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


CONCLUSIONS
Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees.
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Anthony L
AL
Department of Medicine/Oncology, University of Washington, 825 Eastlake Ave E, PO Box 19023, Seattle, WA 98109-1023, USA. tonyback@u.washington.edu
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
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008495:Medical Oncology / Q000193:education* / Q000941:ethics; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000592:standards*; D010817:Physician-Patient Relations / Q000941:ethics*; D012189:Retrospective Studies; D013637:Tape Recording; D014342:Truth Disclosure / Q000941:ethics*