Outcomes and outcome measures used in evaluation of communication training in oncology - a systematic literature review, an expert workshop, and recommendations for future research.

BACKGROUND: Communication between health care provider and patients in oncology presents challenges. Communication skills training have been frequently developed to address those. Given the complexity of communication training, the choice of outcomes and outcome measures to assess its effectiveness is important. The aim of this paper is to 1) perform a systematic review on outcomes and outcome measures used in evaluations of communication training, 2) discuss specific challenges and 3) provide recommendations for the selection of outcomes in future studies. METHODS: To identify studies and reviews reporting on the evaluation of communication training for health care professionals in oncology, we searched seven databases (Ovid MEDLINE, CENTRAL, CINAHL, EMBASE, PsychINFO, PsychARTICLES and Web of Science). We extracted outcomes assessed and the respective assessment methods. We held a two-day workshop with experts (n = 16) in communication theory, development and evaluation of generic or cancer-specific communication training and/or outcome measure development to identify and address challenges in the evaluation of communication training in oncology. After the workshop, participants contributed to the development of recommendations addressing those challenges. RESULTS: Out of 2181 references, we included 96 publications (33 RCTs, 2 RCT protocols, 4 controlled trials, 36 uncontrolled studies, 21 reviews) in the review. Most frequently used outcomes were participants' training evaluation, their communication confidence, observed communication skills and patients' overall satisfaction and anxiety. Outcomes were assessed using questionnaires for participants (57.3%), patients (36.0%) and observations of real (34.7%) and simulated (30.7%) patient encounters. Outcomes and outcome measures varied widely across studies. Experts agreed that outcomes need to be precisely defined and linked with explicit learning objectives of the training. Furthermore, outcomes should be assessed as broadly as possible on different levels (health care professional, patient and interaction level). CONCLUSIONS: Measuring the effects of training programmes aimed at improving health care professionals' communication skills presents considerable challenges. Outcomes as well as outcome measures differ widely across studies. We recommended to link outcome assessment to specific learning objectives and to assess outcomes as broadly as possible.

[Communication with patients about medical incidents]. / Die Kommunikation nach einem Zwischenfall - Die Bedeutung des nonverbalen Verhaltens.

Errors in medicine are common and often inevitable. They represent a dramatic situation for patients and their families. Thus, the physician-patient communication after a critical incident is crucial to prevent increased trauma. An error disclosure is a difficult, often overwhelming challenge for physicians. Doctors commonly experience enormous pressures from patient advocates and ethicists, who encourage full disclosure while risk managers and liability insurers demand restraint. Despite increasing institutional and legal protections, physicians are still reluctant to disclose errors to their patients. And those error disclosures that do occur often fail to meet patients' expectations. In fact, there is a substantial gap between what patients want to hear and what physicians typically disclose. Previous research has proposed a series of verbal messages doctors should communicate during error disclosures. However, considering the emotional content of such messages, patients likely derive much of the meaning from physicians' nonverbal behaviors. This article presents a detailed review of the existing literature on this topic area and discusses the verbal and nonverbal components that constitute a competent error disclosure in the medical field.