Breaking bad news in China--the dilemma of patients' autonomy and traditional norms. A first communication skills training for Chinese oncologists and caretakers.

OBJECTIVE: Current practice of breaking bad news in China involves disclosure of information first to family members who then decide whether the patient should receive this information. Recently, however, patients' right to be informed has been regulated by law. This represents a dilemma for oncologists who now have to balance traditional practice with new legal requirements. A communication skills training (CST) was developed for Chinese practice. It addresses this issue and may help participants find individual solutions within these conflicting requirements. METHODS: A first CST about breaking bad news took place at the Beijing Cancer Hospital, China, with 31 participants. We (i) assessed current practice, (ii) evaluated the workshop and (iii) self-assessed performance ratings about breaking bad news before and after the workshop with the help of questionnaires. RESULTS: (i) Participants stated that in most cases (78%), they inform family members first. Contrary to this practice, participants think that about 75% of patients would like to be informed first, independent of family. (ii) Overall, the workshop received a very good rating (M = 1.2; scale between 1 and 6). (iii) After the workshop, the participants rated their performance significantly higher in all areas, for example, talking about diagnosis, prognosis and death with the patient and the family. CONCLUSIONS: The CST showed high acceptance and led to significantly improved performance ratings of participating physicians in many areas. It helped participants deal with conflicting demands. For future trainings, further socio-cultural adaptations are needed. Obvious conflicts still exist and need to be resolved.

Development and evaluation of a checklist assessing communication skills of oncologists: the COM-ON-Checklist.

OBJECTIVES: Communication skills training (CST) has to be proven effective, and therefore reliable instruments to evaluate CST are required. Most instruments assessing medical consultations do not take individual aspects of CST into consideration. Such assessment tools should naturally also be closely associated with the communication skills taught to the participants. Thus, we developed a new instrument which evaluates the effects of specific CST. DEVELOPMENT: Based on a literature review, we developed a checklist with questions ('items') which assess the behaviour of a doctor in a special doctor-patient consultation (The COM-ON-Checklist, COM-ON = communication in oncology). First, we developed items for general communication skills that are a requirement of every doctor-patient consultation, and in addition to this, we developed items for specific situations which present a particular challenge for doctors in terms of communication skills, namely: the situation in which the doctor is required to discuss the shift from curative to palliative care, and the disclosure of information about clinical trials. For assessment, a 5-point rating scale with anchor points was used. EVALUATION: Blinded raters were trained to use the COM-ON-Checklist. The intra-class correlation (ICC) was used to calculate the agreement between raters. RESULTS: The COM-ON-Checklist consists of two parts: the first part evaluates general communication skills; the second part evaluates content-specific aspects of the consultation. The ICC ranged from 0.5 to 0.8, which demonstrates moderate to very good results of inter-rater reliability. DISCUSSION: The COM-ON-Checklist can be used to evaluate specific CST. It is also a feedback source for clinicians because it assesses their personal communication skills in different settings. In conclusion, the COM-ON-Checklist provides a reliable, structured method for assessing communication skills in oncological settings.

Specific training program improves oncologists' palliative care communication skills in a randomized controlled trial.

PURPOSE: The aim of the study was to demonstrate that COM-ON-p, concise and individualized communication skills training (CST), improves oncologists' communication skills in consultations focusing on the transition to palliative care. METHODS: Forty-one physicians were randomly assigned to a control (CG) or intervention group (IG). At t(0), all physicians held two video-recorded consultations with actor-patient pairs. Afterward, physicians in the IG participated in COM-ON-p. Five weeks after t(0), a second assessment took place (t(1)). COM-ON-p consists of an 11-hour workshop (1.5 days), pre- and postassessment (2 hours), and coaching (0.5 hours). Physicians focused on practicing individual learning goals with actor patients in small groups. To evaluate the training, blinded raters assessed communication behavior of the physicians in video-recorded actor-patient consultations using a specific checklist. Data were analyzed using a mixed model with baseline levels as covariates. RESULTS: Participants in the IG improved significantly more than those in the CG in all three sections of the COM-ON-Checklist: skills specific to the transition to palliative care, global communication skills, and involvement of significant others (all P < .01). Differences between the CG and IG on the global items of communication skills and involvement of significant others were also significant (P < .01). Effect sizes were medium to large, with a 0.5-point improvement on average on a five-point rating scale. CONCLUSION: Physicians can be trained to meet better core challenges during the transition to palliative care through developed concise CST. Generalization and transfer into clinical practice must be proven in additional studies.

Addressing the transition from curative to palliative care: concept and acceptance of a specific communication skills training for physicians in oncology--COM-ON-p.

BACKGROUND: There are several reasons why consultations addressing the transition to palliative care are especially challenging, and physicians are generally not very well prepared to meet these challenges. We therefore conceptualized and evaluated a concise, individualized communication skills training (CST) addressing i) communication concerning the transition to palliative care, and ii) involvement of significant others in the conversation. Core aspects of the CST and data of acceptance will be presented. METHODS: The core elements of the CST are a 1.5-day workshop held in small groups and a subsequent individual coaching session during everyday routine. The workshop is practice-oriented and highly individualized. Acceptance was assessed by using a self-developed 13-item questionnaire. RESULTS: All 41 participating physicians completed the evaluation questionnaire. The participants' overall evaluation of the workshop was very positive and indicated a high personal benefit. Individualized learning tools like 'assessment of individual learning goals' and 'closing with individual take-home messages' were also seen as positive, but not as positive as other elements like practicing with actor patients and feedback from actors and facilitators. CONCLUSIONS: The presented specific, individualized, and concise CST is well accepted, and physicians see a high practical relevance and strong personal benefits.