impact of a withdrawal of life-sustaining measures interprofessional simulation on team communication skills of students representing medicine, nursing, and social work. The 3-phase simulation required teams to communicate with the patient, family, and one another in the care of a seriously ill patient at the end of life. Team communication in the filmed simulations was analyzed via the Gap-Kalamazoo Communication Checklist. Results revealed fair to good communication across the 9 communication domains. Overall team communication was strongest in “shares information” and lowest in “understands the patient’s and family’s perspective” domains. Field notes revealed 5 primary themes— Team Dynamics, Awkwardness, Empathy is Everything, Build a Relationship, and Communicating Knowledge When You Have It—in the course of the data analysis. Logistical challenges encountered in simulation development and implementation are presented, along with proposed solutions that were effective for this study. This simulation provided an opportunity for interprofessional health-care provider students to learn team communication skills within an end-of-life care context.

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