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Improving Clinician Communication Skills (ICCS) (ICCS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00687349
Recruitment Status : Completed
First Posted : May 30, 2008
Last Update Posted : September 16, 2014
National Institute of Nursing Research (NINR)
Information provided by (Responsible Party):
J. Randall Curtis, University of Washington

Brief Summary:
This research study is a randomized trial to evaluate a training program that is designed to improve the communication skills of clinicians. The training program focuses on care for patients with serious illnesses and their family members, and assesses effectiveness using patient and family outcomes. The long term goal of this research is to improve communication skills of doctors and nurses, thereby improving patient and family outcomes.

Condition or disease Intervention/treatment Phase
Advanced Cancer Chronic Obstructive Pulmonary Disease (COPD) Restrictive Lung Disease Congestive Heart Failure End Stage Liver Disease Behavioral: Training Program Intervention Phase 3

Detailed Description:

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6086 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Improving Patient Outcomes in End-of-Life Care Provided by Physicians and Nurses
Study Start Date : April 2007
Actual Primary Completion Date : February 2013
Actual Study Completion Date : March 2013

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
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.

Primary Outcome Measures :
  1. 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 ]

Secondary Outcome Measures :
  1. Patient symptoms of depression as assessed by the PHQ-8 (Memorial Symptom Assessment scale) [ Time Frame: 4/01/2007-3/31/2012 ]
  2. 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 ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:


  • all internal medicine residents at either University of Washington (UW)or the Medical University of South Carolina
  • who have a clinical rotation allowing implementation of the intervention.

NP Student:

  • All NP Students at UW or MUSC
  • in programs that train them to work with the following patient types:
  • Adult patents with Cancer or other chronic, life-limiting illnesses
  • Older Adults
  • Adults Primary Care Patients


One or more of the following diagnostic criteria:

  • Advanced Cancer;
  • Chronic obstructive pulmonary disease (COPD) with FEV1 values < 35% predicted and/or oxygen dependent;
  • Restrictive lung disease with a TLC < 50% predicted;
  • Congestive heart failure with an ejection fraction <30% or functional deficits matching New York Heart Association Class III or IV heart failure;
  • End stage liver disease including Child's Class C cirrhosis, MELD score ≥ 18, a variceal bleed, refractory ascites, or spontaneous bacterial peritonitis (SBP);
  • a Charlson Comorbidity Score point value ≥6;
  • in-patients with a University HealthSystem Consortium (UHC) Risk of Mortality score of major or extreme;
  • OR hospitalized patients ≥ 80 years.


  • The ability to speak English well enough to be able to complete the study procedures
  • AND no significant dementia or delirium that would limit the family member's ability to complete instruments.


  • are working in the hospital or clinic with the resident or NP student enrolled in the study.

Exclusion Criteria:

  • less than 18 years,
  • significant dementia, delirium, or psychosis;
  • the inability to speak English well enough to be able to complete the study procedures.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00687349

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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
Veteran's Affairs Puget Sound HCS
Seattle, Washington, United States, 98108
University of Washington; UW Medical Center
Seattle, Washington, United States, 98195
Sponsors and Collaborators
University of Washington
National Institute of Nursing Research (NINR)
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Principal Investigator: J. Randall Curtis, MD, MPH University of Washington, Div. of Pulmonary and Critical Care Medicine
Publications of Results:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: J. Randall Curtis, Professor of Medicine, University of Washington Identifier: NCT00687349    
Other Study ID Numbers: 31466-G
R01NR009987 ( U.S. NIH Grant/Contract )
First Posted: May 30, 2008    Key Record Dates
Last Update Posted: September 16, 2014
Last Verified: September 2014
Keywords provided by J. Randall Curtis, University of Washington:
End-of-Life issues
Talking with your doctor
Coping with chronic illness
Additional relevant MeSH terms:
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Liver Diseases
End Stage Liver Disease
Lung Diseases
Lung Diseases, Obstructive
Pulmonary Disease, Chronic Obstructive
Heart Failure
Heart Diseases
Cardiovascular Diseases
Respiratory Tract Diseases
Digestive System Diseases
Liver Failure
Hepatic Insufficiency