Enhancing Oncologists' Comfort with Serious Illness Conversations: The Impact of Serious Illness Conversation Guide (SICG) Training.

Providers oftentimes need to have difficult conversations with patients facing a poor prognosis. Research indicates that providers generally feel ill prepared for these conversations and that bad conversations may lead to more anxiety for patients. Communication skills development training programs have shown improvement in providers' skills. Our cancer center embarked on skills development training to help providers improve their skills and comfort in having serious illness conversations. During our phased approach, about 500 physicians and advanced practice providers in the Division of Oncology were trained for over a year. Their level of comfort with serious illness conversations was measured before and after the training by using both quantitative and qualitative methods. We found that mean and median comfort scores increased from pre-training to post-training. The findings suggest that the improved comfort and confidence observed among providers who undergo communications skills training can lead to better provider-patient communication, more patient-centered care, and improved patient satisfaction.

Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial.

BACKGROUND: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (ß=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (ß=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (ß=.71; P=.01) and emotional eating (ß=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (ß=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.

Adaptation of the Serious Illness Conversation Guide to Singapore's Multicultural Setting for Patients With Heart Failure, Renal Failure, or Cancer.

Background: The Serious Illness Conversation Guide (SICG) was developed by Ariadne Labs in the United States. However, there is a scarcity of literature on the cross-cultural adaptations of the SICG in Asian settings. Objectives: We aimed to adapt the SICG for English-speaking patients with serious illnesses in Singapore. Methods: We purposively recruited 28 patients with advanced stages of heart failure, renal failure, or cancer from a tertiary hospital. A designated research team member conducted semistructured interviews to obtain participants' feedback on the SICG. The interviews were transcribed by the designated study team member. Participants' response to each item on the SICG was coded quantitatively into categories to denote participant acceptance, partial acceptance, or nonacceptance. Transcripts were further analyzed using content analysis to understand participants' rationale regarding feedback of the specific SICG item. Modifications to the SICG were iteratively made over time to obtain its current version. Results: Participants indicated a preference for direct language with shorter sentences and inclusive pronouns. It was considered important that clinicians keep the conversation hopeful, individualize the conversation content according to the patient's journey, and use prompts where necessary to support the patient's elaboration. Conclusion: This study outlined a patient-centric approach to localizing the SICG in the English language to a new cultural context, marking the first such effort in an Asian setting. Further study is under way to evaluate the SICG in more disease populations and non-English languages used in Singapore.

'Alright my lovely': The use of terms of endearment as a mitigation device in the care of people living with dementia in the acute hospital environment.

This paper examines how terms of endearment (ToE) are used as a mitigation device in interactions between staff and people living with dementia (PLWD) in the acute hospital environment. ToE are often discouraged in training for healthcare staff. However, this research demonstrates that they are still commonly used in practice. Using conversation analysis, video and audio data were examined to identify the interactional functions of ToE. Analysis showed that ToE play an important role in mitigating potentially face-threatening actions such as when patients are asked to repeat hard-to-interpret talk, or when patient agency is compromised through instruction sequences or having necessary healthcare tasks undertaken. The success of this mitigation is sensitive to the specific interactional circumstances, as well as the responsiveness of the HCP to the patient's voiced concerns. These findings have implications for healthcare practice, training and wider care of PLWD.

How the Listener's Attention Dynamically Switches Between Different Speakers During a Natural Conversation.

The neural mechanisms underpinning the dynamic switching of a listener's attention between speakers are not well understood. Here we addressed this issue in a natural conversation involving 21 triadic adult groups. Results showed that when the listener's attention dynamically switched between speakers, neural synchronization with the to-be-attended speaker was significantly enhanced, whereas that with the to-be-ignored speaker was significantly suppressed. Along with attention switching, semantic distances between sentences significantly increased in the to-be-ignored speech. Moreover, neural synchronization negatively correlated with the increase in semantic distance but not with acoustic change of the to-be-ignored speech. However, no difference in neural synchronization was found between the listener and the two speakers during the phase of sustained attention. These findings support the attenuation model of attention, indicating that both speech signals are processed beyond the basic physical level. Additionally, shifting attention imposes a cognitive burden, as demonstrated by the opposite fluctuations of interpersonal neural synchronization.

Disagreement Gets Mistaken for Bad Listening.

It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.

A clinical assessment of three-dimensional-printed liver model navigation for thrice or more repeated hepatectomy based on a conversation analysis.

PURPOSES: We performed a conversation analysis of the speech conducted among the surgical team during three-dimensional (3D)-printed liver model navigation for thrice or more repeated hepatectomy (TMRH). METHODS: Seventeen patients underwent 3D-printed liver navigation surgery for TMRH. After transcription of the utterances recorded during surgery, the transcribed utterances were coded by the utterer, utterance object, utterance content, sensor, and surgical process during conversation. We then analyzed the utterances and clarified the association between the surgical process and conversation through the intraoperative reference of the 3D-printed liver. RESULTS: In total, 130 conversations including 1648 segments were recorded. Utterance coding showed that the operator/assistant, 3D-printed liver/real liver, fact check (F)/plan check (Pc), visual check/tactile check, and confirmation of planned resection or preservation target (T)/confirmation of planned or ongoing resection line (L) accounted for 791/857, 885/763, 1148/500, 1208/440, and 1304/344 segments, respectively. The utterance's proportions of assistants, F, F of T on 3D-printed liver, F of T on real liver, and Pc of L on 3D-printed liver were significantly higher during non-expert surgeries than during expert surgeries. Confirming the surgical process with both 3D-printed liver and real liver and performing planning using a 3D-printed liver facilitates the safe implementation of TMRH, regardless of the surgeon's experience. CONCLUSIONS: The present study, using a unique conversation analysis, provided the first evidence for the clinical value of 3D-printed liver for TMRH for anatomical guidance of non-expert surgeons.

Resisting wh-questions in business coaching.

Introduction: This study investigates clients' resisting practices when reacting to business coaches' wh-questions. Neither the sequential organization of questions nor client resistance to questions have yet been (thoroughly) investigated for this helping professional format. Client resistance is understood as a sequentially structured, locally emerging practice that may be accomplished in more passive or active forms, that in some way withdraw from, oppose, withstand or circumvent various interactional constraints (e.g., topical, epistemic, deontic, affective) set up by the coach's question. Procedure and methods: Drawing on a corpus of systemic, solution-oriented business coaching processes and applying Conversation Analysis (CA), the following research questions are addressed: How do clients display resistance to answering coaches' wh-questions? How might these resistive actions be positioned along a passive/active, implicit/explicit or withdrawing/opposing continuum? Are certain linguistic/interactional features commonly used to accomplish resistance?. Results and discussion: The analysis of four dyadic coaching processes with a total of eleven sessions found various forms of client resistance on the active-passive continuum, though the more explicit, active, and agentive forms are at the center of our analysis. According to the existing resistance 'action terminology' (moving away vs. moving against), moving against or 'opposing' included 'refusing to answer', 'complaining' and 'disagreeing with the question's agenda and presuppositions'. However, alongside this, the analysis evinced clients' refocusing practices to actively (and sometimes productively) transform or deviate the course of action; a category which we have termed moving around.

Predicting conversational satisfaction of face-to-face conversation through interpersonal similarity in resting-state functional connectivity.

When conversing with an unacquainted person, if it goes well, we can obtain much satisfaction (referred to as conversational satisfaction). Can we predict how satisfied dyads will be with face-to-face conversation? To this end, we employed interpersonal similarity in whole-brain resting-state functional connectivity (RSFC), measured using functional magnetic resonance imaging before dyadic conversation. We investigated whether conversational satisfaction could be predicted from interpersonal similarity in RSFC using multivariate pattern analysis. Consequently, prediction was successful, suggesting that interpersonal similarity in RSFC is an effective neural biomarker predicting how much face-to-face conversation goes well. Furthermore, regression coefficients from predictive models suggest that both interpersonal similarity and dissimilarity contribute to good interpersonal relationships in terms of brain activity. The present study provides the potential of an interpersonal similarity approach using RSFC for understanding the foundations of human relationships and new neuroscientific insight into whether success in human interactions is predetermined.

The role of a community conversation intervention in reducing stigma related to lower limb lymphoedema in Northern Ethiopia.

BACKGROUND: Stigma related to lower-limb lymphoedema poses a major psychosocial burden to affected persons and acts as a barrier to them accessing morbidity management and disability prevention (MMDP) services. Community Conversation (CC), which actively engages community members and disseminates health information amongst them, is believed to break the vicious cycle of stigma by enhancing disease-related health literacy at the community level. METHODS: A quasi-experimental study was conducted in Northern Ethiopia to assess the role of the CC intervention in reducing stigma. In two control districts, a comprehensive and holistic MMDP care package was implemented that included physical health, mental health and psychosocial interventions, whilst in the intervention district the CC intervention was added to the MMDP care package. A total of 289 persons affected by lymphoedema and 1659 community members without lymphoedema were included in the study. RESULTS: Over the course of the intervention, in all sites, community members' knowledge about the causes of lymphoedema increased, and perceived social distance and stigmatizing attitudes towards people with lymphoedema decreased in the community, whilst experienced and internalized stigma decreased amongst affected persons. There were no significant changes for perceived social support. However, the changes were greater in the control sites overall, i.e. those districts in which the holistic care package was implemented without CC. CONCLUSION: The findings suggest that the CC intervention provides no additional stigma reduction when used alongside a holistic MMDP care package. Provision of comprehensive and holistic MMDP services may be adequate and appropriate to tackle stigma related to lower-limb lymphoedema in a resource-constrained setting like Ethiopia.

Patient perceptions of disease burden and treatment of myasthenia gravis based on sentiment analysis of digital conversations.

Myasthenia gravis (MG) is a rare, autoimmune, antibody-mediated, neuromuscular disease. This study analyzed digital conversations about MG to explore unprovoked perspectives. Advanced search, data extraction, and artificial intelligence-powered algorithms were used to harvest, mine, and structure public domain digital conversations about MG from US Internet Protocol addresses (August 2021 to August 2022). Thematic analyses examined topics, mindsets, and sentiments/key drivers via natural language processing and text analytics. Findings were described by sex/gender and treatment experience with steroids or intravenous immunoglobulin (IVIg). The 13,234 conversations were extracted from message boards (51%), social media networks (22%), topical sites (21%), and blogs (6%). Sex/gender was confirmed as female in 5703 and male in 2781 conversations, and treatment experience was with steroids in 3255 and IVIg in 2106 conversations. Topics focused on diagnosis (29%), living with MG (28%), symptoms (24%), and treatment (19%). Within 3176 conversations about symptoms, eye problems (21%), facial muscle problems (18%), and fatigue (18%) were most commonly described. Negative sentiments about MG were expressed in 59% of conversations, with only 2% considered positive. Negative conversations were dominated by themes of impact on life (29%), misdiagnosis problems (27%), treatment issues (24%), and symptom severity (20%). Impact on life was a key driver of negativity in conversations by both men (27%) and women (34%), and treatment issues was a dominant theme in conversations by steroid-treated (29%) and IVIg-treated (31%) patients. Of 1382 conversations discussing treatment barriers, 36% focused on side effects, 33% on lack of efficacy, 21% on misdiagnosis, and 10% on cost/insurance. Side effects formed the main barrier in conversations by both steroid-treated and IVIg-treated patients. Capturing the patient voice via digital conversations reveals a high degree of concern related to burden of disease, misdiagnosis, and common MG treatments among those with MG, pointing to a need for treatment options that can improve quality of life.

Lexical Alignment is Pervasive Across Contexts in Non-WEIRD Adult-Child Interactions.

Lexical alignment, a communication phenomenon where conversational partners adapt their word choices to become more similar, plays an important role in the development of language and social communication skills. While this has been studied extensively in the conversations of preschool-aged children and their parents in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) communities, research in other pediatric populations is sparse. This study makes significant expansions on the existing literature by focusing on alignment in naturalistic conversations of school-aged children from a non-WEIRD population across multiple conversational tasks and with different types of adult partners. Typically developing children aged 5 to 8 years (n = 45) engaged in four semi-structured conversations that differed by task (problem-solving vs. play-based) and by partner (parent vs. university student), resulting in a corpus of 180 conversations. Lexical alignment scores were calculated and compared to sham conversations, representing alignment occurring at the level of chance. Both children and adults coordinated their conversational utterances by re-using or aligning each other's word choices. This alignment behavior persisted across conversational tasks and partners, although the degree of alignment was moderated by the conversational context. These findings suggest that lexical alignment is a robust phenomenon in conversations between school-age children and adults. Furthermore, this study extends lexical alignment findings to a non-WEIRD culture, suggesting that alignment may be a coordination strategy employed by adults and children across diverse linguistic and cultural backgrounds.

Misplaced Divides? Discussing Political Disagreement With Strangers Can Be Unexpectedly Positive.

Differences of opinion between people are common in everyday life, but discussing those differences openly in conversation may be unnecessarily rare. We report three experiments (N = 1,264 U.S.-based adults) demonstrating that people's interest in discussing important but potentially divisive topics is guided by their expectations about how positively the conversation will unfold, leaving them more interested in having a conversation with someone who agrees versus disagrees with them. People's expectations about their conversations, however, were systematically miscalibrated such that people underestimated how positive these conversations would be-especially in cases of disagreement. Miscalibrated expectations stemmed from underestimating the degree of common ground that would emerge in conversation and from failing to appreciate the power of social forces in conversation that create social connection. Misunderstanding the outcomes of conversation could lead people to avoid discussing disagreements more often, creating a misplaced barrier to learning, social connection, free inquiry, and free expression.

The subjective and objective side of helplessness: Navigating between reassurance and risk management when people seek help for suicidal others.

Social psychologists interested in interaction have demonstrated that help-seeking is a fruitful area for understanding how people relate to one another, but there is insufficient knowledge on how people navigate emotional involvement in help activities. Drawing on discursive psychology and conversation analysis, this article examines third-party calls to a crisis helpline, with emergency calls as a point of comparison, to see how participants manage emotional involvement related to callers' concerns for others. The analysis unpacks how participants orient to helplessness-callers' uncertainty and inability to move forward-as justifying a focus on the at-risk person or on the caller's emotions. While dispatchers at emergency centres work to get pertinent information to send help, call-takers at the crisis helpline are trained to offer emotional support. In the latter case, a caller's displays of helplessness may be treated as a sign of danger for the person at-risk, but it can also be taken as a disposition to worry, warranting a focus on the caller's emotional state. Showing how participants manage this challenge as they navigate 'whom to help', the paper contributes to research on the accomplishment of subjectivity and objectivity and demonstrates the utility of this framework in suicide prevention.

Family-Oriented Therapeutic Conversations: A Systematic Scoping Review.

There is increasing evidence that highlights the benefits of Family-oriented Therapeutic Conversations (FAM-TC) for the patient and the family; however, studies show variability regarding the content and the way these interventions are offered. This may hamper its further development in clinical practice. This review systematically maps the available literature on nurse-led FAM-TC and offers a solid synthesis of the characteristic, effectiveness, and feasibility of these interventions. A systematic search in PubMed, CINAHL, Cochrane, Web of Science, PsycINFO, Trip (Turning Research Into Practice), BASE (Bielefeld Academic Search Engine), OATD (Open Access Theses and Dissertations), and ProQuest databases identified 37 studies. The interventions varied in interventionist nurses' profile, the intervention content, or the duration of the sessions offered. Most of the interventions showed beneficial effects on perceived family support and family functioning. This review offers suggestions for future studies, such as the inclusion of specific theoretical frameworks for intervention design, targeting both the patient and the family and offered by nurses with family nursing competency.

When patients demur: Resisting diagnostic closure in US primary care.

Patients are more engaged in their healthcare than ever before, including in the process of diagnostic sensemaking. But in acute primary care encounters, the interactional flow of the visit is shaped by an orientation toward the physician as the authority over diagnostic reasoning. Once physicians close diagnostic inquiry and transition into counseling, their assessment - and the extent to which it converges with the patient's perspective - comes into full view. Yet this is precisely when patients have reduced occasions to speak up if they do have concerns, as the "train has left the station" both diagnostically and interactionally. Using conversation analysis and a dataset of 75 video recordings of acute primary care encounters in the US, this article examines how patients speak up in this constrained environment. The concept of diagnosis demurral is proposed to describe how patients resist diagnostic closure by renewing the relevance of diagnostic inquiry, either in response to a diagnosis or at any point following the transition into counseling. Findings suggest that patients demur more frequently than prior studies on diagnosis resistance may have predicted, but they do so in ways that maintain deference to the physician's authority over matters of diagnosis: speaking up primarily outside the diagnostic moment, relying on actions in their own domain of expertise (e.g., their illness experience), and working to additionally soften the epistemic and interactional inappositeness of their demurral. This behavior sits at the nexus of two opposing forces: patients may be more engaged, but their participation is constrained by a continued legacy of medical authority over diagnosis, to which patients themselves continue to respond and reproduce.

Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain.

OBJECTIVES: Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP. METHODS: Conversation analyses of physician-patient-encounters and graphical expression of AP-based pain were performed. RESULTS: Twenty-two interactions were recorded and analyzed. Fifteen children were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life. CONCLUSION: Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.

Communicating difficult news in pediatric radiology.

Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish… I worry… I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations.

A Mixed Methods Analysis of Standardized Documentation of Serious Illness Conversations Within an Electronic Health Record Module During Hospitalization.

BACKGROUND: Analysis of documented Serious Illness Conversations (SICs) in the inpatient setting can help clinicians align management to address patient and caregiver needs. METHODS: We conducted a mixed methods analysis of the first instance of standardized documentation of a SIC within a structured module among hospitalized general medicine patients from 2018 to 2019. Percentage of documentations that included a description of patient or family understanding of the patient's medical condition and use of radio buttons to answer the "prognostic information shared," "hopes," and "worries" modules are reported. Using grounded theory approach, physicians analyzed free text entries to: "What is important to the patient/family?" and "Recommendations or next steps planned." RESULTS: Out of 5142 patients, 59 patients had a documented SIC. Patient or family understanding of the medical condition(s) was reported in 56 (95%). For "prognostic information shared," the most frequently selected radio buttons were: 49 (83%) incurable disease and 28 (48%) prognosis of weeks to months while those for "hopes" were: 52 (88%) be comfortable and 27 (46%) be at home and for "worries" were: 49 (83%) other physical suffering and 36 (61%) pain. Themes generated from entries to "What's important to patient/family?" included being with loved ones; comfort; mentally and physically present; and reliable care while those for "Recommendations" were coordinating support services; symptom management; and support and communication. CONCLUSIONS: SIC content indicated concern about pain and reliable care suggesting the complex, intensive nature of caring for seriously ill patients and the need to consider SICs earlier in the life course of patients.

Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention.

BACKGROUND: EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. METHODS: EM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. RESULTS: A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice. CONCLUSION: Our study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers' knowledge, attitude, and practice of SI communication skills. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03424109; Registered on January 30, 2018.