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A better understanding of how communication skills education impacts trainees' communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees' communication behaviors.Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training.Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre-post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators.This review demonstrates strong support that experiential communication skills education can impact GME trainees' communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.

Objective The purpose of this study was to evaluate a Communication Skills Training (CST) module for health care providers (HCPs) applying a shared decision-making approach to a meeting with an older adult with cancer and his/her family. Methods Ninety-nine HCPs from community-based centers, cancer centers, and hospitals in the Northeastern U.S. who worked primarily with older adult patients participated in a CST module entitled Geriatric Shared Decision Making. Participants completed pre- and post-training Standardized Patient Assessments (SPAs) and a survey on their confidence in and intent to utilize skills taught. Results Results indicated high HCP satisfaction with the module, with over 95 % of participants reporting high endorsement to all five evaluation items. HCPs’ self-efficacy in utilizing communication skills related to geriatric shared decision making significantly increased pre- to post-training. In standardized patient assessments among a subset of providers (n = 30), HCPs demonstrated improvements in three shared decision-making skills: declare agenda, invite agenda, and check preference. Conclusion A geriatric shared decision-making CST workshop for HCPs showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake. Practice implications This Geriatric Shared Decision-Making CST module provides an intervention for improving provider-patient-family member communication in the context of cancer care for older adults.

ObjectiveEffective communication is an essential part of patient-centered care. The complexity of cancer care in older adults makes communication challenging, particularly when older patients have cognitive deficits and lose their autonomy. This paper describes the development, implementation, and evaluation of a communication skills training module for health care providers (HCPs) who work with older adults with cancer, with or at risk of developing cognitive deficits.MethodUsing a pre-post single arm study design, 99 HCPs from a comprehensive cancer center in North-East USA, who worked primarily with geriatric patients, participated in the study. Participants included Advance Practice Providers (including Nurse Practitioners and Physician Assistants; n = 24, 24.2%); nurses (n = 23, 23.2%), social workers (n = 14, 14.1%), physicians (n = 13, 13.1%), and “other” HCPs (including occupational therapists, physical therapists, and psychologists; n = 20, 20.2%). The HCPs participated in a one-day geriatric communication skills training program in groups of 12–15 over a 2-year period. Participants complete pre-post surveys on module evaluation and perception of self-efficacy as well as pre-post video-recorded Standardized Patient Assessment (SPA) to evaluate communication skill uptake.ResultsMost participants evaluated the module positively; over 90% indicated that they agreed or strongly agreed with five of the six module evaluation items. HCPs’ self-efficacy in communicating with cancer patients with cognitive deficits significantly increased from pre- to post-module training. There was a significant increase in the following communication skill use from pre- to post-training: checking patient preferences, declaring agenda, and inviting agenda.Significance of resultsResults demonstrated a successful implementation of the program as evidenced through favorable program evaluation, significant gains in self-efficacy, as well as significant improvement in several communication skills.

Background Difficult conversations in medical care often occur between physicians and patients' surrogates, individuals entrusted with medical decisions for patients who lack the capacity to make them. Poor communication between patients' surrogates and physicians may exacerbate anxiety and guilt for surrogates, and may contribute to physician stress and burnout.Objective This pilot study assesses the effectiveness of an experiential learning workshop that was conducted in a clinical setting, and aimed at improving resident physician communication skills with a focus on surrogate decision-making.Methods From April through June 2016, we assessed internal medicine residents' baseline communication skills through an objective structured clinical examination (OSCE) with actors representing standardized surrogates. After an intensive, 6-hour communication skills workshop, residents were reassessed via an OSCE on the same day. A faculty facilitator and the surrogate evaluated participants' communication skills via the expanded Gap Kalamazoo Consensus Statement Assessment Form. Wilcoxon signed rank tests (α of .05) compared mean pre- and postworkshop scores.Results Of 44 residents, 33 (75%) participated. Participants' average preworkshop OSCE scores (M = 3.3, SD = 0.9) were significantly lower than postworkshop scores (M = 4.3; SD = 0.8; Z = 4.193; P Conclusions Residents' communication skills specific to surrogate decision-making benefit from focused interventions. Our pilot assessment of a workshop showed promise, and additionally demonstrated the feasibility of bringing OSCEs and simulated encounters into a busy clinical practice.

Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants’ self-efficacy and uptake of communication skills.

Introduction Sustaining the well-being of the caregiving family is a critical agenda in cancer care. In the multidisciplinary team, nurses often serve as a bridge between the family and oncology team. Evidence suggests that dealing with difficult family dynamics is a common source of stress for oncology nurses, yet nurses typically receive very little guidance on how to achieve an effective partnership with families under these circumstances. We report on the application and preliminary evaluation of a new training module for improving nurses' skills in responding collaborative to challenging family situations. Method Training was delivered to 282 inpatient oncology nurses at a comprehensive cancer center over 2 years. Posttraining surveys measured perceived changes in confidence working with families, as well as the utility and relevance of this training. A 6-month follow-up survey measured continued use of skills. Results Of the nurses, 75%-90% reported that the skills learned were useful and relevant to their setting. Retrospective pre-post ratings suggested increased confidence in managing stressful encounters with families. Discussion Further investigation is needed to observe how nurses transport these skills into their practice settings and to understand the role of the nurse-as-family champion within the larger multidisciplinary team. (PsycINFO Database Record

Caregivers for older adults often lack knowledge and skills to ease their burden. 57% of caregivers report that they do not have a choice about performing clinical tasks. Caregivers in underserved groups face additional barriers in accessing resources. The MSKCC Geriatric Resource Interprofessional Program (GRIP) implemented an educational program for South Asian caregivers in Queens, NY with community partnerships. Based on a 90-minute focus group, culturally-competent, practical-skills oriented educational workshops on safe patient handling, cognitive impairment, caregiver burden and medication management were developed and implemented. 134 caregivers attended 12 sessions at five locations over 2016/2017. 88% were women and the average age was 62. Participants spoke 12 different languages and 76% were born in India. Knowledge increased significantly between pre and post for safe patient handling and cognitive impairment (p

Older adults frequently suffer from functional decline and sensory changes which, in turn, may trigger ageism, i.e., stereotyping and discriminating against individuals based on their age. Ageism commonly interferes with medical care. Communication strategies can be used to counteract ageism and to engage in optimal patient-centered care. This study describes the development, application, and evaluation of a communication skills training (CST) module (Geriatrics 101) designed to familiarize health care providers (HCPs) with the concept of ageism, and the frequent sensory and physical impairments in older patients with cancer, and to teach practical communication skills to effectively communicate with these patients.Geriatrics 101 is one of three modules in a 1-day CST program for HCPs, intended to improve the outcome of consultations through utilization of a set of clinically meaningful strategies. Study measures included post-training module evaluation, self-efficacy measured pre- and post-training, and communication skills uptake assessed pre- and post-training.97 clinicians participated over 2 years. Over 90% of participants rated the module favorably. Participants' self-efficacy to communicate efficiently with older patients with impairments improved significantly from pre- (M = 3.52, SD 0.85) to post-module training (M = 4.26, SD 0.50). Participants also demonstrated significant uptake of three skills-invite agenda, transition, and normalize.The successful development and application of our program paves the way for future research that focuses on the evaluation of such geriatric-focused communication training in clinical settings, assessing patient-reported outcomes.

Minorities and older adults represent an intersection of populations that are particularly vulnerable to suboptimal care. The US population is aging and growing more diverse. Dementia afflicts minority populations more than Caucasians. Many people in the community with mild cognitive impairment (MCI) and Alzheimer’s disease do not recognize cognitive, functional or behavioral impairment as abnormal. Several barriers to treatment exist within both the older and minority populations. The Health Resources and Services Administration (HRSA), is the primary Federal agency for improving health and achieving health equity. Queens County in New York City is a multicultural, ethnically diverse urban area with 48% of its population being foreign born. Funded by a grant from HRSA, in collaboration with the South Asian Council for Social Services (SACSS), the Geriatric Resource Interprofessional Program (GRIP) at Memorial Sloan Kettering Cancer Center (MSKCC) developed and conducted educational lectures on “Memory Loss & Dementia” at 7 different community centers in Queens. Between November 2015 and January 2019 eight sessions were conducted. A total of 182 people attended. Their mean age was 68, 59% were women. 71% were born in South Asia. Consecutive interpretation of the lecture was performed; the written materials were translated beforehand. Pre and post-test questionnaires were administered to measure understanding of the topic, and qualitative comments collected. The developmental process, results of the study and challenges we faced in developing and applying the educational initiative will be presented.

Pain is a common problem in older cancer patients, estimated to affect 70% of those with advanced disease. As older adults live longer after diagnosis, the use and misuse of opioids will continue to rise. Gaps in available age-friendly opioid resources for patients were identified at a Comprehensive Cancer Center. An interprofessional team worked to develop a resource to educate older cancer patients and their caregivers regarding safe opioid use. Expert clinical opinions from Supportive Care, Anesthesia Pain, Nursing, and Geriatrics Services as well as patient observations informed drafts of the resource. A total of 22 older patients in three geriatric clinics were approached for a short interview (8 open questions) surrounding opioid understanding and concerns. The most stated concerns were fear of addiction, concern about the opioid epidemic, and potential unwanted side effects. There was an evident lack of awareness of what an opioid was or which one of the medications in their list was an opioid. The interviews underscored the need for the education resource to include names of opioids, address concerns about the opioid epidemic and signs of addiction. Language was added to describe safe use, storage and disposal of opioids. Special considerations in the older adult were emphasized. Links to additional information were provided. Finally, patient education experts reviewed the draft to adapt the language to be patient-friendly. Opioids are often effectively used in cancer pain management and older cancer patients warrant proper education. Patient perspectives are critical in the development of relevant patient education resources.

Facilitating small group role play is an integral component in effective communication skills training (CST) for healthcare professionals, and requires its own training and review in order to provide replicable high-quality CST. This chapter outlines the structure and critical elements of facilitator-led role play sessions. Elements include the importance of structuring the role play; recognizing the importance of established learning goals as expressed by each learner; navigating and directing the simulated patient (SP) to partake in a realistic clinical encounter relevant to the learner; managing an effective role play session with learner and SP; and providing meaningful feedback both directly to the learner, as well as overseeing balanced group feedback provided by observing peers in the small group. This chapter also provides helpful processes in training new and sustaining competent facilitators, keeping in mind available resources for training. Finally, this chapter points to necessary areas for continued development in facilitation.

Older adult patients often have multiple comorbidities, see multiple providers, leading to poor medication management (MM). Educational seminars were conducted to health care providers (HCPs) and community-based organizations to deliver health programs to linguistically diverse communities by a pharmacist utilizing interpreters. Participant knowledge was assessed using matched pre-post surveys (translated to participants’ respective languages). Behavioral intention was measured using a Likert scale. Results indicate participation from 136 community dwelling adults via 6 educational sessions; 44 caregivers via 5 sessions, and 22 HCPs (4 students and 22 residents) participated in one session. 91% of the community population were born outside of the US, 67% coming from South Asian countries, speaking over 7 different languages. Knowledge about medication management increased from an average of 44% correct responses pre-session to 48% correct post-session – a statistically significant change (t (135) =-2.26, p

Background: Most cancer deaths are in patients older than 65 years. Healthcare professionals (HCPs) caring for older adults with cancer must be equipped with skills to manage cognitive related changes and the nuances of communication with patients and caregivers. Methods: A two-day interprofessional symposium was developed to increase knowledge regarding 1) chemotherapy-related cognitive changes; 2) distress, delirium, dementia and depression in older cancer patients; 3) communication with patients with cognitive deficits and their caregivers; 4) decision making capacity. Presenters include geriatric medicine, geriatric psychiatry, occupational therapy and legal, ethics and communication experts. Day one centered on didactics with a complex case interprofessional discussion. Day two comprised of a communication skills training consisting of three modules: Geriatrics 101, Communication and Cognitive Deficits and Shared Decision Making. Participants role-played with simulated older adult patients and caregivers. Knowledge, self-efficacy and satisfaction were assessed. Results: A total of 75 people attended day one and 33 people attended day two. Most attendees were white (74.4%) and female (85.4%). Nurses (36.6%), social workers (29.3%), physicians (14.6%), others (19.5%) were represented. Mean knowledge increased (t=-3.23, df (13), p

Older adults can reduce fall risk in their homes and the community. Health care professionals (HCP) have a role in preventing falls. An interprofessional team of HCPs at a comprehensive cancer center created and delivered educational workshops to increase knowledge about falls prevention. Educational workshops were provided in community centers, libraries, places of worship and at local hospitals to medically underserved, diverse community members, caregivers and HCP. An Occupational (OT) and Physical Therapist (PT) taught three workshops together and the OT taught nine workshops. Workshops included fall prevention, home modifications, safe patient handling (SPH), and the role of OT/ PT in geriatric oncology care. Practical and culturally competent steps were emphasized, with translation of written materials and live interpretation provided as appropriate. Knowledge increase was assessed, and post-session qualitative data was collected. The mean age of community members was 68 years, of nurses was 42, and of caregivers 63. A majority of participants were female. 220 older adults completed surveys, 40 caregivers, and 11 registered nurses. The Falls Prevention workshops with unmatched (n=79) and matched data (n=140) showed significant improvements in knowledge [t(135)=-3.33, p

Date Presented 04/04/19 This abstract discusses the design and results of an interprofessional education (IPE) program for community members, caregivers, and healthcare providers (HCP). Education focused on fall prevention, home modifications, and the role of rehabilitation in geriatric oncology. Knowledge change was assessed by pre-post surveys. Results show significant improvement on knowledge change and intended behavior for all three audiences. Continued training efforts are necessary for broader dissemination. Primary Author and Speaker: Chrysanne Karnick Contributing Authors: Natalie Gangai, Rosario Costas Muñiz, Ruth Manna, Beatriz Korc-Grodzicki

e18149 Background: Community outreach is commonly used to disseminate cancer prevention & screening guidelines (CPSG). Minority, immigrant populations with language barriers tend to be excluded from these activities due to the lack of bilingual professionals available to deliver this education. This program was aimed to test whether CPSG education improves knowledge after being taught by an English-speaking medical professional and nonmedical, community-based interpreters working in South Asian and Hispanic communities in New York City (NYC). Methods: Team members from two cancer centers and community-based minority organizations in NYC partnered to create and deliver programs on CPSG to linguistically diverse communities by an English-speaking medical professional utilizing community-based interpreters. Participant knowledge was assessed using matched pre-post surveys in participants’ respective languages. Behavioral intention was measured using a Likert scale from 1-4 with anchors at 1) “Will not do it” and 4) “Already have/doing it”. Paired t-tests were used to compare pre to post mean score and a p-value < 0.05 was considered statistically significant. Behavioral intention rated positively if participants endorsed “will do it” or “already doing” the healthy behavior. Results: 188 community dwelling adults participated in 5 educational sessions, 122 completing pre and post assessments. Median age was 68, two thirds (69%) were female. 94% were born outside of the US, coming from 12 different countries, speaking 6 different primary languages. Knowledge increased from an average of 33% correct responses pre-session to 63% correct post-session – a statistically significant change ( t (121) = -10.58, p < .001). Behavioral intention scores reveal 83-96% participants reporting they will continue to or plan to seek screening and screening information from their doctors as well as make lifestyle changes related to decreasing their cancer risk. Conclusions: This program demonstrates CPSG can not only be taught in English with use of interpreters, but can be successfully received by immigrant community participants who historically may not have these programs available to them due to language barriers.

80 Background: Medical decision-making is the process of shared understanding of a patient’s personal values and subsequent negotiation to reach a treatment decision. Discussing options and engaging patients in decision-making remains a challenge for many clinicians. The challenge is greater when treating older patients, who may be cognitively impaired, and may have family members or caregivers playing significant roles in their care. The geriatric communication skills training (CST) guides clinicians in effectively communicating with older cancer patients and their caregivers around pivotal cancer care decisions. Methods: A multidisciplinary team from a Comprehensive Cancer Center collaborated on the development of a one-day training program, consisting of three geriatric specific CST modules: Geriatrics 101, Cognitive Syndromes and Shared Decision Making. Each module included a brief didactic (30 min) with exemplary videos, followed by experiential role play (90 min) with standardized patients (SP), co-led by multi-disciplinary facilitators. These sessions were video recorded to enable reflective learning, group discussion, and feedback. We examined preliminary efficacy of the intervention on multiple outcomes, including participant course evaluations, self-efficacy and coded SP assessments. Results: 28 clinicians, including mental health professionals, oncologists, family practitioners, physician assistants, nurse practitioners, and social workers participated in the training. All participants reported strong satisfaction results with the workshop. Self-efficacy ratings increased significantly across all three modules, t(21) = -4.58, p < .001 between pre-training (M = 3.39, SD = .66) and post-training (M = 4.13, SD = .59). In SP assessments, participants also demonstrated significant uptake of agenda setting skills and increased responsiveness to caregiver concerns from pre to post training. Conclusions: The geriatric CST program was well received and demonstrated improvements in knowledge. Interdisciplinary training groups present for excellent case discussion and modeling opportunities for a variety of communication challenges.

The purpose of this paper is to report on the development, implementation, and evaluation of a Communication Skills Training (CST) module for inpatient oncology nurses on how to respond empathically to patients.248 nurses from a USA cancer center participated in a CST module on responding empathically to patients. Nurses completed pre- and post-training Standardized Patient Assessments (SPAs), a survey on their confidence in and intent to utilize skills taught, and a six-month post-training survey of self-reported use of skills.Results indicate that nurses were satisfied with the module, reporting that agreement or strong agreement to 5 out of 6 items assessing satisfaction 96.7%-98.0% of the time. Nurses' self-efficacy in responding empathically significantly increased pre- to post-training. Additionally, nurses showed empathy skill improvement in the post-SPAs. Finally, 88.2% of nurses reported feeling confident in using the skills they learned post-training and reported an increase of 42-63% in the use of specific empathic skills.A CST module for nurses in responding empathically to patients showed feasibility, acceptability, and improvement in self-efficacy as well as skill uptake.This CST module provides an easily targeted intervention for improving nurse-patient communication and patient-centered care.

Despite nurses’ centrality in the process of the healthcare team communicating with patients, few receive formal education specific to communication, particularly related to end-of-life care (Chant, Jenkinson, Randle, & Russell, 2002; Kruijver, Kerkstra, Bensing, & van de Wiel, 2000; Vydelingum, 2006). However, nurses rank communication as one of the most important competencies to their practice (McCabe, 2004; McGilton, Irwin-Robinson, Boscart, & Spanjevic, 2006). Although nurses generally feel confident in providing care for the physical needs of patients with cancer, they find addressing the patients’ emotional concerns to be more difficult (Rask, Jensen, Andersen, & Zachariae, 2009). These reported difficulties in communication exist among hospice nurses as well (Ellington et al., 2008; Ellington, Reblin, Clayton, Berry, & Mooney, 2012). Nurses’ communication skills are crucial to patient care because they provide much of the care and support to patients and their families throughout the disease trajectory. Nurses are also more likely to be present at the time of death than any other healthcare professional (Wiegand & Russo, 2013). In acknowledgment of this reality, the Institute of Medicine (2010) reported that, although physicians have traditionally been responsible for these difficult end-of-life conversations, nurses are taking the lead with the advancement of nursing practice. Key to improving nurses’ involvement in patients’ end-of-life care is training them how to communicate these issues to patients and their families. According to the American Nurses Association (2010), nurses have several responsibilities in caring for dying patients, including discussing life preferences and communicating relevant information. Because communication has been shown to be a cornerstone of improving patients’ quality of care and quality of life (Wittenberg-Lyles, Goldsmith, Ferrell, & Ragan, 2013), the National Consensus Project for Quality Palliative Care (2013) has emphasized the need for effective, compassionate communication in palliative care. Nurses have reported that merely learning communication skills on the job is not enough (Humphris, 2002), suggesting the need for formalized training. To address this need, a variety of interventions to improve nurses’ communication skills and efficacy has been developed. The majority of communication skills training (CST) has been effective at increasing nurses’ abilities to provide psychosocial support to patients, their confidence in handling conflicts and criticism, and communication-related self-efficacy (Langewitz et al., 2010; Sheldon, 2011; van Weert, Jansen, Spreeuwenberg, van Dulmen, & Bensing, 2011; Wilkinson, Linsell, Perry, & Blanchard, 2008). Most CST developed for nurses has focused on general communication, with participants focusing on how to have difficult conversations and break bad news (Baer & Weinstein, 2013). Because of the prevalence of nurses present at the end of life (Wiegand & Russo, 2013) and their increased involvement in end-of-life care discussions (Institute of Medicine, 2010), developing CST modules for nurses that specifically target end-of-life care discussions is critical. To address this key need, the researchers adapted and modified a physician end-of-life care module for oncology nurses that already had been developed and evaluated by the researchers’ institution. In this adapted CST module, the researchers were able to incorporate the communication differences inherent in the nurse–patient relationship and the communication skills necessary to that relationship. The primary aim of this article is to discuss the content and adaptation of the CST module. The secondary aim of this article is to evaluate the module by reporting the results on pilot self-report data on nurses’ confidence in discussing death and dying, their intention to use the skills they learned in training, and their overall satisfaction with the module.