A Controlled Trial of a Short Course to Improve Residents' Communication with Patients at the End of Life
High-quality palliative care requires physicians who communicate effectively, yet many do not receive adequate training. This study evaluated the effectiveness of a relatively brief end-of-life communication skills training program for internal medicine residents. Fifty-six medical residents took part in the study; 37 participated in an intensive two-day palliative care retreat composed of a 16-hour curriculum and 19 made up the control group. The course aimed to teach control of pain and symptom management and communication skills, as well as to promote residents' understanding of the experience of patients and families. Each topic was introduced via small group lecture/discussion supported by audio-visual materials and learners practiced their skills through role play. Researchers evaluated residents' communication skills using audio-recorded encounters with standardized patients in which physicians delivered bad news and discussed patients' preferences for life-sustaining treatments.
The authors report that residents improved in overall terms of delivery of bad news, as well as specific areas of information giving and responded to patients' emotional cues. Although there was no overall improvement with regard to discussions about patient preferences for treatment, significant improvement occurred in specific skills used by physicians in these conversations, including discussing probability, presenting clinical scenarios and asking about prior experience with end-of-life decision-making. The authors suggest that this intervention deserves replication in larger samples at other institutions.