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Efficacy of Communication Skills Training for Giving Bad News and Discussing Transitions to Palliative Care
Anthony L. Back, MD;
Robert M. Arnold, MD;
Walter F. Baile, MD;
Kelly A. Fryer-Edwards, PhD;
Stewart C. Alexander, PhD;
Gwyn E. Barley, PhD;
Ted A. Gooley, PhD;
James A. Tulsky, MD
Arch Intern Med. 2007;167(5):453-460.
Background Few studies have assessed the efficacy of communication skills training for postgraduate physician trainees at the level of behaviors. We designed a residential communication skills workshop (Oncotalk) for medical oncology fellows. The intervention design built on existing successful models by teaching specific communication tasks linked to the patient's trajectory of illness. This study evaluated the efficacy of Oncotalk in changing observable communication behaviors.
Methods Oncotalk was a 4-day residential workshop emphasizing skills practice in small groups. This preintervention and postintervention cohort study involved 115 medical oncology fellows from 62 different institutions during a 3-year study. The primary outcomes were observable participant communication skills measured during standardized patient encounters before and after the workshop in giving bad news and discussing transitions to palliative care. The standardized patient encounters were audiorecorded and assessed by blinded coders using a validated coding system. Before-after comparisons were made using each participant as his or her own control.
Results Compared with preworkshop standardized patient encounters, postworkshop encounters showed that participants acquired a mean of 5.4 bad news skills (P<.001) and a mean of 4.4 transitions skills (P<.001). Most changes in individual skills were substantial; for example, in the bad news encounter, 16% of participants used the word "cancer" when giving bad news before the workshop, and 54% used it after the workshop (P<.001). Also in the bad news encounter, blinded coders were able to identify whether a standardized patient encounter occurred before or after the workshop in 91% of the audiorecordings.
Conclusion Oncotalk represents a successful teaching model for improving communication skills for postgraduate medical trainees.
Author Affiliations: Departments of Medicine (Dr Back) and Medical History and Ethics (Drs Back and Fryer-Edwards), University of Washington, and Clinical Research Division (Drs Back and Gooley), Fred Hutchinson Cancer Research Center, Seattle; Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (Dr Arnold); Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston (Dr Baile); Department of Medicine (Drs Alexander and Tulsky), Center for Palliative Care (Drs Alexander and Tulsky), and Duke Comprehensive Cancer Center (Dr Tulsky), Duke University and Center for Health Services Research (Drs Alexander and Tulsky), Durham Veterans Affairs Medical Center, Durham, NC; and Department of Family Medicine, University of Colorado at Denver, Aurora (Dr Barley).
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