Mentor communication skills training: development, feasibility, and preliminary efficacy.

BACKGROUND: Mentoring is vital to career development in academic medicine, and communication underlies all aspects of the mentoring relationship. Although training research mentors has been shown to be effective, few academic medicine faculties have received training in how to mentor. The investigators developed a novel intervention, the Mentor Communication Skills Training for Oncology Faculty ("Comskil Mentor Training") and examined feasibility and preliminary efficacy. METHODS: The study was a single arm pre-post intervention design. The intervention (Comskil Mentor Training) was offered in one virtual 3-hour session and included a didactic lecture with exemplary skill demonstration videos, facilitator-led small group role plays with trained actors, and evaluation. 19 faculty members from 12 departments participated in the training. RESULTS: All participants completed the training. Overall, the training was rated favorably, with more than 80% of participants indicating that they "agreed" or "strongly agreed" with training evaluation. From pre- to post-training, significant improvement was seen in participants' overall self-efficacy to communicate with mentees, as well as participants' overall use of communication skills and mentoring-specific language. CONCLUSIONS: Our findings support the feasibility and preliminary efficacy of a virtually delivered experiential mentor communication skills training program for multidisciplinary clinical and research faculty in oncology.

Geriatric Communication Skills Training Program for Oncology Healthcare Providers: a Secondary Analysis of Patient and Caregiver Outcomes.

Geriatric cancer patients and their caregivers have unique needs that make it difficult for their healthcare providers (HCPs) to effectively communicate with them. As ineffective communication can lead to negative health outcomes, it is important that oncology HCPs receive specialized training on communication with older adult patients and their caregivers. We conducted a small pilot study examining audio recordings of clinical encounters between HCPs and older adult cancer patients/caregivers and questionnaires completed by the patients and their caregivers before and after the HCPs participated in a geriatric communication skills training program. Eleven HCPs completed the 6-h Geriatric Comskil Training. Two clinic consultations with unique geriatric patients (n = 44) and their caregivers (n = 29) were recorded before and after training and coded for HCPs' use of communication skills. Patients and caregivers also completed surveys measuring their satisfaction with HCP communication and perceived empathy. Analysis of the audio recordings revealed that HCPs did not increase their use of communication skills after training. Although our sample was too small to detect statistical significance, measures of effect size showed trending improvements in patients' and caregivers' perceptions of HCPs' empathy and satisfaction with their communication after training. Our findings build on previous studies evaluating the feasibility and effectiveness of the Geriatric Comskil Training in real world setting and indicate that the training may have improved HCPs' communication with older adult patients and their caregivers even if their use of their observable communication skills did not change.

Geriatric Oncology Cognition and Communication (Geri-Onc CC): An interactive training for healthcare professionals.

INTRODUCTION: The number of older adults with cancer continues to increase. Many national and international organizations have called for the development of training opportunities for healthcare professionals (HCPs) to meet the unique needs of older adults with cancer and their families. MATERIALS AND METHODS: We developed and implemented the Geriatric Oncology Cognition and Communication (Geri-Onc CC) training program for HCPs of all disciplines. This program included a two-day, intensive didactic and experiential training followed by six bi-monthly booster videoconference calls. We describe the format and content of this training, the preliminary results of program evaluation, as well as changes in knowledge, self-efficacy, and attitudes toward older adults pre- to post-training. RESULTS: We describe data from the first six cohorts of HCPs who attended the training (n = 113). Participants rated the training highly favorably and reported that it met their training goals Mean = 4.8 (1-5 Scale). They also demonstrated a significant increase in their knowledge about geriatric oncology [(Pre-Mean = 6.2, standard deviation [SD] = 1.7; Post-Mean 6.8, SD = 1.6), p = 0.03] and self-efficacy in their ability to utilize the knowledge and skills they learned in the course [(Pre-Mean = 3.3, SD = 0.7; Post-Mean 4.5, SD = 0.4), p < 0.001]. There were no significant changes in attitudes toward older adults (p > 0.05), which were already very positive before the training. DISCUSSION: There is a strong need for training in geriatric oncology. We have demonstrated that implementing this training was feasible, highly regarded, and positively impacted knowledge and self-efficacy regarding utilization of the knowledge and skills learned in the training.

Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees' Communication Behaviors: A Systematic Review.

PURPOSE: A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors. METHOD: Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training. RESULTS: Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators. CONCLUSIONS: This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.

Geriatrics communication skills training program for oncology healthcare providers to improve the management of care for older adults with cancer.

Objective: We evaluated the feasibility, acceptability, and preliminary efficacy of a novel intervention, the Geriatric Communication Skills Training Program (Geriatric Comskil Training) for multidisciplinary healthcare providers (HCPs). Methods: Three 2-h modules comprised the training: Geriatrics 101, Cognitive Syndromes, and Shared Decision-Making. Modules consisted of didactic knowledge, exemplary videos, and experiential learning role plays with standardized patients. We collected pre- and post-training data from 11 HCPs (module evaluations, self-efficacy, communication skills uptake in interaction with standardized patients, perceived ageism) and 44 patients (perceived HCP empathy, satisfaction with HCP communication). Results: HCPs rated all modules high, with over 90% agreement on all course evaluation items assessing involvement, critical thinking, and reflectiveness, and significant improvements in self-efficacy. HCPs demonstrated an uptake in communication skills from pre- to post-training in agenda setting and overall skill use and reported promising trends towards lower ageism scores (d = 0.58). Promising trends in patient-reported HCP empathy (d = 0.39) and satisfaction with communication (d = 0.29) emerged from pre- to post-training. Conclusion: Continued efforts are needed to strengthen HCP education related to geriatric communication across the cancer continuum. Innovation: The Geriatric Comskil Training demonstrated feasibility, acceptability, and increases in self-efficacy and communication skills uptake for HCPs.

Incorporating shared decision making into communication with older adults with cancer and their caregivers: Development and evaluation of a geriatric shared decision-making communication skills training module.

OBJECTIVE: The purpose of this study was to evaluate a Communication Skills Training (CST) module for health care providers (HCPs) applying a shared decision-making approach to a meeting with an older adult with cancer and his/her family. METHODS: Ninety-nine HCPs from community-based centers, cancer centers, and hospitals in the Northeastern U.S. who worked primarily with older adult patients participated in a CST module entitled Geriatric Shared Decision Making. Participants completed pre- and post-training Standardized Patient Assessments (SPAs) and a survey on their confidence in and intent to utilize skills taught. RESULTS: Results indicated high HCP satisfaction with the module, with over 95 % of participants reporting high endorsement to all five evaluation items. HCPs' self-efficacy in utilizing communication skills related to geriatric shared decision making significantly increased pre- to post-training. In standardized patient assessments among a subset of providers (n = 30), HCPs demonstrated improvements in three shared decision-making skills: declare agenda, invite agenda, and check preference. CONCLUSION: A geriatric shared decision-making CST workshop for HCPs showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. PRACTICE IMPLICATIONS: This Geriatric Shared Decision-Making CST module provides an intervention for improving provider-patient-family member communication in the context of cancer care for older adults.

Addressing the quality of communication with older cancer patients with cognitive deficits: Development of a communication skills training module.

OBJECTIVE: Effective communication is an essential part of patient-centered care. The complexity of cancer care in older adults makes communication challenging, particularly when older patients have cognitive deficits and lose their autonomy. This paper describes the development, implementation, and evaluation of a communication skills training module for health care providers (HCPs) who work with older adults with cancer, with or at risk of developing cognitive deficits. METHOD: Using a pre-post single arm study design, 99 HCPs from a comprehensive cancer center in North-East USA, who worked primarily with geriatric patients, participated in the study. Participants included Advance Practice Providers (including Nurse Practitioners and Physician Assistants; n = 24, 24.2%); nurses (n = 23, 23.2%), social workers (n = 14, 14.1%), physicians (n = 13, 13.1%), and "other" HCPs (including occupational therapists, physical therapists, and psychologists; n = 20, 20.2%). The HCPs participated in a one-day geriatric communication skills training program in groups of 12-15 over a 2-year period. Participants complete pre-post surveys on module evaluation and perception of self-efficacy as well as pre-post video-recorded Standardized Patient Assessment (SPA) to evaluate communication skill uptake. RESULTS: Most participants evaluated the module positively; over 90% indicated that they agreed or strongly agreed with five of the six module evaluation items. HCPs' self-efficacy in communicating with cancer patients with cognitive deficits significantly increased from pre- to post-module training. There was a significant increase in the following communication skill use from pre- to post-training: checking patient preferences, declaring agenda, and inviting agenda. SIGNIFICANCE OF RESULTS: Results demonstrated a successful implementation of the program as evidenced through favorable program evaluation, significant gains in self-efficacy, as well as significant improvement in several communication skills.

Addressing communication challenges in older patients with cancer and geriatric syndromes: a communication skills training module for health care providers.

PURPOSE: Older adults frequently suffer from functional decline and sensory changes which, in turn, may trigger ageism, i.e., stereotyping and discriminating against individuals based on their age. Ageism commonly interferes with medical care. Communication strategies can be used to counteract ageism and to engage in optimal patient-centered care. This study describes the development, application, and evaluation of a communication skills training (CST) module (Geriatrics 101) designed to familiarize health care providers (HCPs) with the concept of ageism, and the frequent sensory and physical impairments in older patients with cancer, and to teach practical communication skills to effectively communicate with these patients. METHODS: Geriatrics 101 is one of three modules in a 1-day CST program for HCPs, intended to improve the outcome of consultations through utilization of a set of clinically meaningful strategies. Study measures included post-training module evaluation, self-efficacy measured pre- and post-training, and communication skills uptake assessed pre- and post-training. RESULTS: 97 clinicians participated over 2 years. Over 90% of participants rated the module favorably. Participants' self-efficacy to communicate efficiently with older patients with impairments improved significantly from pre- (M = 3.52, SD 0.85) to post-module training (M = 4.26, SD 0.50). Participants also demonstrated significant uptake of three skills-invite agenda, transition, and normalize. CONCLUSION: The successful development and application of our program paves the way for future research that focuses on the evaluation of such geriatric-focused communication training in clinical settings, assessing patient-reported outcomes.

A rigorous evaluation of an institutionally-based communication skills program for post-graduate oncology trainees.

OBJECTIVE: Integrating education about physician-patient communication into oncology specialists' education is important to improve quality of care. Our aim was to rigorously evaluate a 4-year institutionally-based patient communication skills program for oncology post-graduate trainees. METHODS: Trainees from 10 specialties in the U.S. participated in patient communication skills modules tailored to sub-specialties. The program was evaluated by comparing pre-post scores on hierarchical outcomes: course evaluation, self-confidence, skills uptake in standardized and real patient encounters, and patient evaluations of satisfaction with communication. We examined breadth of skill usage as key outcome. Generalized estimating equations were used in data analysis. RESULTS: Two hundred and sixty-two trainees' data were analyzed, resulting in 984 standardized and 753 real patient encounters. Participants reported high satisfaction and demonstrated significant skill growth with standardized patients, but transfer of these skills into real patient encounters was incomplete. Participants with lower baseline scores had larger improvements with both standardized and real patients. CONCLUSION: The program was well received and increased participant skills in the simulated setting without effective transfer to real patient encounters. PRACTICE IMPLICATIONS: Future work should allocate proportionally greater resources to trainees with lower baseline scores and measure breadth of participant skill usage as an outcome.

Improving Communication With Surrogate Decision-Makers: A Pilot Initiative.

BACKGROUND: Difficult conversations in medical care often occur between physicians and patients' surrogates, individuals entrusted with medical decisions for patients who lack the capacity to make them. Poor communication between patients' surrogates and physicians may exacerbate anxiety and guilt for surrogates, and may contribute to physician stress and burnout. OBJECTIVE: This pilot study assesses the effectiveness of an experiential learning workshop that was conducted in a clinical setting, and aimed at improving resident physician communication skills with a focus on surrogate decision-making. METHODS: From April through June 2016, we assessed internal medicine residents' baseline communication skills through an objective structured clinical examination (OSCE) with actors representing standardized surrogates. After an intensive, 6-hour communication skills workshop, residents were reassessed via an OSCE on the same day. A faculty facilitator and the surrogate evaluated participants' communication skills via the expanded Gap Kalamazoo Consensus Statement Assessment Form. Wilcoxon signed rank tests (α of .05) compared mean pre- and postworkshop scores. RESULTS: Of 44 residents, 33 (75%) participated. Participants' average preworkshop OSCE scores (M = 3.3, SD = 0.9) were significantly lower than postworkshop scores (M = 4.3; SD = 0.8; Z = 4.193; P < .001; effect size r = 0.52). After the workshop, the majority of participants self-reported feeling "more confident." CONCLUSIONS: Residents' communication skills specific to surrogate decision-making benefit from focused interventions. Our pilot assessment of a workshop showed promise, and additionally demonstrated the feasibility of bringing OSCEs and simulated encounters into a busy clinical practice.

The implementation and evaluation of a communication skills training program for oncology nurses.

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.

Responding to challenging interactions with families: A training module for inpatient oncology nurses.

INTRODUCTION: Sustaining the well-being of the caregiving family is a critical agenda in cancer care. In the multidisciplinary team, nurses often serve as a bridge between the family and oncology team. Evidence suggests that dealing with difficult family dynamics is a common source of stress for oncology nurses, yet nurses typically receive very little guidance on how to achieve an effective partnership with families under these circumstances. We report on the application and preliminary evaluation of a new training module for improving nurses' skills in responding collaborative to challenging family situations. METHOD: Training was delivered to 282 inpatient oncology nurses at a comprehensive cancer center over 2 years. Posttraining surveys measured perceived changes in confidence working with families, as well as the utility and relevance of this training. A 6-month follow-up survey measured continued use of skills. RESULTS: Of the nurses, 75%-90% reported that the skills learned were useful and relevant to their setting. Retrospective pre-post ratings suggested increased confidence in managing stressful encounters with families. DISCUSSION: Further investigation is needed to observe how nurses transport these skills into their practice settings and to understand the role of the nurse-as-family champion within the larger multidisciplinary team. (PsycINFO Database Record

Oncology nurses' communication challenges with patients and families: A qualitative study.

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions.

Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses.

OBJECTIVE: The purpose of this paper is to report on the development, implementation, and evaluation of a Communication Skills Training (CST) module for inpatient oncology nurses on how to respond empathically to patients. METHODS: 248 nurses from a USA cancer center participated in a CST module on responding empathically to patients. Nurses completed pre- and post-training Standardized Patient Assessments (SPAs), a survey on their confidence in and intent to utilize skills taught, and a six-month post-training survey of self-reported use of skills. RESULTS: Results indicate that nurses were satisfied with the module, reporting that agreement or strong agreement to 5 out of 6 items assessing satisfaction 96.7%-98.0% of the time. Nurses' self-efficacy in responding empathically significantly increased pre- to post-training. Additionally, nurses showed empathy skill improvement in the post-SPAs. Finally, 88.2% of nurses reported feeling confident in using the skills they learned post-training and reported an increase of 42-63% in the use of specific empathic skills. CONCLUSIONS: A CST module for nurses in responding empathically to patients showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. PRACTICE IMPLICATIONS: This CST module provides an easily targeted intervention for improving nurse-patient communication and patient-centered care.

Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

BACKGROUND: Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. OBJECTIVES: The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. METHODS: The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. FINDINGS: Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

Randomized trial of a presurgical scheduled reduced smoking intervention for patients newly diagnosed with cancer.

OBJECTIVE: Cancer patients who smoke are advised to quit smoking to reduce treatment complications and future cancer risk. This study's main objective was to evaluate the efficacy of a novel, presurgical cessation intervention in newly diagnosed cancer patients scheduled for surgical hospitalization. METHOD: We conducted a parallel-arm, randomized controlled trial comparing the efficacy of our hospital-based, tobacco cessation "best practices" treatment model (BP; cessation counseling and nicotine replacement therapy) with BP enhanced by a behavioral tapering regimen (scheduled reduced smoking; BP + SRS) administered by a handheld computer before hospitalization for surgery. Cessation outcomes were short (hospital admission and 3 months) and longer-term (6 months) biochemically verified smoking abstinence. We hypothesized that BP + SRS would be superior to BP alone. One hundred eighty-five smokers were enrolled. RESULTS: Overall, 7-day-point prevalence, confirmed abstinence rates at 6 months for BP alone (32%) and BP + SRS (32%) were high; however, no main effect of treatment was observed. Patients who were older and diagnosed with lung cancer were more likely to quit smoking. CONCLUSION: Compared to best practices for treating tobacco dependence, a presurgical, scheduled reduced smoking intervention did not improve abstinence rates among newly diagnosed cancer patients.reserved).