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Improving end-of-life care | Follow-up to April 24 Session

  • 26 Apr 2014 10:28 AM
    Quote
    Message # 1543721
    Anonymous
    In the recent Virtual Journal Club session, Barbara Barnes discussed a study examining the effect of an educational intervention on communication with patients around end-of-life care (Curtis JR et al.  Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness.  JAMA, 2013;310(21):2271-2281). Despite an intensive, longitudinal educational intervention (8 4-hour sessions that included simulations), the investigators found that compared to usual education, the intervention did not result in improved communication but was associated with a small increase in patients' depressive symptoms.

    In the interest of encouraging discussion, I'd like to pose three questions:
    1. What was your reaction to the study?
    2. Were you surprised at the results?  Why or why not?  
    3. In your view, what issues does this study raise for CEHP practitioners and evaluators?
    Last modified: 26 Apr 2014 10:30 AM | Anonymous
  • 27 Apr 2014 9:46 AM
    Quote
    Reply # 1543939 on 1543721
    Mila Kostic
    Here is some evidence we have found in support of communication skill training that informed our planning and development of communication training curriculum to address adherence issues in chronic disease management for practicing primary care teams. Our training included small group expert facilitated workshop with standardized patients (SPs).

    Effective provider-patient communication is linked to improved patient satisfaction, health status, recall of information, and adherence1-4

    –      Poor communication results in 19% higher risk of  non-adherence

    –      Good communication results in 2.16-fold greater patient adherence

    –      Communication training results in 1.62-fold greater patient adherence

    1. Hall JA, et al. Med Care. 1988;26:657-675.

    2. Stewart MA. CMAJ. 1995;152:1423-1433.

    3. Ong LM, et al. Soc Sci Med. 1995;40:903-918. 

    4. Haskard Zolnierek KB, et al. Med Care. 2009;47:826-34.
  • 28 Apr 2014 3:46 AM
    Quote
    Reply # 1544177 on 1543721
    Anonymous
    Any insight into why communication training in the studies Mila cited was more effective at the level of pt outcomes than the Curtis et al. Intervention?  Characteristics of the interventions?  Study methodologies? Targeted behaviors?  The clinical context?
  • 09 Jul 2021 7:03 PM
    Quote
    Reply # 10741221 on 1543721
    Vjeko Hlede

    This is an exciting study.

    What I'm wondering is how did authors neutralize significant variation between quality and value inside each educational/learning format? We know that no technology/format can compensate for not the best learning design; that well-designed lecture or even printed book will be more valuable than not so well designed technology-enhanced activity.

    I'm also wondering can we map the discussion with a patient and changes that follow with the Transtheoretical Stages of Change model (Prochaska). I'm wondering how the follow-up stages were supported?

    Last modified: 09 Jul 2021 7:03 PM | Vjeko Hlede
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