title: Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis.
abstract: BACKGROUND
  Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum.
  
  
  METHODS
  We searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE.
  
  
  RESULTS
  Of 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95% confidence interval [CI] 0.40-0.75; P < 0.001; very low quality evidence), more knowledge (4 studies, SMD 0.76;95% CI 0.40-1.12; p < 0.001; low quality evidence), and improvements in communication scores (8 studies, SMD 0.69; 95% CI 0.41-0.96; p < 0.001; very low quality evidence). There was insufficient evidence to determine whether these educational interventions affect patient-level outcomes.
  
  
  CONCLUSIONS
  Very low to low quality evidence suggests that end-of-life communication training may improve healthcare professionals' self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes.
  
  
  BACKGROUND
  PROSPERO CRD42014012913.
authors.affiliation: , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada. hanoh.chung@mcmaster.ca.
authors.forename: Han-Oh
authors.initials: HO
authors.lastname: Chung
authors.affiliation: Hamilton General Hospital, McMaster Clinic 4th floor, Room 434, 237 Barton St East, Hamilton, Ontario, L8L2X2, Canada.
authors.forename: Simon J W
authors.initials: SJ
authors.lastname: Oczkowski
authors.affiliation: Canadian Hospice Palliative Care Association, Annex D, Saint-Vincent Hospital, 60 Cambridge Street North, Ottawa, ON, K1R 7A5, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Hanvey
authors.affiliation: , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.|St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.affiliation: , 1280 Main Street West, HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.|St Joseph's Healthcare, 50 Charlton Avenue East, 3rd Floor Martha Wing, Room H321, Hamilton, Ontario, L8N4A6, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
mesh_terms: D003142:Communication; D004501:Education, Medical; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D013727:Terminal Care
keywords: Advance care planning; Advance directives; Communication; Communication training; End of life care; Medical education