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Challenging Conversations in Palliative Care: improving doctors’ communication via education and simulation

Background and Objectives

When patients approach the end of life, doctors are often expected to manage challenging conversations with patient, their relatives and colleagues. The Internal Medicine Training (IMT) curriculum renews focus on developing effective consultation skills for complex situations alongside compassionate professional behaviour.

This project assesses the impact of communication skills training for challenging situations related to palliative care for Internal Medicine Stage Two trainees (IMTs)

Method

A multifaceted teaching session exploring positive communication in challenging situations was created by palliative medicine registrars. An interactive presentation was followed by four small group simulation scenarios designed to give participants opportunity to practice communication using role-play and receive feedback. The scenarios were dealing with anger, breaking bad news, collusion with relatives, and challenging senior colleagues when active treatment is no longer felt appropriate.

Sixteen IMTs participated in the teaching session. They completed pre- and post-course questionnaires regarding their skills and confidence in communicating effectively in challenging situations. Questionnaire responses were analysed alongside supplementary qualitative feedback.

Results

All trainees agreed course content was of utmost relevance to their training. Qualitative data highlighted benefits of introducing concepts of facilitative and blocking behaviours, and communication support models such as SPIKES and ‘Wish, Worry, Wonder’. Mean difference demonstrated improved confidence in communicating effectively in all challenging situations covered by the scenarios. The largest improvements on a 5-point scale from strongly disagree to strongly agree were in confidence in challenging senior colleagues (+0.94) and managing collusion (+0.69).

Conclusion

Trainees report improved confidence in communicating in challenging situations following teaching and simulation. Challenging a senior colleague about appropriateness of ongoing active treatment was identified as a situation IMTs had not previously explored in formal training, and their confidence in communicating in this situation markedly improved. IMTs nationally may benefit from introduction of scenario-based training focusing on interprofessional communication in difficult palliative care encounters.

Details
  • Organisation: University Hospitals Birmingham
  • Project Lead: Jennifer Hancox
  • Email address: jennifer.hancox@nhs.net
Project Type

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