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 older patients.
Research Results
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.
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.
Project Team
Principal Investigator:
James Downar, MDCM, MHSc, FRCPC — Toronto General Hospital, University Health Network
Co-Investigators:
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 — james.downar@utoronto.ca
CAT 2013-18
Key words: health communication; empathy; patient care planning; data collection; questionnaires; pilot projects
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.
Project Contact: Dr. James Downar — james.downar@utoronto.ca
Key Findings for Families
- Most doctors had at least one assessment from a patient during their shifts on the medical ward
- Patients reported high satisfaction with communication
- Most patients said they would feel comfortable giving honest and even negative feedback using this method
This study showed that real-time collection of patient-report measures can be done and can help patients to communicate with their doctor.
Why This Matters
- Communication by health professionals is not always ideal. Communication is important to understand what the patient wants and needs – this can improve the patients’ satisfaction with the care and the quality of the care received
- Measuring communication during a hospital stay is not usually done because it can be difficult
About This Study
- A tablet-based platform was created to collect information about patients’ satisfaction with communication and empathy
- Patients admitted to hospital at risk of death in the coming six months, who had discussed goals of care with their doctor, were included
- The tool was used to collect anonymous feedback about the communication skills of doctors, and was given to the doctor
Key Findings for Researchers
- 50% of participating physicians had at least one assessment from a patient during their rotation on the medical ward
- Patients reported high mean scores on satisfaction with communication questionnaires
- Most patients said they would feel comfortable giving honest and even negative feedback using this method
This study showed that real-time collection of patient-report measures is feasible and can have broad applicability to audit and feedback of patient-reported measures.
- This could be applied to any assessment and feedback process involving inpatients, including quality improvement projects that affect the patient experience
Why This Study was Needed
Effective communication, especially during end-of-life care, is important for improved patient satisfaction and to improve the quality of care delivered. Training physicians and trainees to improve their communication skills has been done, but measuring the impact of this training at the patient level is challenging. This study tested a method of measuring the effectiveness of communication training, and can also be used for other aspects of communication assessment and feedback.
How This Study Addresses the Gap
- A tablet-based platform was developed to collect patient data about satisfaction with physician communication and empathy
- Patients admitted to hospital at risk of mortality in the coming six months, who had discussed goals of care or resuscitation with their care providers were included
- The tool was used to collect de-identified feedback about the communication skill of physicians, and was then fed back to the physician
- Our primary objectives were to test the feasibility of (1) collecting real-time patient-level measures of communication and empathy in an inpatient setting; (2) linking this to an interaction with a specific trainee (as opposed to the healthcare team as a whole); and (3) aggregating, de-identifying and feeding back patient responses to specific trainees to guide their future interactions
Future Research
Further studies looking at broader applicability of this platform and method are needed, in order to investigate the scale of this platform and method of patient-reported data collection.
Rationale: Patient-level outcomes are a key focus in quality improvement, and are highly desirable as translational outcomes for medical education. However, they are challenging and costly to collect, particularly in real time for seriously ill and frail elderly patients. We conducted a pilot study to determine the feasibility of using an electronic platform to collect patient-level data about communication skill and empathy for individual trainees, and feed this data back to the trainees to guide their own learning.
Research Plan: Two-site pilot study of an electronic data collection and feedback tool. We enrolled seriously ill and frail elderly inpatients or their family members who had discussed goals of care with a medical trainee in the previous 72 hours. Consenting patients or family members completed the Communication and Relational Empathy (CARE) and the Canadian Health Care Evaluation Project (CANHELP Lite) surveys on a tablet computer. This data was aggregated, de-identified and fed back to trainees who consented to participate. Patients, family members and trainees were surveyed for their experience with the platform.
CFN Webinar (June 15, 2016): Decision-making and communication tools for hospitalized patients (DECIDE-2-COMMUNICATE)