Education modalities for serious illness communication training: A scoping review on the impact on clinician behavior and patient outcomes

Abstract

Background: Several clinician training interventions have been developed in the past decade to address serious illness communication. While numerous studies report on clinician attitudes and confidence, little is reported on individual education modalities and their impact on actual behavior change and patient outcomes. Aim: To examine what is known about the education modalities used in serious illness communication training and their impact on clinician behaviors and patient outcomes. Design: A scoping review using the Joanna Briggs Methods Manual for Scoping Reviews was conducted to examine studies measuring clinician behaviors or patient outcomes. Data sources: Ovid MEDLINE and EMBASE databases were searched for English-language studies published between January 2011 and March 2023. Results: The search identified 1317 articles: 76 met inclusion criteria describing 64 unique interventions. Common education modalities used were: single workshop ( n = 29), multiple workshops ( n = 11), single workshop with coaching ( n = 7), and multiple workshops with coaching ( n = 5); though they were inconsistently structured. Studies reporting improved clinician skills tended to be in simulation settings with neither clinical practice nor patient outcomes explored. While some studies reported behavior changes or improved patient outcomes, they did not necessarily confirm improvements in clinician skills. As multiple modalities were commonly used and often embedded within quality improvement initiatives, the impact of individual modalities could not be determined. Conclusion: This scoping review of serious illness communication interventions found heterogeneity among education modalities used and limited evidence supporting their effectiveness in impacting patient-centered outcomes and long-term clinician skill acquisition. Well-defined educational modalities and consistent measures of behavior change and standard patient-centered outcomes are needed.

Interpersonal energy: New and bold directions in palliative care health professions education research

“…We are curious about several health professions education research questions: How might learners be fully present in a nonverbal but meaningful way to connect with a dying patient, and is this less taxing for the patient than engaging through oral communication? Building on the work of Lavecchia et al, 11 should patients’ subjective experiences of interpersonal energy be considered meaningful measures when evaluating learners who engage in serious illness conversations? How can learners develop skillful perception and heightened sensory awareness of patients, family members, and colleagues’ interpersonal energy?…”

Samtal vid allvarlig sjukdom - Kronobergsmodellen

“…Forskning som visat på förändringar tenderar att beskriva förändringar i en simulerad träningsmiljö, där resultat från klinisk praxis eller patientresultat inte utforskas. Så även om träningen har bidragit till beteendeförändringar, behöver inte det betyda förbättringar i vårdpersonalens färdigheter i praxis (206). Även om studier har visat positiva effekter när det gäller patientutfall och vårdpersonalens vilja att lära sig, visar studier att det förblir en utmaning att implementera det strukturerade arbetssättet (7)(8)(9)(207)(208)(209).…”

“…Utbildning via sin arbetsplats var även associerat till högre tilltro till egen förmåga i palliativ vård i alla tre av skattningsinstrumentets (Tilltro till egen förmåga i palliativ vård) domäner (kommunikation, patienters vård och behandling och multiprofessionellt teamarbete) (IV).Vårdpersonal beskrev att medverkan i implementeringen av samtal vid allvarlig sjukdom ökade deras medvetenhet om deras agerande under samtal med patienter (I). Forskning skildrar att samtalsträna samtal vid allvarlig sjukdom innan samtal med en patient kan öka vårdpersonalens självmedvetenhet och tilltro (212), men de kan dock behöva stöd i att överföra sina kunskaper till praktiken (206). Utbildning inom hälso-och sjukvård är mer än att lära sig olika tekniker.…”