Communication skills training through ‘role play’ in an acute critical care course

ObjectivesTo describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management.MethodsProspective before-and-after cohort study in a tertiary teaching hospital in Australia. The population was 222 adult patients with LLI referred to the intensive care unit (ICU). The study was divided into two periods, before (1 May to 31 July 2015) and after (15 September to 15December 2015) the intervention. The intervention was a 2-day, small group, simulated-patient, communication skills course, and process of care for patients with LLI. The primary outcome was documentation of patient-centred goals of care discussion (PCD) within 48 hours of referral to the ICU. Secondary outcomes included clinical outcomes and 90-day mortality.ResultsThe intervention was associated with increased documentation of a PCD from 50% to 69% (p=0.004) and 43% to 94% (p<0.0001) in patients deceased by day 90. A significant decrease in critical care as the choice of resuscitation goal (61% vs 42%, p=0.02) was observed. Although there was no decrease in admission to ICU, there was a significant decrease in medical emergency team call prevalence (87% vs 73%, p=0.009). The cancer and organ failure groups had a significant decrease in 90-day mortality (75% vs 44%, p=0.02; 42% vs 16%, p=0.01), and the frailty group had a significant decrease in 90-day readmissions (48% vs 19%, p=0.003).ConclusionsThe intervention was associated with increased PCD documentation and decrease in the choice of critical care as the resuscitation goal. Admissions to ICU did not decrease, and although limited by study design, condition-specific trajectory changes, clinical interventions and outcomes warrant further study.

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Responding to difficult emotions

10.1093/med/9780198736134.003.0015 ◽

2017 ◽

Author(s):

Jennifer Philip ◽

David W. Kissane

Keyword(s):

Communication Skills ◽

Symptom Relief ◽

Role Play ◽

Skills Training ◽

Active Listening ◽

Narrative Approach ◽

Communication Skills Training ◽

Clinical Scenarios ◽

And Coping ◽

Difficult Situations

Patient distress can be acute or enduring, and contribute to the experience of a challenging consultation. Difficult emotions could include anger, resentment, morbid fear, intense grief, despair, or demoralization. A narrative approach is recommended involving active listening to the story, empathic acknowledgement of the emotions expressed, involvement of experienced clinicians, and reframing of the experience constructively to enable symptom relief and containment of the distress. When suffering persists, its further acknowledgement is warranted with efforts to promote adaptation and coping by exploration of the person and their life, sources of meaning, value and worth, and affirmation of these in the ill person. Role play in communication skills training involves the practice of a variety of empathic responses. Clinical scenarios for these difficult situations are provided in this chapter.

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