A controlled trial of a short course to improve residents' communication with patients at the end of life.

Full Abstract

PURPOSE:
High-quality palliative care requires physicians who communicate effectively, yet many do not receive adequate training. Leading efforts to demonstrate the effectiveness of such training have involved time-intensive programs that included primarily attending physicians, which have been conducted outside of the United States. The goal was to evaluate the effect of a short course to improve residents' communication skills delivering bad news and eliciting patients' preferences for end-of-life care.

METHOD:
This prospective trial enrolled internal medicine residents at Duke University Medical Center from 1999 to 2001. The course consisted of small-group teaching with lecture, discussion, and role-play. The outcome measure was observed communication skills delivering bad news and eliciting patients' preferences for end-of-life treatment, assessed via audio-recorded standardized patient encounters before and after receiving the intervention.

RESULTS:
Thirty-seven residents received the intervention and 19 were in the control group. Residents attending the course demonstrated statistically significant increases in their overall skill ratings in the delivery of bad news, with improvement in the specific areas of information giving and responding to emotional cues. Although cumulative scores for discussions about patient preferences for treatment did not increase, residents demonstrated enhanced specific skills including discussing probability, presenting clinical scenarios, and asking about prior experience with end-of-life decision making.

CONCLUSION:
A relatively short, intensive course can improve the end-of-life communication skills of U.S. medical residents.

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Author information

Author/s: Alexander, Stewart C (SC); Keitz, Sheri A (SA); Sloane, Richard (R); Tulsky, James A (JA);

Affiliation: Durham VA Medical Center, North Carolina, USA. alexa054(-atsign-)mc.duke.edu

Journal and publication information

Publication Type: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't

Journal: Academic medicine : journal of the Association of American Medical Colleges (Acad Med), published in United States. (Language: eng)

Reference: 2006-Nov; vol 81 (issue 11) : pp 1008-12

Dates: Created 2006/10/26; Completed 2006/12/20;

PMID: 17065871, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Advance Care Planning
Communication
Competency-Based Education
Curriculum
Female
Humans
Internal Medicine - education
Internship and Residency - standards
Male

Male
North Carolina
Patient Satisfaction
Physician-Patient Relations
Professional Competence
Program Evaluation
Prospective Studies
Schools, Medical
Terminal Care - psychology; standards
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