title: Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Participants were randomized to an 8-session, simulation-based, communication skills intervention (N = 232) or usual education (N = 240).
  
  
  METHODS
  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
  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.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00687349.
authors.affiliation: Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle2Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
authors.forename: Lois
authors.initials: L
authors.lastname: Downey
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Shannon
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
authors.forename: Erin K
authors.initials: EK
authors.lastname: Kross
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.forename: Barbara
authors.initials: B
authors.lastname: Edlund
authors.forename: Richard W
authors.initials: RW
authors.lastname: Arnold
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D003863:Depression; D004493:Education; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D009722:Nurse Practitioners / Q000193:education*; D005791:Patient Care / Q000592:standards*; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D057566:Self Report; D013727:Terminal Care / Q000592:standards*; D055815:Young Adult