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06-09-2011 | General practice | Article

Novel communication training method improves palliative transition


Free abstract

MedWire News: A novel communication skills training (CST) method can enable physicians to better meet the three "core" challenges presented to them as they help transition patients to palliative care, report researchers.

Physicians who took part in COM-ON-p, showed significantly improved skills specific to the transition to palliative care, global communication skills, and involvement of significant others compared with their counterparts who were assigned to standard CST (control group).

"Because [these skills are] essential to good palliative care practice, CST like COM-ON-p should be an integral part of the medical education of all physicians caring for patients in the palliative care setting," suggest Tanja Goelz and colleagues from the Albert-Ludwigs-University Freiburg in Germany.

The team believes that the demands required in the transition to palliative care can be "challenging and sometimes overstrain the communication skills of oncologists," particularly in the area of providing prognostic information.

Therefore, Goelz and co-investigators developed COM-ON-p, which consisted of a pre-assessment with actor-patients, a 1.5-day workshop, and an individual coaching session 2 weeks after the workshop, and postassessment with actor-patients. A total of 22 physicians from the University Medical Center in Freiburg, Germany, were randomly assigned to take part in the intervention.

A further 19 physicians from the same center were randomly assigned to participate in a standard CST, comprising two video-recorded consultations with actor-oncology patient pairs.

The researchers constructed two scenarios to assess physicians on their abilities to cope with transition to palliative care, and these scenarios were "marked" by blind assessors using a COM-ON-Checklist.

"The checklist included addressing the information requirements of patients, such as answering questions about prognosis, and meeting emotional needs of patients, such as showing empathy," explain Goelz et al.

Physicians assigned to undertake COM-ON-p improved significantly more than those who undertook standard CST in all three areas of the COM-ON-Checklist, with an average, half-point improvement on the five-point rating scale used by the blind assessors. Effect sizes were medium to large, report the researchers in the Journal of Clinical Oncology.

The differences between physicians who underwent COM-ON-p training and standard CST were also significant in the areas of global communications skills and involvement of patients' significant others.

"Transfer of skills acquired in COM-ON-p into real life and effects on patient outcomes are ultimate goals of CST and must be demonstrated in future studies," concludes the research team.

"Next research steps include clarifying the dose-response relationship of duration of training and coaching and studying transfer into real life."

By Sarah Guy

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