Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

ObjectiveThis study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures.MethodsThis randomized control study (N = 66) compared intervention and control groups of students (n = 28) and residents’ (n = 38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures.ResultsFollow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p = 0.007, r = −0.47; breast cancer (BC), p = 0.003, r = −0.53), attention to patient responses after BBN (CC, p < 0.001, r = −0.74; BC, p = 0.001, r = −0.65), and addressing feelings (BC, p = 0.006, r = −0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r = −0.43), communication related to emotions (p = 0.034, r = −0.30), determining patient’s readiness to proceed after BBN and communication preferences (p = 0.041, r = −0.28), active listening (p = 0.011, r = −0.37), addressing feelings (p < 0.001, r = −0.65), and global interview performance (p = 0.001, r = −0.51).ConclusionThis brief BBN training module is an effective method of improving BBN communication skills among medical students and residents.Practice implicationsImplementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.     

The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial

ObjectiveExamine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care.MethodsThree arm single-blind RCT in community primary care (PC) practices. PC practitioners (n = 18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia.Interventions(1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care.OutcomeProportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for.ResultsPatients (n = 322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00–2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up.ConclusionsTraining patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients.Practice implicationsWeb communication interventions are an effective tool that can be used in primary care.     

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded,randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students.MethodsAll students of the first clinical treatment course (n = 46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically.ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p < 0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p > 0.05).ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students.Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.     

Patient-centered communication in digital medical encounters

ObjectivePatients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses.DesignA total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system.MethodsContent analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building.ResultsPatients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk.ConclusionPartnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship.Practice implicationsAs secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes.     

促进公立医院文化建设的探索与实践

通过搭建文化交流沟通平台,大力开展院间协作和交流、充分利用和发挥公立医院的公益职能,强化公立医院文化建设工作、提高医院的综合实力和竞争力。     

ESP理论指导下提升医学生医患沟通英语表达能力的途径

随着全球经济一体化、医学教育国际化的趋势,社会对涉外人才的需求越来越大,英语教学尤其是医患沟通英语教学已成为这一专业的重点教学内容。医患沟通学是研究医务工作者与患者之间如何互相理解、信任并合作共同战胜疾病的一门学科,而ESP教学理念强调以能力为导向,与职业相结合,倡导以学生为中心,把英语教学作为手段与工具来学习运用,把二者有机地结合在一起。实践表明,以ESP教学理念为指导,对提升医学生医患沟通英语表达能力具有显著的成效。     

合肥市社区卫生服务机构护患风险沟通现况调查

目的了解社区卫生服务机构护士的护患风险沟通能力现状,为提高护士护患风险沟通能力提供参考。方法随机抽取合肥市市区40家社区卫生服务中心(站),采用自行设计问卷,对211名护士的护患风险沟通能力现状进行调查。结果 178人(84.36%)认为护患风险沟通能力很重要;护士整体护患风险沟通能力不高,总得分只有(63.27±5.21)分;高年龄、高学历、高职称组护士护患风险沟通能力得分高于低年龄、低学历和低职称组护士,差异具有统计学意义(P<0.001);211名护士心理健康K10评分(19.10±5.82)分,有45名护士存在心理健康不良,占总人数的21.33%。护士心理健康状况与护患风险沟通能力总分及各因子相关,是护患风险沟通能力的影响因素。结论社区护士护患风险沟通能力较低,需要加强护士在人文社科知识、沟通技能和心理健康方面的培训,提高护理质量。     

Effectiveness of Psychological Adaptation Model of Mental Health Nursing for nurse survivors experiencing post-earthquake disaster post-traumatic stress syndrome

Objective

The study to assess the effectiveness of psychological adaptation model of mental health nursing for nurse survivors experiencing post-earthquake post-traumatic stress syndrome (PTSS).

Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background

: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation.

Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery

Purpose: To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. Methods and findings: The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. Conclusions: The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.