Improving Clinician Communication Skills (ICCS)
Chronic Obstructive Pulmonary Disease (COPD)
Restrictive Lung Disease
Congestive Heart Failure
End Stage Liver Disease
Behavioral: Training Program Intervention
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:||Improving Patient Outcomes in End-of-Life Care Provided by Physicians and Nurses|
- Patient and family ratings on the "End-of-Life domain" of the Quality of Communication Questionaire (QOC) [ Time Frame: 4/1/2007-3/31/2012 ] [ Designated as safety issue: No ]
- Patient symptoms of depression as assessed by the PHQ-8 (Memorial Symptom Assessment scale) [ Time Frame: 4/01/2007-3/31/2012 ] [ Designated as safety issue: No ]
- Patient-, family-, and nurse-assessed ratings of the quality of end-of-life care provided by study clinicians using Quality of End-of-Life Care questionaire [ Time Frame: 4/01/2007-3/31/2012 ] [ Designated as safety issue: No ]
|Study Start Date:||April 2007|
|Study Completion Date:||March 2013|
|Primary Completion Date:||February 2013 (Final data collection date for primary outcome measure)|
Experimental: Intervention Arm
The training program will assign resident or NP student to a rotation. They will be receiving the educational intervention during 8 half-day sessions.
Behavioral: Training Program Intervention
Resident or NP Student receives the educational intervention during 8 half-day sessions.
No Intervention: Control Arm
Resident or NP student is assigned to usual education.
Three decades of research on end-of-life care in the United States indicates that people who are dying often spend their final days with a significant burden of pain and other symptoms and receive care they would not choose. Patient-clinician communication about end-of-life care is an important focus for improving patient-centered end-of-life care for three reasons: 1) it is an integral component of clinician skill that affects all other aspects of end-of-life care; 2) physicians and nurses in practice do not demonstrate adequate skills for communicating about end-of-life care; and 3) current training in end-of-life communication is inadequate. Studies have shown that clinicians can improve their communication skills with experiential training, but no studies to date have shown that an intervention to improve clinician communication skill improves patient outcomes. Furthermore, despite widespread knowledge that end-of-life care is best delivered in an interdisciplinary context, most studies do not incorporate interdisciplinary training that includes physicians and nurses.
This is a randomized trial of a communication skills workshop for internal medicine residents and nurse practitioner (NP) students. A total of 373 residents and 128 NP students from two large training programs (UW and MUSC) will be randomized to either the intervention or usual education. The study's primary outcome measure will be the QOC scores on the "communication about end-of-life care" domain. The QOC will be assessed by patients, family members, and nurses before and after the intervention time period for all trainees. Secondary outcome measures are patient symptoms and patient-, family - and nurse-assessed QEOLC scores. Outcome measures will be collected for 5 patients and family members per trainee before the intervention period and 5 patients and family members per trainee after the intervention period. Process measures for both residents and NP students will include pre- and post-intervention assessment of knowledge, attitudes, and behavior regarding communication using standardized patient assessment as well as self-assessment and faculty assessment.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00687349
|United States, South Carolina|
|Medical University of South Carolina|
|Charleston, South Carolina, United States, 29425|
|United States, Washington|
|University of Washington; Harborview Medical Center|
|Seattle, Washington, United States, 98104|
|University of Washington; UW Medical Center|
|Seattle, Washington, United States, 98195|
|Veteran's Affairs Puget Sound HCS|
|Seattle, Washington, United States, 98108|
|Principal Investigator:||J. Randall Curtis, MD, MPH||University of Washington, Div. of Pulmonary and Critical Care Medicine|