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Objectives To evaluate the effectiveness of the Blended Communication Skills Training Program for Nurses (CSTN). The program aims to improve nurses’ knowledge about communication skills and structure for interactions with individuals who a have life limiting illness. Methods This was a quasi-experimental study using a pre- and post-test quiz and self-efficacy questionnaire undertaken in Victoria, Australia. Nurses employed across three wards participated. The Blended CSTN comprised two major components: Asynchronous Web-Based Education Program and Experiential Workshop. The program focused on specific communication challenges: Gathering Information, Dealing with Difficult Questions, and Articulating Empathy. The primary outcome was improvement in knowledge of communication skills and structure. Self-efficacy and perceived importance of communication skills were assessed as secondary outcomes. Results Eighteen nurses completed both Web-Based and Workshop components. Statistically significant increases in knowledge regarding communication skills and structure were found, with a large effect size for Gathering Information (r=0.80) and moderate effect for Articulating Empathy (r=0.62), and Responding to Difficult Questions (r=0.532). Self-efficacy significantly increased for all measured communication skills. Conclusions Knowledge improvements and perceived self-efficacy in communication were observed after nurses participated in a blended education program Practice implications A blended CSTN may improve nurse-patient communication in the clinical setting, worthy of further study.

Communication skills is a core competency for critical care fellowship training. The coronavirus disease (COVID-19) pandemic has made it increasingly difficult to teach these skills in graduate medical education. We developed and implemented a novel, hybrid version of the Critical Care Communication (C3) skills with virtual and in-person components for pulmonary and critical care fellows.To develop and implement a new hybrid virtual/in-person version of the traditional C3 serious illness communication skills course and to compare learner outcomes to prior courses.We modified the C3 course in 2020 in response to the COVID-19 pandemic by adapting large-group didactic content to an online format that included both virtual asynchronous and virtual live content. Small-group skills training remained in person with trained actors and facilitators. We administered self-assessments to the participants and compared with historical data from the traditional in-person courses beginning in 2012. After the 2020 course, we collected informal feedback from a portion of the learners.Like the traditional in-person version, participants rated the hybrid version highly. Learners reported feeling well prepared or very well prepared over 90% of the time in most communication skills after both versions of the course. Over 90% of participants in both versions of the course rated the specific course components as effective or very effective. Feedback from the learners indicates that they prefer the virtual didactics over traditional in-person didactics.Pulmonary and critical care fellows rated a hybrid version of a communication skills training similarly to the traditional in-person version of the course. We have provided a scaffolding on how to implement such a course. We anticipate some of the virtual components of this training will outlive the current pandemic based on learner feedback.

Context Communities of Practice (CoP) can help geographically separated individuals who share a joint enterprise, mutual engagement, and a repertoire of tools to gain, maintain, and implement new skills, including serious illness communication. Objectives To investigate the health system uptake, implementation and outcomes of the Serious Illness Community of Practice (SICoP). Methods Participants included members of the online SICoP, including participants from all 50 states in the United States and 44 countries, interested in implementation of the Serious Illness Care Program. Yearly surveys asked members about their program's composition, completed trainings, number of serious illness conversations, and utilization of the online SICoP tools and resources. Results Over four years, membership in the SICoP increased from 429 to 1,912, with an estimated 17,785 clinicians trained and 38,945 serious illness conversations conducted. Members have continued to utilize and modify the SICoP resources. Conclusions Utilizing a CoP has contributed to improving the health care system implementation and process outcomes of serious illness communication training. Key Message This article describes the implementation and health system outcomes of a Community of Practice developed to support serious illness communication. The results indicate that the membership of the community grew and that the community supported growth in the number of trained clinicians and the number of serious illness conversations conducted.

Objective Simulated and standardized patients (SPs) are increasingly being used in communication skills training for healthcare professionals' education. Despite this broad use of SPs, there is no recent literature with an overview on SP working formats being used. We ran a study to fill this gap. Methods First, a survey on formats on the use of SPs in various curricula for education of healthcare professionals in Belgium and The Netherlands was run by members of the Dutch Association of Medical Education Special Interest Group on Simulated and Standardized patients (SIG-NL/B). Then the SIG-NL/B organized a national workshop where professionals working with or interested in SPs were invited to come forward with SP working formats they used. They were also asked to provide relevant details about the use. Finally, the outcomes of these two phases were combined. Results Fifteen SP working formats were found. Six of them were described before. The details of all formats are listed and discussed. Conclusion We categorised 15 SP working formats. The choice to use a particular format is mainly based on the learning objectives of the session involved and the expertise at hand.

Objectives In Austria a national train-the-trainer programme (TTT) has been developed, implemented and evaluated with the aim of training and certifying participants for developing, implementing and delivering communication skills training (CST) for health professionals. Methods The programme included 5 in-person courses, application homework with feedback, peer work, and regular trainer network meetings. Global satisfaction with training and changes in self-efficacy among TTT-participants and their learners in the CST delivered as practice projects were evaluated. Results 18 participants have graduated from the TTT-pilot. 98 people took part in the 9 CST delivered by TTT-participants. Participants’ satisfaction has been rated very positively both for TTT and CST. At post-programme/post-training, statistically significant improvement was observed in self-efficacy for the TTT-participants and for the CST-participants. Additionally, valuable suggestions for programme/training improvement were identified. Conclusions This programme is an important step to sustainably improving CST in Austria. To guarantee high quality and consistency, a set of standards for certification have been developed for TTT and CST. Practice implications Implementation of best practices in training trainers and communication skills teaching can be guided by a structured approach. Those wanting to implement similar programmes can benefit from strengths and suggestions for improvement identified in this national project.

Background Spirituality is a fundamental dimension of our human nature that impacts on medical care and yet is relatively neglected by medical education courses in Australia. Aim This systematic review was conducted to assess the curriculum content currently used to develop medical student understanding of, and engagement with, spirituality in the context of patient care. Methods Studies published in English from 2010 to the review date were included in order to focus on the most recent curricula. Studies included medical students in undergraduate or postgraduate programs, doctors in resident training programs, and registrars. Interventions considered for inclusion were curriculum modules on communication skills in spirituality, spiritual needs assessments and holistic care planning. Six databases including PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched electronically using the following keywords and MeSH search terms:- 'medical students', 'doctor', 'physician', 'spirituality', 'spiritual care', 'religion', 'education', 'history taking' and 'communication skills training' from 2010 to 2020. Results For 342 articles, three researchers screened the titles and abstracts; disagreements were resolved by discussion. Full-text articles were assessed for eligibility based on study and report characteristics: 17 papers were included in the analysis. Curriculum content of each study was reviewed. The following key features were employed frequently: chaplain shadowing, communications skills training, self-reflection, examining evidence and relationship building. Conclusion This review has determined the core content, aims and objectives to guide construction of spirituality curricula in Australian medical education. This article is protected by copyright. All rights reserved.

Objectives Most practicing health professionals lack communication skills training (CST). Increasingly health care systems have implemented CST programs, mainly through single workshops which are limited in creating meaningful change in communication behaviors in practice. This paper describes a provider CST program which includes coaching to reinforce skills learned in CST workshops. Method In 2017, a pilot CST workshop was implemented in a large Midwestern US health system. In 2018, a modified program was launched for all physicians, physician assistants and advanced practice nurses and included in-person clinical coaching for each provider 30- and 60-days post-workshop. Evaluation measures included pre and post-program aggregate patient satisfaction scores and coaching evaluation surveys. Results 248 providers completed the workshop plus coaching program between October 2018 – March 2020. Aggregated patient satisfaction Top Box ratings increased from 73.9% to 75.1% following the pilot and to 79.5% following workshop plus coaching. Participants rated coaching positively and reported more confidence in using the workshop skills in clinical practice. Conclusion Our data show that coaching can help facilitate and reinforce skills learned in CST workshops and can lead to improvements in patient satisfaction scores. Practical implications Incorporating coaching as part of CST can help facilitate meaningful skills transfer.

ComPsych communication skills training is designed to teach psychiatry trainees effective skills and strategies for undertaking key communication tasks relating to mental illness, such as schizophrenia, with patients and their families/carers. This study examined the program’s feasibility, utility, and trainees’ self-efficacy. Trainee cohorts attending their first year formal education course were recruited annually over 4 years between 2015 and 2018. Each trainee attended at least one session of training in their cohort year. Trainees completed a questionnaire presenting questions about personal demographics, their perceived confidence in communication, and the effectiveness of elements of training delivery. A total of 41 trainee psychiatrists (15 male) completed the questionnaires presented at four time points (two pre-training and two post-training). Participants reported a significant increase in confidence in their own communication skills post-training (d = 1.12) and rated elements of training delivery (video feedback, feedback from peers in small groups, small group facilitation, and use of simulated patients) as significantly more helpful or effective post-training (d = 0.42). Trainees also reported a significantly increased ability to critically evaluate their own communication skills post-training (d = 0.59), suggesting an increased ability to recognize their own communication skill competence. Following ComPsych training, trainees were more confident discussing information about schizophrenia with patients and their families/carers and were more able to critically evaluate their own communication skills: an important feature of good clinical acumen. These subjective ratings provide important self-efficacy information, including the benefits perceived and evidence of the program’s feasibility and utility.

Background: VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. Objectives: To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. Setting/Subjects: We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. Measurements: To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. Results: All learners (n = 48, male 79%) participated in the survey. The mean score of the learners’ satisfaction was 4.69 or higher in all questions. The mean score of the virtual format’s satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). Conclusion: Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.

Background: Nurses are the most precious assets of any health-care institution, thus it's critical to understand their behavior. In this regard, the present study was carried out in order to examine the effect of communication skills training program for head nurses on interpersonal relations and nurses' organizational commitment. This study was carried out at Zagazig University Hospitals, using quasi experimental design. A convenience sample of 50 head nurses and simple random sample of 221 staff nurse from the previously mentioned setting. Tools: A questionnaire sheet was used to collect data for this study that was composed of three parts; Organization Communication Questionnaire, Fundamental interpersonal relation orientation - behavior questionnaires and organizational commitment scale. Results revealed that there was significant improvement in head nurses' communication skills mean score after the program implementation (P < 0.01). As well, there was statistically significant enhancement in their interpersonal relations with nurses mean score (P < 0.01). Additionally, there was a statistically significant improvement in nurses' organizational commitment after the program implementation (P < 0.01). Conclusion: communication skills training program for head nurses is effective in improving interpersonal relations and commitment of their nurses. Recommendation: hospital administration should establish training activities to offer nurses with key skills such as active listening, accurate feedback, and problem-solving techniques.

Although multiple consensus statements have called for large-scale efforts to improve clinicians' communication skills regarding a variety of difficult conversations in medicine, this goal will be difficult to attain because there are no readily scalable, validated communication skills training programs for clinicians. However, novel applications of existing technologies and approaches grounded in learning science can overcome the scalability barriers. Moreover, future advances in virtual reality and artificial intelligence are likely to greatly enhance the possibilities for communication skills training programs. The purpose of this paper is to propose a scalable, theoretically grounded method to train clinicians in advanced communication skills in medicine. First, we summarize four key principles of adult learning relevant to communication skills training in medicine. Second, we discuss recommended practices to design effective technology-enhanced educational interventions, with an emphasis on achieving high amounts of user engagement. Third, we synthesize these principles into a framework for a web- and videoconference-based platform for teaching advanced communication skills in medicine. Once developed, this low-cost, scalable training platform has the potential to allow thousands of clinicians to acquire the advanced communication skills needed for difficult conversations in medicine.

Due to the prevalence of distress following a cancer diagnosis, routine symptom and distress screening is recommended as best practice. RTs perceive psychosocial support and screening to be part of their role, however feel they lack the education and skills to perform this confidently. The study aimed to evaluate the impact of providing communication skills training (RT Prepare CST) on the perceived barriers, knowledge, attitude, role, and confidence of radiation therapists (RTs) in using routine symptom and distress screening.A single-arm, pre-post intervention design was implemented. All RTs at one regional and one rural centre participated in RT Prepare CST. RTs completed a questionnaire: pre-intervention (T1); immediately post-intervention (T2); and, three months post-intervention (T3). Cochran's Q and McNemar's tests for non-parametric data were conducted to compare outcomes over time.Of 39 RTs approached, 37 (95%) consented to participate with 36 (92%) completing questionnaires at all three time points. Significant and sustained improvements post-intervention were noted from T1-T3 including: confidence in describing the PROMPT-Care tool to patients (p=0.002), discussing psychosocial issues (p=0.014); recognising signs of anxiety/depression (p0.001); dealing with signs of anxiety (p=0.002), depression (p=0.015) and distress (p=0.008) as well as agreeing 'the tool is useful in identifying psychosocial problems' (p=0.029).RT Prepare CST was effective in increasing confidence, knowledge and attitudes of RTs in the psychosocial care of patients with a change in RT behaviour noted by a significant increase in the number of patients screened following the intervention. Providing routine CST and emotional cues training to RTs enhances their ability to care for patients holistically, equipping them with skills to be included within a psychosocial model of care. Engaged leadership and role models are essential to sustain the learnings from education programs and provide an environment to discuss and define roles within radiation therapy departments.

CONTEXT: High quality communication is essential to older adults’ medical decision-making, quality of life, and adjustment to serious illness. Studies have demonstrated that Geritalk, a two day (16 hours total) in-person communication skills training improves self-assessed preparedness, skill acquisition, and sustained practice of communication skills. Due to the COVID-19 pandemic, Geritalk was adapted to a virtual format (4 days, 10 hours total). OBJECTIVES: Our study evaluated the change in participants’ self-assessed preparedness for serious illness communication before and after the virtual course and satisfaction with the course, and compared these findings to responses from a prior in-person Geritalk course. METHODS: Geriatrics and Palliative Medicine fellows at three urban academic medical centers completed surveys, which employed 5-point Likert scales, before and after the virtual course to assess satisfaction with the course and preparedness for serious illness communication. RESULTS: Of the 20 virtual Geritalk participants, 17 (85%) completed the pre-course assessment, and 14 (70%) completed the post-course assessment. Overall, satisfaction with the course was high (mean 4.9 on a 5‐point scale). Compared to in-person Geritalk participants, virtual course participants reported comparable and significant (p

This study aimed to provide an updated and comprehensive review of the efficacy of psychosocial interventions for the employability of individuals with autism spectrum disorder (ASD). Ten studies (423 participants) were identified in the literature. Compared to control groups, the proportion of those who could work was significantly higher among those who had participated in employment support programs and higher, but not significantly, among those who had received communication skills training. The communication skills training group had an improved communication score on employment. This systematic review showed that psychosocial interventions could increase the number of individuals with ASD who are employable and improve their communication skills for employment.

Objective Test whether a single e-learning session can improve empathy and communication across pre-registration and postgraduate physiotherapy students. Methods Design: Two-phase sequential mixed methods study. Phase 1: Pilot randomised control trial. Phase 2: Qualitative study using interpretive phenomenological analysis. Sampling: A purposive sample for both phases. Outcome measures: Phase 1: At baseline, post and 6-week follow up. Demographics. Primary outcome: Inter-personal Reactivity Index (IRI). Phase 2: Demographics and interview schedule. Intervention: An e-learning (E) narrative intervention group or active control condition. Analysis: Phase 1: Descriptive statistics and confidence intervals. Mann-Whitney U test to compare across group change. Phase 2: Thematic analysis. Results Thirty-nine participants took part in the mixed methods study (Phase 1 n = 25; Phase 2 n = 14). Phase 1: No significant differences between groups were identified. Potentially importance changes across time were found for the intervention group and control group. Phase 2 results identified 5 themes and 12 sub-themes. Conclusion The e-learning groups identified an increase in the perceived ability to handle distressing communication. Other important findings from the e-learning are discussed. Further research is warranted. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

Objective: Communication Skills via Health Literacy (CSvHL) was a pilot elective communication skills training (CST) course, which allowed preclinical medical students to gain communication competence through the experience of being a health educator for high school students (HSSs). The efficacy of CSvHL was explored. Materials and Methods: All 10 medical students were prepared for their HSS-health-educator roles by participating in several observation sessions at an outpatient department and via communication workshops. In-field health education courses were subsequently delivered to HSSs by the medical students. Developments of the medical students’ communication skills were fostered through loops of learning activities and regular feedbacks. Assessments of the pre- and post-CSvHL communication skill levels by means of an OSCE, with adapted ComON Check were evaluated by each medical student, a standardized patient, and three medical instructors. Results: In general, the overall and category-specific average ComON Check scores of the whole class were significantly improved after the CSvHL course. The 3 communication defects with the lowest scores in the pre-CSvHL assessments were subsection division, summarization, and comprehension-check while counseling. Conclusion: CSvHL was successfully established as a preclinical-year CST course. The improvements in the ComON Check scores reflected the transformative learning gained from the hands-on experience, individualized CST, and 360° feedback OSCE for communication skill assessment.

Introduction: Little is known about Australian podiatry students’ preparedness for clinical placement and graduates’ preparedness for clinical practice. This qualitative study explored clinical supervisors’ perceptions of podiatry students’ and graduates’ preparedness-related challenges and their recommendations for improvement. Methods: Eleven registered podiatrists who had supervised or were still supervising students were interviewed. Transcribed interviews were thematically analysed. Benner’s (1984) stages of clinical competence from novice to expert informed the study. Results: Clinical supervisors were divided about students’ preparedness for clinical placements, with their perceptions ranging from generally prepared (n = 2) to unsure (n = 5) to unprepared (n = 4). They commented on junior versus senior students, institutional differences and specific clinical skill deficiencies, e.g., scalpel debridement and patient communication skills. Perceived challenges for students on placement included poorly developed clinical skills and low self-efficacy, both stemming primarily from insufficient hands-on experience. Participants suggested that for improved placement preparedness, students required better quality clinical experiences and communication skills training. Being work-ready, which most graduating Australian podiatrists were reported to be, involved being safe and self-efficacious. Participants also suggested that a supportive clinical environment, an internship and more advanced interpersonal skills would facilitate preparedness. Conclusion: In terms of Benner’s (1984) framework, during training, podiatry students should be considered novices, and they should be considered advanced beginners on graduation. An entry-level graduate should not be expected to be competent across all areas of clinical practice. Hands-on clinical practice during placements was needed for moving successfully through Benner’s (1984) stages of clinical competence. While clinical supervisors believed that podiatry training generally prepared students for clinical practice immediately following graduation, they asserted that manual clinical and communication skills improvement is required for clinical placements.

Background Advance care planning (ACP) is an important factor that affects the quality of end-oflife. However, health care providers are not able to sufficiently support patients' ACP due to their lack of knowledge and psychological burden. This study investigated how the knowledge, attitudes, and practices of health care providers who completed a communication skills training (CST) program for ACP discussion changed before and after the course. Methods Health care providers who participated in the Education for Implementing End of Life Discussion (E-FIELD) CST training program in Japan were surveyed at three time points: before, immediately after, and 6 months after training. The number of participants who completed all three surveys was 306. Knowledge, confidence, communication difficulties, number of discussions and completions of ACP were measured using a questionnaire. Results Participants' knowledge and confidence increased right after training compared with before training. The number of ACP discussions and completions increased significantly 6 months after training compared with before training and difficulties tended to decrease. Physicians maintained their confidence, which increased immediately after training until 6 months after training and their number of ACP discussions and completions also increased significantly 6 months after training compared with before training. Conclusions The CST program for ACP, E-FIELD, has the potential to increase the knowledge, confidence, and number of ACP discussions and completions used by physicians, nurses, and social workers, and also lower their difficulties.

Sexual agreements (SAs)—guidelines that outline what type of sexual behaviors are permissible with sexual partners outside of their primary relationship—are often negotiated within same-sex male relationships to reduce their risk for HIV infection. However, HIV risk is not only a function of sexual behavior, but is also affected by factors such as antiretroviral therapy (ART) adherence. We examined whether HIV-positive partners in serodiscordant male couples who have better communication about SAs and report concordant SAs with their partners have greater odds of being adherent to ART to not only improve their health, but to also reduce the risk of transmitting HIV to partners. We analyzed longitudinal data from 135 HIV-positive partners in serodiscordant male couples recruited from Atlanta, GA, Boston, MA, and Chicago, IL to examine the relationship between optimal ART adherence and two independent variables: communication about SAs and if the couples have discrepant SAs. HIV-positive male partners who reported high levels of communication regarding SAs had nearly three times the odds of optimal adherence to ART compared to those who reported lower levels. The HIV-positive partners with discrepant SAs with their male partner had approximately half the odds of optimal adherence to ART compared to those with concordant SAs. Our findings suggest that integrating communication skills training into dyad-level HIV interventions to improve communication regarding HIV may provide more opportunities for couples to discuss ways of reducing the risk of HIV transmission. Couples may benefit from interventions that assist them in composing SAs.

Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication.What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)?Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP.OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P .05], stigma-mitigating skills [t(28) = -3.88; P .001], and breadth of communication skill use [t(28) = -2.91; P .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy.Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.

Medical students who are given opportunities to teach and communicate complex information in an understandable manner will be more effective in educating patients in the future. We provided faculty and near-peer training to medical student facilitators of a community outreach program for middle school students to assess which type of training resulted in better teaching preparedness and confidence. Near-peer–trained students were more confident in their teaching compared to faculty trained counterparts; therefore, there may be some added benefit to peer-delivered/faculty-supervised training for community outreach programs.

The aim of this study was to investigate the effect of emotional communication skills training on emotion regulation, parental self-efficacy and child acceptance in mothers of children with special learning disabilities. The statistical population of this study consisted of all mothers of students with special learning disabilities. Sampling method was accessible in that the participants were selected from mothers of children with learning disabilities who referred to clinics under the supervision of education in Shiraz. Of the 32 selected participants, 15 were assigned to the experimental group and 17 to the control group, randomly. After the pretest, the experimental group was trained in emotional communication skills in ten sessions, while the control group did not receive any specific intervention. Then, post-test was performed for both groups. Garnefski Cognitive Emotion Regulation Questionnaire (CERQ), Dumka Parental Self Agency Measure (PSAM) and Parental Acceptance Questionnaire (PAQ) were used to collect data. The results indicated that the experimental and control groups had significant differences in the variables of cognitive emotion regulation, parental self-efficacy and parental acceptance. In general, the findings supported the effectiveness of emotional-communication regulation skills training on parental characteristics and personality of parents.

Objective (s): The association between self-esteem and the process of mental development of individuals and mental health is well established. In adolescence, the role of parents and their skills in communicating is very sensitive and vital. The purpose of this study was to assess the effect of parentschr('39') communication skills training on the self-esteem of adolescent female students. Methods: This was a quasi-experimental study that conducted in one of the state high schools in Damavand, Iran in 2019. The sample consisted of 77 adolescent girls and their parents who were assigned to two groups: intervention and control. Parents in the intervention group received 16 training sessions in a group pf 10 participants. The control group received nothing. In both groups students completed a self-esteem questionnaire (Cooper-Smith questionnaire) at two points in time: before intervention and three months after the intervention. The data were analyzed by Wilcoxon, Mann-Whitney and analysis of covariance using SPSS22 software. Results: Both groups were similar in most characteristics and at baseline self-esteem score did not differ significantly between two groups (p=0.49). However, after the intervention, there was a significant difference between the experimental and control groups according to analysis of covariance (p=0.001). Conclusion The findings suggest parentschr('39') communication skills training could be effective in improving adolescents’ self-esteem.

Introduction Globally, pharmacy undergraduate programs are evolving to reflect a more patient-centered approach to clinical practice. The importance of teaching communication skills in any undergraduate pharmacy curriculum cannot be overstated. This article compares current literature and practices related to pharmacy services and communication skills training (CST) in pharmacy undergraduate education in the United Kingdom (UK) and Turkey and discusses the need for an urgent change in the CST curriculum in Turkey. Additionally, the article provides potential strategies for improving the quality of CST and for expanding pharmacy practice to ensure students and graduates are motivated to use communication skills. Commentary The traditionally structured curriculum in Turkey, where the basic sciences components are in the early years and clinical experiences in the later years, should be changed into an integrated environment so that CST could be more effectively incorporated. The CST offered at the University of Nottingham could be considered as a framework. Implications To meet patient care and educational needs, the authors have identified three key strategies to develop a change in CST for curriculum planners and policy makers in Turkey.

The promotion of mental health and well-being for the working population is crucial. Several studies have examined the effects of group cognitive-behavioral therapy (CBT)-based interventions on promoting employees’ mental health, but whether their work performance-related factors also improved has not been studied thoroughly. This systematic review was conducted to summarize and synthesize the effectiveness and characteristics of group CBT-based interventions on improving mental health and enhancing work performance-related factors from previous studies. A systematic search of studies published until November 2019 was performed using the Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and MEDLINE. Only ten studies investigated the impact of group CBT-based interventions on both mental health and work performance-related factors in a non-clinical working population using a randomized controlled trial study design. Studies on group CBT-based interventions such as psychosocial skills training and communication skills training were included. Eight studies showed that group CBT-based interventions improved aspects of mental health; ten studies demonstrated that group CBT-based interventions influenced some aspects of work performance-related factors. Overall, the reported effect sizes varied widely, from small to large. This review supports the idea that group CBT-based interventions in a non-clinical working population may partially influence mental health and work performance-related factors. All ten included articles were published after 2015. Additional research on this topic, such as through meta-analysis, is necessary to assess whether group CBT-based intervention is effective for supporting mental health and enhancing work performance-related factors in non-clinical working populations.

Background: Effective communications skills are necessary in each area of life, but of particular importance in the field of nursing. Communication is the process of transmitting thoughts, feelings, and facts It is an essential element of the nurse-patient relationship. Nurses are core in strengthening the health system through effective communication with women which affects their level satisfaction. Aim: to evaluate the effect of infertility clinic nurse communication skills training on women satisfaction. Methods: Research Design: quasi experimental design (pre-post training). Setting: Private infertility center (Elbasma center). Sample: A purposive sample of all nurses working in the previously mentioned center; 20 nurses evaluated by 200 women were recruited for the study. Instruments: Four instruments were used for data collection a) Two interviewing questionnaires b) Communication skills assessment instrument c) Satisfaction assessment instrument. Results: This study revealed that there was a high significant difference at nurses communication skills and women satisfaction scores pre and post the training program. Conclusion: Communication skills training program had high significant effect on improving total communication skills of nurses and women satisfaction scores. Recommendations: On- going education for infertility clinic nurses regarding communication skills and its positive effect on women satisfaction and replication of the study with large sample size to further settings.

Introduction As junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this. Methods Pre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points. Results Pre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life. Conclusions Education around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

This study examined group-delivered behavioral skills training (BST) as a method for preparing special education teacher candidates to demonstrate active listening communication skills. Results indicated that: (a) BST was effective for instruction, (b) all instructional groups maintained communication skills across probes, and (c) participants felt prepared to talk to general education teachers and parents after BST in communication skills. Results offer evidence that BST can be implemented in group settings and can be used to teach communication skills to teacher candidates. Teacher preparers should consider BST as a method for communication skills training in university classrooms as a way to support preservice teachers.

Background Transvaginal ultrasound (TVUS) training opportunities are limited due to its intimate nature; however, TVUS is an important component of early pregnancy assessment. Simulation can bridge this learning gap. Aim To describe and measure the effect of a transvaginal ultrasound simulation programme for obstetric registrars. Materials and methods The transvaginal ultrasound simulation training (TRUSST) curriculum consisted of supported practice using virtual reality transvaginal simulators (ScanTrainer, Medaphor) and communication skills training to assist obstetric registrars in obtaining required competencies to accurately and holistically care for women with early pregnancy complications. Trainee experience of live transvaginal scanning was evaluated with a questionnaire. Programme evaluation was by pre-post self-reported confidence level and objective pre-post training assessment using Objective Structured Assessment of Ultrasound Skills (OSAUS) and modified Royal Australian and New Zealand College of Obstetrics and Gynaecology assessment scores. Quantitative data was compared using paired t tests. Results Fifteen obstetric registrars completed the programme. Numbers of performed live transvaginal ultrasound by trainees were low. Participants reported an increase in confidence level in performing a TVUS following training: mean pre score 1.6/5, mean post score 3/5. Objective assessments improved significantly across both OSAUS and RANZCOG scores following training; mean improvement scores 7.6 points (95% CI 6.2–8.9, p < 0.05) and 32.5 (95% CI 26.4–38.6, p < 0.05) respectively. It was noted that scores for a systematic approach and documentation were most improved: 1.9 (95% CI 1.4–2.5, p < 0.05) and 2.1 (95% CI 1.5–2.7, p < 0.05) respectively. Conclusion The implementation of a simulation-based training curriculum resulted in improved confidence and ability in TVUS scanning, especially with regard to a systematic approach and documentation.

Objective Genetic counselors need advanced communication skills, particularly when discussing tests involving massively parallel sequencing. Increasingly, non-genetic healthcare professionals (HCPs) also need to provide genetic counseling. Communication skills training (CST) may equip HCPs with the required communication skills. This scoping review provides an overview of the content, approach, effectiveness and effective features of CSTs aimed at improving genetic and non-genetic HCPs’ communication skills in providing genetic counseling. Methods Following the PRISMA-ScR statement, four databases were searched for articles. Two researchers independently screened titles and abstracts, and extracted data. When applicable, information on effectiveness and effective features of CST was collated. Results Twenty-three articles were included. Sixteen CSTs targeted non-genetic HCPs, five targeted genetic HCPs and two targeted both. Most CSTs addressed multiple communication behaviors and consisted of role play. CSTs were found to be effective for improving HCPs (mainly self-reported) attitudes and skills. Limited evidence on specific effective features of CST was found. Conclusions There is a clear need for evidence on the effectiveness of CST on improving both HCPs’ communication skills in the context of genetic counseling, and patient outcomes, and its specific effective features. Practice implications Clinical practice could benefit from evidence-based CST for genetic and non-genetic HCPs.

Background: Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news. Materials and Methods: This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t‑test) in SPSS software. Results: The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between‑group difference was statistically significant ( t 59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses’ participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between‑group difference was statistically significant ( t 75,48 = 3.94, p < 0.001). Conclusions: It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.

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.

Funding: This research was funded by Excellent Medical Education Joint ASME/GMC Award 2018 Undergraduate category. Background : Empathy is a cornerstone of patient‐centred care. However, empathy levels among health care professionals and medical students are currently suboptimal. An empathy map is a tool which aids in understanding another person’s perspective. Empathy maps have up until now not been used in a medical education setting. Objective : To assess the attitudes towards, applicability and usefulness of empathy maps as part of medical student’s communication skills training. Methods : Empathy map training was introduced to first‐year medical student communication skills training at two UK‐based medical schools. Twenty‐eight participants in total agreed to be interviewed about their experiences using the empathy map, including sixteen students and twelve patient partners who assisted with communication skills training. Results : Medical students and patient partners perceive value in empathy map training. Medical students stated that the empathy map training impacted on their views of empathy and patient‐centredness by highlighting the importance of patient‐centred care. Medical students and patient partners enjoyed the experience of completing the empathy map and had suggestions for how it could be improved in the future. Conclusions : Empathy maps could provide a cost‐effective way to encourage empathic and patient‐centred care in medical education. Furthermore, there is no reason why empathy maps would not aid in any caring profession. Further research is needed to confirm that empathy maps do increase empathy. Publisher PDF

Background Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient’s preferences and values. Little is known about patients’ experiences of these discussions. Objective This study explored patients’ perspectives of the GOC discussion in the hospital setting. Design An explorative qualitative design was used within a social constructionist framework. Participants Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. Approach Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient’s home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. Key Results Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process. Conclusions Effective communication, and patients’ values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions. Electronic supplementary material The online version of this article (10.1007/s11606-020-06233-y) contains supplementary material, which is available to authorized users.

Background There is widespread agreement about the importance of communication skills training (CST) for healthcare professionals caring for cancer patients. Communication can be effectively learned and improved through specific CST. Existing CSTs have some limitations with regard to transferring the learning to the workplace. The aim of the study is developing, piloting, and preliminarily assessing a CST programme for hospital physicians caring for advanced cancer patients to improve communication competences. Methods This is a Phase 0-I study that follows the Medical Research Council framework; this paper describes the following sections: a literature review on CST, the development of the Teach to Talk training programme (TtT), the development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and the pilot programme. The study was performed at a 900-bed public hospital. The programme was implemented by the Specialized Palliative Care Service. The programme was proposed to 19 physicians from 2 departments. Results The different components of the training course were identified, and a set of quality indicators was developed. The TtT programme was implemented; all the physicians attended the lesson, videos, and role-playing sessions. Only 25% of the physicians participated in the bedside training. It was more challenging to involve Haematology physicians in the programme. Conclusions The programme was completed as established for one of the two departments in which it was piloted. Thus, in spite of the good feedback from the trainees, a re-piloting of a different training program will be developed, considering in particular the bed side component. The program should be tailored on specific communication attitude and believes, probably different between different specialties.

Aims and objectives The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. Background Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. Design An interpretative descriptive method was used. Methods A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub-acute care, and their relatives, were invited to participate. The study was undertaken in one sub-acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio-recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. Conclusions Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. Relevance to clinical practice Clinicians may benefit from systematic dignity-related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated.

Introduction: Family denial of organ donation from deceased donor-eligible patients is a major contributor to the deficit of transplantable organs in the United States. Research Question: Does an evidence-based communication intervention improve deceased organ donor authorization rates from family decision-makers? Design: This implementation and dissemination study used Communicating Effectively about Donation on Organ Procurement Organization professionals responsible for discussing donation and obtaining authorization from family decision-makers. A 14-month, nationwide social marketing campaign generated a sample of 682 requesters, yielding a final analyzable sample of 253 participants. Serving as their own controls, participants spent the first 3 months in a preintervention period, completed the web-based intervention, and progressed to a 3-month postintervention period. Participants completed brief online weekly surveys to assess the intervention’s impact on their communication skills. Results: Authorization rates did not improve overall between the pre- and postintervention periods. A differential effect of the intervention on 3 distinct groups of requesters was found: one group exhibited high and stable authorization rates pre–post (78%-74%); a second group had low initial authorization rates that increased after exposure to the intervention (46%-73%); the third had low and variable rates of authorization that failed to improve after the intervention (45%-36%). Conclusion: This study underscores the value of evidence-based communication training. Training targeted to requesters’ skill levels is needed to realize overall improvements in individual performance, the quality of donation discussions, and rates of family decision-maker authorization to solid organ donation.

Purpose To assess Taiwanese nurses' attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients. Design A cross-sectional descriptive design was employed. Methods A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses' needs for promoting culturally competent care. Results Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self-identified as heterosexuals, were married, had more than 10 years' work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities' physical and mental health issues; the populations' social and welfare resources; communication skills training; privacy; and safe space. Conclusions Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities. Clinical relevance This study's results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.

Despite widespread recommendations for involving patient research partners (PRPs), there is little information about how patients have been involved in research. Our aim was to describe and assess the contributions of four PRPs in a project on communication-skills training funded by Deutsche Rheuma-Liga Bundesverband e. V. (German League Against Rheumatism [GLR] is a patient organisation for people with rheumatic and musculoskeletal diseases). The PRPs' participation was beneficial with regards to content and organisation. Thanks to their participation, we could enlarge our sample by over a third, and they contributed their own ideas to the training. Four PRPs added their perspective of various regional organisations. Outside this project, they were also very active within GLR and experienced in managing their rheumatic disease. To achieve more representativeness, future studies might also employ strategies to engage individuals with less experience in dealing with their disease, e.g. newly diagnosed patients. While the collaboration between PRPs and researchers proved very successful, more regular discussions about tasks and responsibilities would be worthwhile.Obwohl die Einbeziehung von Patient*innen als Forschungspartner*innen (FP) in wissenschaftlichen Forschungsprojekten weithin befürwortet wird, gibt es bisher wenig Erfahrungsberichte über die konkrete Umsetzung partizipativer Forschungsprojekte. Dieser Beitrag beschreibt die Mitarbeit von 4 FP im Rahmen eines von der Deutschen Rheuma-Liga Bundesverband e. V. (DRL) geförderten Projekts zur Entwicklung einer Kommunikationsschulung und bewertet die Mitarbeit systematisch. Die Mitwirkung der FP ging mit inhaltlichen und organisatorischen Vorteilen einher: So konnte die Teilnehmerzahl um über ein Drittel erhöht werden. Außerdem ergänzten die FP die im Projekt entwickelte Schulung um eigene Ideen. Die 4 FP brachten ihre Erfahrungen in Bezug auf verschiedene Landesverbände ein. Sie waren unabhängig vom Projekt sehr engagiert in der DRL und hatten viel Vorerfahrung bezüglich des Umgangs mit ihrer jeweiligen rheumatischen Erkrankung. Zur Erreichung einer besseren Repräsentativität sollten künftige Studien versuchen, auch neu erkrankte und somit in Bezug auf das Krankheitsmanagement unerfahrenere Patient*innen zu beteiligen. Obwohl sich die Zusammenarbeit zwischen den FP und den Forschern als sehr erfolgreich erwies, wird ein regelmäßigerer Austausch über Aufgaben und Verantwortlichkeiten als vorteilhaft angesehen.

Patient communication courses are time-intensive, making incorporation into residency curricula challenging. Using a short video could be an efficient means to teach residents communication skills. We created a 4-min animated video focused on the “ask more and summarize technique”. Residents rotating on the inpatient oncology and palliative care service received a video link with a survey (S1) on the tool and its projected utility. A second survey (S2) was sent upon rotation completion to assess the utility of the technique. A 6-month follow up e-mail was sent to determine retention of skills. A total of 52/106 residents responded to S1 and 32/52 to S2. Median age was 28 years and 86% were PGY-1. On S1, 95% enjoyed the format, and 95% thought the narration was an effective learning tool and 90% that the animation was effective. A majority (87%) felt the tool would be useful. On comparing self-reported acquisition of skills for paired survey responses, there was a significant increase in asking more regarding patient questions (p = 0.04) but not summarizing back responses (p = 0.1). This tool was reported to be useful in a variety of settings including explaining prognoses, unrealistic patient expectations, upset patients, and patients with fear or anxiety. A 6-month follow up survey (n = 22) showed that almost all the respondents continued to report using the skills learned. A short video is a brief and effective tool that can be incorporated into a busy clinical curriculum to teach residents communication skills in the areas of cancer and palliative care.

Communication skills training is standardly offered to health professionals working in cancer; however, there is no consensus on the precise style or duration of training, which is most effective. This study aimed to examine the experiences of health professionals who had participated in either a 1-day communication skills training workshop focusing on experiential learning or a 2-h workshop in which participants discussed different communication styles demonstrated on purpose-designed videotapes. Twenty health professionals comprising ten from each workshop type participated in a semi-structured interview with an interpretative descriptive design. Participant characteristics were summarised using descriptive statistics. Thematic analysis was conducted. Consistent themes across both groups were the importance of good communication and perceived barriers. All participants strongly endorsed the value of their respective training experience and considered this was due in part to the skill of facilitators and the creation of a supportive learning environment. Role plays were reported to be helpful in promoting skill development, and some participants in the 2-h workshop indicated that they would have liked the opportunity to practice new skills through role play, which was not possible in the short workshop. Participants self-reported increased confidence following both workshops and perceived improvements in delivery of person-centred care. Both the 1-day and the 2-h communication workshops were a positive experience for the groups who attended. The 1-day communication workshop offered an opportunity for experiential learning, which the 2-h group felt would have been worthwhile; however, both groups found value in attending the workshops.

Background Early integration of palliative care concurrently to standard cancer care is associated with several benefits for patients and their caregivers. However, communication barriers on part of the caring physicians often impede a timely referral to palliative care. This study describes the protocol of the evaluation of a communication skills training aiming to strengthen the ability of physicians to address palliative care related topics adequately and early during disease trajectory. Methods We will implement a communication skills training and evaluate it within a prospective, multi-centered, two-armed randomized controlled trial (RCT), which will be conducted at four sites in Germany. Eligible subjects are all physicians treating patients with advanced cancer in their daily routine. An intervention group (IG) receiving a group training will be compared to a wait-list control group (CG) receiving the training after completion of data collection. At pre- and post-measurement points, participants will conduct videotaped conversations with standardized simulated patients (SP). Primary outcome will be the external rating of communication skills and consulting competencies addressing palliative care related topics. Secondary outcomes on core concepts of palliative care, basic knowledge, attitudes, confidence and self-efficacy will be assessed by standardized questionnaires and self-developed items. A further external assessment of the quality of physician-patient-interaction will be conducted by the SP. Longitudinal quantitative data will be analyzed using covariate-adjusted linear mixed-models. Discussion If the communication skills training proves to be effective, it will provide a feasible intervention to promote an earlier communication of palliative care related topics in the care of advanced cancer patients. This would help to further establish early integration of palliative care as it is recommended by national and international guidelines. Trial registration German Clinical Trials Register DRKS00017025 (date of registration: 4 June 2019).

Background For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians’ communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. Aim and methods We describe the design of a digital CST-tool for information provision skills that meets oncologists’ learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians’ regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. Results Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. Conclusion We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.