Pilot Study to Improve Goals of Care Conversations Among Hospitalists

Abstract

Context. Many hospitalized patients receive care that is not concordant with their goals. Teaching communication skills that better align goals and treatment can improve the care that patients receive.Objective. To develop and test an innovative approach that encourages hospitalists to engage in goals of care (GOC) conversations with their patients.Methods. We recruited 14 hospitalists and randomized half to receive electronic health record alerts for patients who might benefit most from a goals-of-care conversation, as well as communication coaching. The coaching required an initial meeting, then audio recording of two GOC conversations and feedback from the coach. Outcomes were the presence of GOC conversations (primary), the quality of the GOC conversations, physician perceptions of the intervention, and hospital metrics (e.g., 30-day readmissions, referrals to palliative care).Results. We did not increase the frequency of GOC conversations but did improve the quality of the conversations. Patients of physicians who received the intervention had fewer 30-day readmission rates and were less likely to die 90 days after admission than patients of physicians in the control arm. Patients of intervention physicians also had fewer palliative care consults than patients of control physicians.Conclusions. Teaching hospitalists to have GOC conversations translated into better skills and outcomes for patients. This pilot study shows promise and should be tested in a larger trial.

Medical Communication Training: The Effect of Gender and Experience with Goals of Care Discussions

“…The evaluation of residents' perception of their communication skill e cacy can help us understand the conversations between patients and physicians which produce positive clinical outcomes (28). Research routinely shows an increase in con dence in leading GOC discussions after communication training (29)(30)(31). This study shows that year of residency and gender do not impact e cacy of a standardized communication training workshop.…”

Effect of a Coaching Intervention to Improve Cardiologist Communication

“…Clinicians can learn effective communication via face-to-face courses and interactive computer programs that include practice and tailored feedback . Communication coaching shows signals for improving communication, patient satisfaction, and clinician burnout . However, studies have been small, nonrandomized, and lacked objective assessments.…”

“…12 Communication coaching shows signals for improving communication, patient satisfaction, and clinician burnout. 4,[13][14][15] However, studies have been small, nonrandomized, and lacked objective assessments. We chose to study cardiologists because they frequently navigate challenging conversations with patients with serious illness, yet are understudied.…”

Adapting a communication coaching intervention for obstetric sonographers delivering unexpected news: A qualitative study

“…11 Previous studies indicate that Communication Coaching is feasible and acceptable to clinicians and is associated with higher quality communication and lower burnout. [14][15][16] However, studies have previously been limited to clinicians based in the United States, and it is unclear how the intervention would need to be adapted to make it accessible for sonographers and relevant for their care recipients within other healthcare systems. To address this, the current study aimed to adapt the Communication Coaching intervention for qualified UK sonographers working within the National Health Service (NHS).…”