Training Clinicians with Communication Skills Needed to Match Medical Treatments to Patient Values

Anthony L. Back1, Erik K. Fromme2, Diane E. Meier3
1VitalTalk, University of Washington, Seattle, Washington
2Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts
3Center to Advance Palliative Care, Mount Sinai School of Medicine, New York City, New York

Tóm tắt

Most clinicians currently in practice did not receive the evidence‐based communication skills training they need to provide high‐quality communication for seriously ill older adults and their families. Clinician communication skills are a critical factor in achieving a patient and family understanding of their illness that enables them to share in decision making that will result in medical treatments and social supports that are aligned with their goals and values. Research demonstrates that existing clinician competence in communication skills is extremely variable, that most clinicians need specific communication training to have an adequate level of skill, and that evidence‐based training is efficacious. A conservative estimate suggests that more than 219,000 physicians and advance practice providers (APPs) (50% of physicians in high‐contact subspecialties and 25% of all APPs) could benefit from training. Combining evidence‐based clinician training with health system workflow redesign would likely maximize the impact of this training. We conclude with recommendations designed to address gaps in communication skills through effective training and health system changes in the service of enabling all patients with serious illness and their families to receive care aligned with their personal priorities. J Am Geriatr Soc 67:S435–S441, 2019.

Từ khóa


Tài liệu tham khảo

Perry Undem Research/Communication. Physicians' views toward advance care planning and end‐of‐life care conversations. 2016. Available at:https://www.cambiahealthfoundation.org/assets/files/Advance_Care_Report_F_Embargo.pdf. Accessed October 17 2018.

10.3322/canjclin.55.3.164

10.1001/archinte.167.5.453

10.1016/S0140-6736(02)07810-8

Maguire P., 1990, Can communication skills be taught?, Br J Hosp Med, 43, 215

10.1016/S0959-8049(99)00301-9

10.1089/jpm.2013.0318

10.1016/j.jacc.2017.05.030

10.7326/0003-4819-155-9-201111010-00007

10.1200/JCO.2016.70.1474

10.1089/jpm.2017.0548

10.1089/jpm.2014.0164

10.7249/WP137

Institute of Medicine (U.S.), 2015, Committee on Approaching Death: Addressing Key End‐of‐Life Issues, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life

World Health Organization Geneva Switzerland 2007 https://www.afro.who.int/sites/default/files/2017-06/CC_PalliativeCareModule.pdf

10.1200/JCO.2007.12.4180

10.1191/0269216302pm575oa

Ericsson KA, 2016, Peak: Secrets From the New Science of Expertise

10.1089/jpm.2009.0249

10.1089/jpm.2011.0386

10.1023/A:1011103326656

10.1016/S0959-8049(99)00212-9

10.1007/3-540-30758-3_10

10.1177/0269216309348179

10.1002/(SICI)1099-1611(200003/04)9:2<147::AID-PON443>3.0.CO;2-X

10.1002/(SICI)1097-0142(19960615)77:12<2630::AID-CNCR29>3.0.CO;2-S

10.1080/07347332.2017.1357666

10.1136/bmj.325.7370.929

10.1136/bmj.326.7385.368

10.1136/bmj.320.7239.909

10.1056/NEJMoa1204410

10.1089/jpm.2006.2543

10.1200/JCO.2015.63.6696

10.1097/ACM.0000000000002230

10.1038/bjc.1995.244

10.1370/afm.1531

10.1377/hlthaff.2017.0790

10.1200/JCO.2006.06.7827

10.1177/0269216312449683

Epstein RM, 2017, Effect of a patient‐centered communication intervention on oncologist‐patient communication, quality of life, and health care utilization in advanced cancer: The VOICE randomized clinical trial, JAMA Oncol, 3, 92

10.1097/01.ACM.0000242580.83851.ad

Senot C, 2015, What has the biggest impact on hospital readmission rates, Harv Bus Rev

10.1377/hlthaff.2017.0219

10.1001/jama.2013.282081

10.1200/JOP.2017.027144

10.1200/JCO.2002.08.004

10.1080/01421590701392903

10.1207/s15430154jce1904_8

10.1111/j.1532-5415.2011.03787.x

Communication/Research P.U. Physicians' Views Toward Advance Care Planning and End‐of‐Life Care Conversations Washington DC. 2016.https://www.cambiahealthfoundation.org/assets/files/Advance_Care_Report_F_Embargo.pdf

10.1016/j.jpainsymman.2015.11.003

10.4037/ajcc2017336

Matzo ML, 2003, Communication skills for end‐of‐life nursing care: Teaching strategies from the ELNEC curriculum, Nurs Educ Perspect, 24, 176

10.1016/j.pec.2017.09.012

American Association of Nurse Practitioners AANP fact sheet. 2018. Available at:https://www.aanp.org/all-about-nps/np-fact-sheet. Accessed October 15 2018.

National Commision on Certification of Physician Assistants 2016 Statistical Profile 2018. Available at:http://prodcmsstoragesa.blob.core.windows.net/uploads/files/2017StatisticalProfileofCertifiedPhysicianAssistants%206.27.pdf. Accessed October 15 2018.

HayesSL SalzbergCA McCarthyD et al. High‐need high‐cost patients: Who are they and how do they use health care? a population‐based comparison of demographics health care use and expenditures. Issue Brief (Commonw Fund) 2016;26:1‐14.

Centers for Disease Control. Deaths and mortality. 2015. Available at:https://www.cdc.gov/nchs/fastats/deaths.htm. Accessed October 15 2018.

10.1377/hlthaff.2011.0650