Com-On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists.

OBJECTIVE: The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. METHODS: A first draft of the questionnaire was compiled based on skills reflecting good physician-patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. RESULTS: After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient-centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. CONCLUSION: A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com-On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. PRACTICE IMPLICATIONS: The questionnaire is suitable for measuring both the strengths and deficits within the physician-patient communication in oncology from the patients' perspective.

Interventions for children of parents with cancer: an overview.

PURPOSE OF REVIEW: The purpose of this overview is to analyze existing reviews on psychosocial interventions for children of parents with cancer and synthesize implications for further practice, interventions, and research in this field. The aim of this overview is therefore to generate systematic knowledge about what can be classed as evidence-based knowledge in this field. RECENT FINDINGS: The literature search in MEDLINE, CINAHL, PsycINFO, PSYNDEX, and PsycARTICLES resulted in three systematic reviews, which were evaluated by the AMSTAR-2-tool for quality assessment and the PRISMA-checklist for reporting. Results were analyzed through narrative synthesis due to the heterogeneity of the studies. The three systematic reviews were evaluated by the AMSTAR-2-tool for quality assessment and the PRISMA-checklist for reporting. AMSTAR-2 revealed critically low quality for all three reviews but taking into account the study situation of this scientific context, a more optimistic quality assessment can be suggested. The PRISMA checklist revealed good results. Positive evidence was found for the effect of psychosocial interventions concerning depressive symptoms, children's behavior, communication within the family, and quality of life. A comparison of the interventions is not possible due to the high degree of heterogeneity of the studies. SUMMARY: Following the principles of evidence-based medicine, this overview, together with clinical-practical expertise and the needs of those affected, could contribute to evidence-based care and stimulate future guidelines in this important field. The valuable engagement with questions around evidence-based practice invites professionals and researchers to enter into a common discourse to ultimately contribute to an improvement of the life situation of children of parents with cancer.

Teacher Self-Efficacy and Mental Health-Their Intricate Relation to Professional Resources and Attitudes in an Established Manual-Based Psychological Group Program.

Introduction: Teaching is considered a mentally challenging occupation. Teacher self-efficacy is a personal resource which buffers the experience of stress and may be important in maintaining mental health. The preventive intervention "Manual-Based Psychological Group Program for Teachers" (MBPGPT) was applied and evaluated state-wide to improve the mental health of teachers. This study aims to investigate the intricate relation between teacher self-efficacy and mental health and their changes in the course of the intervention. Method: Using a single-group pre-/post-design, the relation between teacher self-efficacy and mental health was investigated in 742 teachers. Pre- and post-changes in teacher self-efficacy and their interaction with mental health were examined in a subsample of 171 teachers, who met the conservative inclusion criteria. In ancillary analyses, correlations with underlying changes in work-related behavior and experience patterns were analyzed to better understand the intricate link between teacher self-efficacy and mental health. Results: Teacher self-efficacy showed a significant, moderate correlation with mental health. Self-efficacy was moderately higher after the intervention than before the intervention, but independent of changes in mental health. Teacher self-efficacy was related to work-related psychological resistance and positive emotions. An increase in teacher self-efficacy was accompanied by an improvement in life satisfaction and distancing ability. A decrease in teacher self-efficacy went hand in hand with reduced experience of social support. Discussion: This study confirmed teacher self-efficacy as an important, reliable resource and its correlation with psychological resistance. The absence of a control group limits what causal conclusions can be drawn from the study. Nevertheless, self-efficacy seems to be a worthwhile goal of preventive interventions for teachers and should be promoted due to its wide-ranging implications. Suggestions for further studies and interventions are made.

Mental distress and need for psychosocial support in prostate cancer patients: An observational cross-sectional study.

OBJECTIVE: Prostate cancer is the most common cancer in German men and associated with various physical and psychosocial problems. This study investigated the association between mental distress and the subjective need for psychosocial support comparing subgroups of patients with different treatments and disease stages. METHOD: We performed an observational, cross-sectional study including patients with four medical conditions: Active Surveillance, radical prostatectomy, biochemical relapse, metastasized disease. Mental distress (NCCN Distress-Thermometer), symptoms of depression and anxiety (PHQ-9, GAD-7), psychosocial needs and coping resources (self-designed questionnaire) were assessed. RESULTS: N = 130 patients were included. 33.3% showed distress, 16.5% symptoms of moderate depression and 13% symptoms of moderate anxiety. We found no significant differences between the four groups. An association was present between distress and wish for psychosocial support (χ2 = 4.3; p < 0.05; ϕ = 0.19). Almost 90% lived with a partner, which represents a resource. CONCLUSIONS: Prostate cancer patients showed low levels of mental distress, depression and anxiety with no difference in terms of disease stage and treatment modality. Therefore, careful psychosocial screening of all patients is essential to identify those in need for support. Distressed patients express a need for psychosocial support more often. Interpersonal relationships, most often wives and children, represent important coping resources.

Supporting migrants and refugees with posttraumatic stress disorder: development, pilot implementation, and pilot evaluation of a continuing interprofessional education for healthcare providers.

BACKGROUND: Refugees and migrants face an increased risk of developing posttraumatic stress disorder (PTSD). Adequate care can be insufficient due to language barriers, cultural differences, and knowledge deficits of health service providers. Therefore, professional associations requested that healthcare providers to be educated to provide culturally sensitive care. An evidence-based educational intervention in the form of a continuing interprofessional education (CIPE) for healthcare providers on the topic of PTSD in migrants and refugees was developed, pilot-implemented, and evaluated according to the first two levels of the Kirkpatrick evaluation model (reaction and learning). METHODS: The development of a curriculum for the CIPE intervention was based on a narrative literature review. Its content was validated by experts (N = 17) in an online survey and analyzed using both the Content Validity Index and a thematic analysis. The evaluation of the CIPE intervention was performed by conducting a pilot study with a quasi-experimental single group, using a pre-posttest design. In total, there were 39 participants distributed among three pilot courses. We collected and analyzed data on satisfaction, knowledge, and feasibility. RESULTS: The curriculum for a half-day course, consisting of 8 modules, showed almost excellent content validity (S-CVI = 0.92). In the pilot-implementation phase, participants were "very satisfied" with the pilot courses and a positive effect on their knowledge was detected. No correlation between satisfaction and knowledge gain was found. CONCLUSIONS: The CIPE intervention can be considered feasible and seems promising in its effects on satisfaction and knowledge. The insights gained in this study can be used to adapt and optimize the educational intervention, whereby the feedback from course attendees is particularly useful. Future studies need to further examine the effects in larger samples and more robust study designs.

Improving physicians' surgical ward round competence through simulation-based training.

OBJECTIVE: Ward rounds are an essential part of physicians' daily routine. Existing studies suggest that their practical implementation is inconsistent. Therefore, developing interventions to train ward round competence and assessing if they are effective educational tools are crucial goals for research. METHODS: We analysed a simulation-based tutorial dedicated to fourth-year medical students, including casework and ward round simulation. We investigated the effectiveness of this intervention regarding ward round competence through a randomized controlled trial. Performance was assessed with the modified/validated surgical ward round assessment tool by two blinded and trained raters. Supplementary, motivation during the ward round tutorial was assessed for all students at different time points. RESULTS: Analysis of the ratings show that, in contrast to the control group (pre: 66.1 vs. post: 64.8 points, p =  0.72), the ward round competence of the intervention group (pre: 62.6 vs. post: 69.6 points, p =  0.0169) improved significantly after participating in the ward round tutorial. CONCLUSION: The results show that our simulation-based training is an effective way to improve competence of medical students in conducting surgical ward rounds. PRACTICE IMPLICATIONS: Participation in ward round trainings is a valuable tool to prepare students for their future professional practise.

The course of cancer-related insomnia: don't expect it to disappear after cancer treatment.

OBJECTIVE: The study aimed to examine the 12-month course of cancer-related insomnia (CRI) and to identify possible predictors for the prevalence and persistence of CRI. METHODS: This longitudinal multicenter study included N = 405 patients with cancer (56% females, mean age: 58.6 years). CRI was measured by the Insomnia Severity Index (ISI). Socio-demographic and clinical data, as well as psychological parameters (Distress Thermometer, PHQ-9, GAD-7, and EORTC-Fatigue), were assessed at baseline (T1) and 12 months later (T2). RESULTS: In our sample, a high prevalence of relevant insomnia symptoms (49.4%, ISI > 7) was found, while a clinical insomnia diagnosis was verified in 12.8% (ISI > 14). When insomnia was present at T1, this problem was persistent after one year in 64%. At T2, however, significantly more women suffered from insomnia symptoms (53.3% women vs. 39.3% men; p = 0.003). Insomnia was associated with many clinical and psychological parameters, especially with fatigue (r = 0.5). Multiple regression analysis revealed that, in women, only insomnia at T1 was a significant predictor for insomnia at T2 (R2 = 0.40; F(5) = 12.5; p < 0.001), whereas in men insomnia, depressive symptoms and the use of psychotropic drugs at T1 predicted the extent of insomnia at T2 (R2 = 0.28; F(7) = 9.5; p < 0.001). In all participants, levels of distress, depression, and anxiety decreased from T1 to T2 (p's < 0.016). CONCLUSION: Insomnia is a common disorder in cancer patients. Although medical and psychological parameters improved during the 12-month course of cancer treatment, our results show that insomnia is highly persistent, especially in women. This indicates that adequate support for those affected is needed. CLINICAL TRIAL REGISTRATION NUMBER: DRKS00004860.

Specific feedback makes medical students better communicators.

BACKGROUND: Feedback is regarded a key element in teaching communication skills. However, specific aspects of feedback have not been systematically investigated in this context. Therefore, the aim of this study was to investigate the effectiveness of communication skills training (CST) integrating specific, structured and behavioral feedback. METHODS: We condensed best practice recommendations for feedback in a CST for undergraduate medical students and compared the effect of specific, structured and behavior-orientated feedback (intervention group CST-behav) to general, experience-orientated feedback (CST- exp. as our control group) in a randomized controlled trial (RCT). We investigated changes on communication skills evaluated by independent raters, and evaluated by standardized patients (SP). To do that, every student was video-recorded in a pre and post assessment. RESULTS: Sixty-six undergraduate medical students participated voluntarily in our study. Randomization did not result in equally skilled groups at baseline, so valid inter-group comparisons were not possible. Therefore, we analyzed the results of 34 students of our intervention group (CST-behav). Five out of seven domains in communication skills as evaluated by independent raters improved significantly, and there was a significant change in the global evaluation by SP. CONCLUSIONS: Although we were unable to make between-group comparisons, the results of the within group pre-post evaluation suggest that specific feedback helps improve communication skills.

Correction: ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial.

[This corrects the article DOI: 10.1371/journal.pone.0205315.].

Assessing Communication Skills in Real Medical Encounters in Oncology: Development and Validation of the ComOn-Coaching Rating Scales.

One of the challenges in research on teaching physician-patient communication is how to assess communication, necessary for evaluating training, the learning process, and for feedback. Few instruments have been validated for real physician-patient consultations. Real consultations involve unique contexts, different persons, and topics, and are difficult to compare. The aim of this study is to develop and validate a rating scale for assessment of such consultations. For the evaluation study of a communication skills training for physicians in oncology, real consultations were recorded in three assessment points. Based on earlier work and on current studies, a new instrument was developed for assessment of these consultations. Two psychologists were trained in using the instrument and assessed 42 consultations. For inter-rater reliability, interclass correlation (ICC) was calculated. The final version of the rating scales consists of 13 items evaluated on a 5-point scale. The items are grouped in seven areas: "Start of conversation," "assessment of the patient's perspective," "structure of conversation," "emotional issues," "end of conversation," "general communication skills," and "overall evaluation." ICC coefficients for the domains ranged from .44 to .77. An overall coefficient of all items resulted in an ICC of .66. The ComOn-Coaching Rating Scales are a short, reliable, and applicable instrument for the assessment of real physician-patient consultations in oncology. If adapted, they could be used in other areas. They were developed for research and teaching purposes and meet the required methodological criteria. Rater training should be considered more deeply by further research.

Decisional conflict of physicians during the decision-making process for a simulated advanced-stage cancer patient: an international longitudinal study with German and Belgian physicians.

BACKGROUND: Decision making with advanced cancer patients is often associated with decisional conflict regarding treatment outcomes. This longitudinal multicenter study investigated German physicians' course of decisional conflict during the decision-making process for a Simulated advanced-stage cancer Patient (SP). Results were compared to a matched sample of Belgian physicians. METHODS: German physicians' (n = 30) decisional conflict was assessed with the Decisional Conflict Scale (DCS) at baseline (t1) and after the four steps of a decision-making process: after reviewing the SP chart (t2), after viewing an assessment video interview with the SP (t3), after reviewing the team recommendations (t4), and after conducting the patient-physician decision-making interview (t5). The results were compared to those of a Belgian matched sample (n = 30). RESULTS: Decisional conflict of German physicians decreased during the Decision-Making process (M = 53.5, SD = 11.6 at t2 to M = 37.8, SD = 9.6 at t5, p < 0.001). This was similar to the pattern in the Belgian sample (M = 53.5, SD = 12.5 at t2 to M = 34.1, SD = 10.9 at t5, p < 0.001). There was no significant difference between the two groups for Decisional conflict end scores (p = 0.171). At the end of the Decision-making process, in both groups, still 43.3% of the physicians among each group (n = 13) reported a high Decisional Conflict (DCS > 37.5). CONCLUSIONS: Physicians' decisional conflict decreases during the decision-making process for an advanced cancer SP, though it remains at a high level. Culture, language and different health care systems have no influence on this process. The results emphasize the influence of psychosocial factors. We conclude that this issue should be considered more intensively in future research and in clinical care.

ComOn-Coaching: The effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training in oncology: Results of a randomized controlled trial.

OBJECTIVE: To investigate the effect of the number of coaching sessions after communication skills training on the medical communicative performance of oncologists in clinical practice. METHODS/DESIGN: The training, consisting of a workshop and one (control group) vs. four (intervention group) sessions of individual coaching, was evaluated in a randomized controlled trial. Eligible participants included physicians working in any setting where patients with oncological diseases were treated. Real medical consultations were video recorded at three time points: before the workshop (t0), after the workshop (t1) and after completion of coaching (t2). The 1.5-day workshop was based on role-playing in small groups; in the coaching sessions, the videos recorded at t1 were analyzed in detail by both the trainer and the physician. The coaching sessions were manualized and based on the physician's learning goals. The primary hypothesis was that the intervention group would improve to a higher extent than the control group, as assessed by external raters using rating scales specially developed for this project. Physicians were stratified for sex and setting and randomized by an independent statistician. The group assignment was revealed for physicians and trainers at the end of the workshop, while the raters were blinded to group assignments and assessment points. RESULTS: A total of 72 physicians participated in one of 8 workshops and could be allocated to either the control or intervention group. The intervention group showed a statistically significant improvement (ES d = 0.41, p<.01) in the All items domain of the rating scales between t1 and t2 and showed a significant advantage compared with the CG (ES = .41, p = .04). The impact on diverse specified skills was heterogeneous; a larger sample is necessary for more detailed analysis. CONCLUSIONS: The training achieved some observable and significant changes in the communicative behavior of oncologists in clinical practice. The four coaching sessions showed some significant advantages compared to the single coaching session. Considerable effort is necessary to achieve sustained changes in communication in clinical every-day practice. Thus, our coaching concept is a promising method for this purpose.

Psychological outcome after severe traumatic brain injury in adolescents and young adults: The chronic phase.

OBJECTIVES: Young individuals surviving severe traumatic brain injury (TBI) frequently experience a wide range of cognitive, emotional and behavioural consequences. This cross-sectional follow-up study investigated psychological outcome of young survivors in the chronic phase, and whether psychological outcome was associated with improvement of functional abilities during sub-acute admission. METHODS: Patients, who acquired a severe TBI during adolescence or early adulthood (n = 36) and received early intensive rehabilitation, were contacted for follow-up assessment concerning psychological outcome and completed the Adult Self Report 18-59 (ASR18-59). Demographic data, functional outcomes and severity measures were obtained from the local database. RESULTS: The participants had a mean age of 24.1 years (SD = 4.1) at follow-up, and the mean time since injury was 72.1 months (SD = 44.2). Results showed significantly higher scores compared with the normative reference population in relation to the subscales withdrawal/isolation (p = 0.013), attention problems (p = 0.008) and intrusive behaviour (p = 0.046). Pearson correlation analyses showed that young survivors experiencing more functional improvement during inpatient rehabilitation had fewer psychological problems during the chronic phase in the subscales: withdrawal/isolation, rule breaking, intrusive behaviour and total problems. CONCLUSION: Young patients reported psychological problems in several areas during the chronic phase of injury, which may hinder complete reintegration and participation in society. Larger functional improvement during sub-acute rehabilitation seemed to be associated with less psychological problems in the chronic phase.

Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients.

BACKGROUND: To evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients. METHODS: This multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables. RESULTS: In our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = -.391, p < .001), depression (r = -.488, p < .001), anxiety (r = -.439, p < .001), health-related anxiety (r = -.398, p < .001), dysfunctional illness perception (r = -.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45. CONCLUSIONS: QOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients' QOL.

Effect of individualized communication skills training on physicians' discussion of clinical trials in oncology: results from a randomized controlled trial.

BACKGROUND: Discussing randomized clinical trials (RCTs) with cancer patients is one of the most challenging communication tasks a physician faces. Only two prior Communication Skills Trainings (CSTs) focused on RCTs in oncology have been reported. Their results demonstrated the need for further improvement. We developed and evaluated an enhanced, individually-tailored CST focused on improving physicians' communication during discussions of RCTs. METHODS: The CST focused on personal learning goals derived from video pre-assessment that were addressed in a 1.5-day group workshop and one-on-one coaching sessions. Forty physicians were recruited and randomly assigned to intervention and control groups. Video-recorded standardized consultations with actor-patients were utilized. As a primary outcome (1), training success was evaluated by blinded raters using a previously developed checklist. Change in checklist items was evaluated between pre- and post-training assessment and compared against control group results. As a secondary outcome (2), the physicians' feeling of confidence was assessed by a questionnaire. RESULTS: (1) Significant improvements in the intervention group were observed for the score on all items (p = 0.03), for the subgroup of content-specific items (p = 0.02), and for the global rating of communication competence (p = 0.04). The improvement observed for the subgroup of general communication skill items did not achieve significance (p = 0.20). (2) The feeling of confidence improved in nine out of ten domains. CONCLUSION: While the individually-tailored CST program significantly improved the physicians' discussions of RCTs, specifically related to discussion content, what remains unknown is the influence of such programs in practice on participant recruitment rates. The study was registered retrospectively in 2010/07/22 under DRKS-ID: DRKS00000492 .

Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients.

OBJECTIVE: We researched associations between somatic symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. METHODS: This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]-15), depression (PHQ-9), anxiety (General Anxiety Disorder [GAD]-7), health anxiety (Whiteley-7 [WI-7]), illness perception (Brief-Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire-Revised [IPQ-R]), and sense of coherence (Sense of Coherence [SOC]-9). Logistic regression was applied to identify the strongest correlates with SSS. RESULTS: Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = 0.339, P < .001), symptom-related disability (Karnofsky Index) (r = 0.182, P < .001), depression (r = 0.556, P < .001), anxiety (r = 0.433, P < .001), health anxiety (r = 0.400, P < .001), illness perception (r = 0.349, P < .001), psychological illness attributions (r = 0.217, P < .01), and sense of coherence (r = -0.254, P < .001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI-7, B = 0.388, P = .002), higher depression (PHQ-9, B = 0.158, P < .001), younger age (B = -0.042, P = .048), higher impairment in daily life (B = 1.098, P = .010), and longer symptom duration (Wald = 18.487, P = .001) showed a significant association with high SSS; the model explained 55.1% of the variance. CONCLUSIONS: High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.

Integrating 360° behavior-orientated feedback in communication skills training for medical undergraduates: concept, acceptance and students' self-ratings of communication competence.

BACKGROUND: Feedback is considered a key didactic element in medical education, especially for teaching of communication skills. This study investigates the impact of a best evidence-based practice feedback concept within the context of communication skills training (CST). We evaluate this concept for acceptance and changes in students self-ratings of communication competence. METHODS: Our CST integrating feedback process comprises a short theoretical introduction presenting standards for good communication and a constructive 360° feedback from three perspectives: feedback from peers, from standardized patients (SPs), and from a trainer. Feed-forward process was facilitated for documenting suggestions for improvements based on observable behaviors to maximize learning benefits. Our CST was applied to four groups of eight or nine students. We assessed the data on students' acceptance using a 6-point scale ranging from very good (1) to poor (6), applied a forced choice question to rank didactic items, and assessed changes in student' self-ratings of their communication competence on a 10-cm visual analogue scale (VAS). RESULTS: Thirty-four medical undergraduates (82 % female, 18 % male) in their first clinical year, with an average age of 21.4 years (SD = 1.0), participated in the new training. The concept achieved high acceptance from good to very good: overall impression (M = 1.56), sufficient interaction for discussion (M = 1.15), and constructive learning atmosphere (M = 1.18). Specific elements, such as practical training with SPs (M = 1.18) and feedback by SPs (M = 1.12), showed highest acceptance. The forced choice ranking placed all feedback elements at the top of the list (feedback (FB) by SPs, rank 2; FB by trainer, rank 3; FB by colleagues, rank 4), whereas theoretical elements were at the bottom (theoretical introduction, rank 7; memory card, rank 9). Overall, student self-ratings of communication competence significantly improved in nine of the ten communication items assessed by VAS and showed a pre-post effect size of ES = 0.74 on a global rating. CONCLUSIONS: This study demonstrates that the training concept based on 360° behavioral feedback was well accepted and generated significant changes in student self-ratings of their communication competence. Further research is needed to determine the effects on objective communication performance.

ComOn Coaching: Study protocol of a randomized controlled trial to assess the effect of a varied number of coaching sessions on transfer into clinical practice following communication skills training.

BACKGROUND: Communication skills training has proven to be an effective means to enhance communication of health care professionals in oncology. These effects are well studied in standardized settings. The question of transferring these skills into clinical consultations remains open. We build up on a previous developed training concept consisting of a workshop and coaching. This training achieved a medium effect size in two studies with standardized patients. In the current study, we expanded and manualized the coaching concept, and we will evaluate effects of a varied number of coaching sessions on real clinical consultations. Our aim is to determine how much coaching oncologists need to transfer communication skills into clinical practice. METHODS/DESIGN: Physicians of two German medical centers will participate in a workshop for communication skills and will be randomized to either a group with one coaching session or a group with four coaching sessions following the workshop. The participation is voluntary and the physicians will receive medical education points. Consultations held by the participating physicians with actual patients who gave their informed consent will be filmed at three time points. These consultations will be evaluated by blinded raters using a checklist based on the training content (primary outcome). Secondary outcomes will be the self-evaluated communication competence by physicians and an evaluation of the consultations by both physicians and patients. DISCUSSION: We will evaluate our communication training concept on three levels - rater, physician and patient - and concentrate on the transfer of communication skills into real life situations. As we emphasize the external validity in this study design, limitations will be expected due to heterogeneity of data. With this study we aim to gain data on how to improve communication skills training that will result in better patient outcomes. TRIAL REGISTRATION: German Clinical Trials Register DRKS00004385 .