DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1
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DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1 ST YEAR IM RESIDENTS Carissa Pereda Internal Medicine R3. End-of-life Communication: Problems and Importance. Patients report poor clinician-patient communication as primary concern 1 2

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DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1 ST YEAR IM RESIDENTS Carissa Pereda

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DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1ST YEAR IM RESIDENTS

Carissa Pereda

Internal Medicine R3


End-of-life Communication: Problems and Importance

  • Patients report poor clinician-patient communication as primary concern1 2

  • Trainees report being uncomfortable and untrained in end of life communication

  • Trainees’ self-reported competence not associated with patient/family assessments

  • Trainees benefit from experiential trainings


Improving Clinician Communication Skills Study

  • Design: RCT of interdisciplinary communication intervention– “CodeTalk”1

  • Goal: to improve end-of-life communication skills among MD, NP trainees

  • Curriculum: experiential, adult learning

    • Communication strategies (SPIKES, NURSE)

    • Practice with simulated patients

  • Evaluation:

    • Outcomes: Patient, family, clinician surveys of trainee communication skills

    • Process: Pre- and post- intervention audiorecordings of trainees with standardized patients

  • 1Curtis et al.


    Study Goal: What Do Trainees Do?

    • How do trainees respond to patients, prior to workshop training?

      • Recognizing diversity of communication styles

      • Identifying/describing these styles/techniques

      • Reproducibility with existing data?

        • Standardized patient interviews with required behaviors or “triggers”

          • “I have to tell you, I’m really scared”

          • “Is there any hope for a cure”


    Methods and Materials

    • Sample: pre-intervention audiotapes (n=173)

      • MUSC, n=60; UW, n= 113

      • Trainees: 1st year IM residents

      • Random selection of 50 pre-intervention recordings

  • Standardized patient interviews

    • “Cathy” with recurrent ovarian cancer

    • “Thomas” with recurrent colon cancer


  • Interviews

    • Resident task: Deliver results of a CT scan:

      • Recurrent cancer (colon and ovarian) with metastases

    • Patient task: Stay in character!

      • Provide 3 behaviors at any point during the interview

        • 20 second silence post bad news

        • “I have to tell you, I’m really scared”

        • “Is there any hope for a cure”


    Analysis

    • Goals:

      • Identify and describe communication techniques utilized by residents in response to target statements

      • Develop a framework of “codes” to describe/evaluate communication techniques

    • Methods:

      • Team (n=3) established codes from 5 audios

      • Single investigator coded and compared subset of audiotapes to assess trustworthiness (n=25)

      • Trainees review subset (n=5-10) for validity


    CODEBOOK


    Is there any hope for a cure?

    • I can’t be a 100%. Right now it looks like your disease would actually be classified as stage 4. I don’t know if you know the stages of cancer, but stage 4 would be the end stage, meaning that it has spread from the colon to another part of the body.

    • I can’t really answer that question. I wish I could. I think it’s better if you talk to the oncologist. If they could offer you surgery, maybe there’s a small chance for a cure. I can’t comment on exactly what your prognosis is going to be.


    I have to tell you, I’m really scared.

    • Tell me more about that. What is making you feel scared?

    • That’s very understandable. It is normal to be scared.


    “The single biggest problem with communication is the illusion that it has taken place.”-George Shaw

    MANY THANKS:

    -Research Team

    -Randy Curtis

    -Ruth Engelberg

    -Erin Kross

    -GOOGLE images

    -Invaluable mountain of prior research


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