Document Detail

Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial.
MedLine Citation:
PMID:  24302090     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Communication about end-of-life care is a core clinical skill. Simulation-based training improves skill acquisition, but effects on patient-reported outcomes are unknown.
OBJECTIVE: To assess the effects of a communication skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Randomized trial conducted with 391 internal medicine and 81 nurse practitioner trainees between 2007 and 2013 at the University of Washington and Medical University of South Carolina.
INTERVENTION: Participants were randomized to an 8-session, simulation-based, communication skills intervention (N = 232) or usual education (N = 240).
MAIN OUTCOMES AND MEASURES: Primary outcome was patient-reported quality of communication (QOC; mean rating of 17 items rated from 0-10, with 0 = poor and 10 = perfect). Secondary outcomes were patient-reported quality of end-of-life care (QEOLC; mean rating of 26 items rated from 0-10) and depressive symptoms (assessed using the 8-item Personal Health Questionnaire [PHQ-8]; range, 0-24, higher scores worse) and family-reported QOC and QEOLC. Analyses were clustered by trainee.
RESULTS: There were 1866 patient ratings (44% response) and 936 family ratings (68% response). The intervention was not associated with significant changes in QOC or QEOLC. Mean values for postintervention patient QOC and QEOLC were 6.5 (95% CI, 6.2 to 6.8) and 8.3 (95% CI, 8.1 to 8.5) respectively, compared with 6.3 (95% CI, 6.2 to 6.5) and 8.3 (95% CI, 8.1 to 8.4) for control conditions. After adjustment, comparing intervention with control, there was no significant difference in the QOC score for patients (difference, 0.4 points [95% CI, -0.1 to 0.9]; P = .15) or families (difference, 0.1 [95% CI, -0.8 to 1.0]; P = .81). There was no significant difference in QEOLC score for patients (difference, 0.3 points [95% CI, -0.3 to 0.8]; P = .34) or families (difference, 0.1 [95% CI, -0.7 to 0.8]; P = .88). The intervention was associated with significantly increased depression scores among patients of postintervention trainees (mean score, 10.0 [95% CI, 9.1 to 10.8], compared with 8.8 [95% CI, 8.4 to 9.2]) for control conditions; adjusted model showed an intervention effect of 2.2 (95% CI, 0.6 to 3.8; P = .006).
CONCLUSIONS AND RELEVANCE: Among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education did not improve quality of communication about end-of-life care or quality of end-of-life care but was associated with a small increase in patients' depressive symptoms. These findings raise questions about skills transfer from simulation training to actual patient care and the adequacy of communication skills assessment.
TRIAL REGISTRATION: Identifier: NCT00687349.
J Randall Curtis; Anthony L Back; Dee W Ford; Lois Downey; Sarah E Shannon; Ardith Z Doorenbos; Erin K Kross; Lynn F Reinke; Laura C Feemster; Barbara Edlund; Richard W Arnold; Kim O'Connor; Ruth A Engelberg
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA     Volume:  310     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-04     Completed Date:  2013-12-13     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2271-81     Citation Subset:  AIM; IM    
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MeSH Terms
Clinical Competence
Internal Medicine / education*
Internship and Residency*
Nurse Practitioners / education*
Patient Care / standards*
Patient Satisfaction
Patients / psychology
Physician-Patient Relations
Quality of Health Care*
Self Report
Terminal Care / standards*
Young Adult
Grant Support
Comment In:
JAMA. 2014 Apr 2;311(13):1355   [PMID:  24691613 ]
JAMA. 2014 Apr 2;311(13):1356-7   [PMID:  24691616 ]
Evid Based Med. 2014 Aug;19(4):158   [PMID:  24510480 ]
JAMA. 2013 Dec 4;310(21):2257-8   [PMID:  24302087 ]
JAMA. 2014 Apr 2;311(13):1356   [PMID:  24691615 ]
JAMA. 2014 Apr 2;311(13):1355-6   [PMID:  24691614 ]
Erratum In:
JAMA. 2014 Apr 2;311(13):1360

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