Efficacy of communication skills training for giving bad news and discussing transitions to palliative care.

Full Abstract

BACKGROUND:
Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors.

METHODS:
Oncotalk was a 4-day residential workshop emphasizing skills practice in small groups. This preintervention and postintervention cohort study involved 115 medical oncology fellows from 62 different institutions during a 3-year study. The primary outcomes were observable participant communication skills measured during standardized patient encounters before and after the workshop in giving bad news and discussing transitions to palliative care. The standardized patient encounters were audiorecorded and assessed by blinded coders using a validated coding system. Before-after comparisons were made using each participant as his or her own control.

RESULTS:
Compared with preworkshop standardized patient encounters, postworkshop encounters showed that participants acquired a mean of 5.4 bad news skills (P<.001) and a mean of 4.4 transitions skills (P<.001). Most changes in individual skills were substantial; for example, in the bad news encounter, 16% of participants used the word "cancer" when giving bad news before the workshop, and 54% used it after the workshop (P<.001). Also in the bad news encounter, blinded coders were able to identify whether a standardized patient encounter occurred before or after the workshop in 91% of the audiorecordings.

CONCLUSION:
Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees.

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Author information

Author/s: Back, Anthony L (AL); Arnold, Robert M (RM); Baile, Walter F (WF); Fryer-Edwards, Kelly A (KA); Alexander, Stewart C (SC); Barley, Gwyn E (GE); Gooley, Ted A (TA); Tulsky, James A (JA);

Affiliation: Department of Medicine/Oncology, University of Washington, 825 Eastlake Ave E, PO Box 19023, Seattle, WA 98109-1023, USA. tonyback(-atsign-)u.washington.edu

Grants: R25 CA92055 (Agency:NCI NIH HHS)

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2007-Mar; vol 167 (issue 5) : pp 453-60

Dates: Created 2007/03/13; Completed 2007/04/12; Revised 2007/12/03;

PMID: 17353492, 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.

Comments and Corrections

CommentIn: Arch Intern Med. 2007 Nov 12;167(20):2261-2; author reply 2262. (PMID: 17998502)

CommentIn: Arch Intern Med. 2007 Nov 12;167(20):2261; author reply 2262. (PMID: 17998503)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Female
Follow-Up Studies
Humans
Internship and Residency
Male
Medical Oncology - education; ethics

Middle Aged
Neoplasms - therapy
Palliative Care - standards
Physician-Patient Relations - ethics
Retrospective Studies
Tape Recording
Truth Disclosure - ethics

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