DECIsion-making about goals of care for hospitalized medical patiEnts II: a COMMUNICATion intErvention (DECIDE II COMMUNICATE) – Patient Data Collection and Feedback Pilot
The results of this project will be used to inform a future multicentre study (DECIDE II COMMUNICATE), and could be relevant to any researcher looking to evaluate the effectiveness of an intervention using patient-level outcomes among seriously ill and hospitalized elderly patients.
Findings: We enrolled 44 of 88 eligible patients (50%) and 54 of 89 (61%) eligible trainees over the study period. Overall, 50% of participating trainees had at least one assessment from a patient during their rotation on the medical ward, and 25% received more than one patient assessment; 37% of trainees who completed 2 months on the ward received 2 or more assessments, which allowed for aggregated and de-identified feedback. Patients reported high mean scores on the CARE (42 out of 50) and CANHELP Lite (80 out of 100) tools, but the CARE scores were not significantly correlated with the CANHELP Lite scores. Patients reported being very comfortable giving communication feedback about the trainees and all but one reported that they would be comfortable giving negative feedback if appropriate.
Impact of findings: It is feasible to use a tablet-based platform collect real-time patient-level measures of communication and empathy in an inpatient setting, and to link these measures to an interaction with a specific trainee. Patients can assess the communication skill of a trainee independently from their assessment of their overall experience communicating with other members of the healthcare team. It may be feasible to use an electronic platform to reliably aggregate, de-identify and feedback patient survey data to a specific trainee, although there are obstacles to using this approach on clinical teaching units. The platform may be useful to evaluate system-level interventions over a short term, but as a teaching and feedback tool it may only be useful over the long term for trainees who complete two or more months.
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About the Project
The majority of elderly and seriously-ill Canadians prefer to avoid aggressive life-sustaining treatment at the end of life, and remain at home to receive comfort-oriented care. Yet most Canadians die in an institution, often receiving aggressive care that is associated with a poor quality of life. One of the major contributors to unwanted aggressive end-of-life care is the fact that very few patients discuss their wishes with a physician and develop a care plan before they become seriously ill.
In order to improve communication skill and comfort, physicians need to be trained to have these conversations. We have developed effective means of teaching skills and improving physician comfort using simulation workshops and expert feedback, but we have not yet determined whether this training leads to improvements at the patient level. We would like to measure the patient-level effects of communication training, but first we need to demonstrate that our data collection methods are feasible.
In this project, we piloted the collection of patient survey data about satisfaction with physician communication and empathy, to see if we could use this technique to evaluate the effectiveness of a multimodal communication intervention in DECIDE II COMMUNICATE.
For more details on the project rationale and research plan, click here.
James Downar, MDCM, MHSc, FRCPC -- Toronto General Hospital, University Health Network
Amane Abdul-Razzak, MD -- University of Calgary
Stan Hamstra, PhD -- University of Ottawa
Michael Hartwick, MD -- University of Ottawa
Daren Heyland, MD, MSc, FRCPC -- Queen’s University
John C. MacDonald, BSc, MD, CCFP, FRCPC -- University of Ottawa
Jeff Myers, MD, MSEd -- University of Toronto
José Pereira, MBChB, DA, CCFP, MSc(MEd) -- University of Ottawa
Amanda Roze des Ordons, MD -- University of Calgary
Jessica Simon, MD -- University of Calgary
John You, MD, MSc, FRCPC -- McMaster University
Project Contact: Dr. James Downar -- firstname.lastname@example.org
Key words: health communication; empathy; patient care planning; data collection; questionnaires; pilot projects