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Delphi-endorsed Communication Skills Clinicians Need to Care for Hospitalized Incapacitated Patients.
Butler, Rachel A; White, Douglas B; Arnold, Robert M; Cook, Tara; Klein-Fedyshin, Michele; Mohan, Deepika; Seaman, Jennifer B.
Afiliação
  • Butler RA; Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine.
  • White DB; Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine.
  • Arnold RM; Division of General Internal Medicine, Department of Medicine, School of Medicine.
  • Cook T; Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Klein-Fedyshin M; Division of General Internal Medicine, Department of Medicine, School of Medicine.
  • Mohan D; Palliative and Supportive Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
  • Seaman JB; Program on Ethics and Decision Making in Critical Illness, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine.
ATS Sch ; 3(2): 285-300, 2022 Jun.
Article em En | MEDLINE | ID: mdl-35924204
ABSTRACT

Background:

The National Academy of Medicine recently identified improving clinicians' serious illness communication skills as a necessary step in improving patient and family outcomes near the end of life, but there is not an accepted set of core communication skills for engaging with surrogate decision makers.

Objective:

To determine the core serious illness communication skills clinicians should acquire to care for incapacitated, hospitalized patients with acute, life-threatening illness, including patients with Alzheimer's disease and related dementias.

Methods:

From January 2019 to July 2020, we conducted a modified Delphi study with a panel of 79 experts in the field of serious illness communication. We developed a preliminary list of candidate communication skills through a structured literature review. We presented the candidate skills to the panelists in the context of three prototypical serious illness conversations. Over three rounds, panelists first augmented the list of candidate skills, then voted on the skills. The final set included skills deemed "very important" or "essential" by 70% of panelists. For external validation, we engaged 11 practicing clinicians and 7 community stakeholders for their perspectives on the expert-endorsed list of skills.

Results:

The panelists' ratings indicate the importance of a diverse set of communication skills related to providing clear information exchange as well as emotional and psychological support to surrogates. The final set included 33 skills, 12 of which were endorsed for all three prototypical serious illness conversations. Practicing clinicians and community stakeholders supported the expert-endorsed framework with only minor additions.

Conclusion:

We generated a stakeholder-endorsed list of skills that can inform the content of communication skills training programs for clinicians who care for incapacitated patients in the inpatient setting. The skills go beyond those required to provide traditional cognitive decision support and suggest the need for a paradigm shift in curricular content for communication training.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: ATS Sch Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: ATS Sch Ano de publicação: 2022 Tipo de documento: Article