DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1 ST YEAR IM RESIDENTS Carissa Pereda

1. DELIVERING BAD NEWS: COMMUNICATION STYLES AMONG 1ST YEAR IM RESIDENTS Carissa Pereda Internal Medicine R3

3. End-of-life Communication: Problems and Importance • Patients report poor clinician-patient communication as primary concern1 2 • Trainees report being uncomfortable and untrained in end of life communication • Trainees’ self-reported competence not associated with patient/family assessments • Trainees benefit from experiential trainings

4. Improving Clinician Communication Skills Study • Design: RCT of interdisciplinary communication intervention– “CodeTalk”1 • Goal: to improve end-of-life communication skills among MD, NP trainees • Curriculum: experiential, adult learning • Communication strategies (SPIKES, NURSE) • Practice with simulated patients • Evaluation: • Outcomes: Patient, family, clinician surveys of trainee communication skills • Process: Pre- and post- intervention audiorecordings of trainees with standardized patients 1Curtis et al.

5. Study Goal: What Do Trainees Do? • How do trainees respond to patients, prior to workshop training? • Recognizing diversity of communication styles • Identifying/describing these styles/techniques • Reproducibility with existing data? • Standardized patient interviews with required behaviors or “triggers” • “I have to tell you, I’m really scared” • “Is there any hope for a cure”

6. Methods and Materials • Sample: pre-intervention audiotapes (n=173) • MUSC, n=60; UW, n= 113 • Trainees: 1st year IM residents • Random selection of 50 pre-intervention recordings • Standardized patient interviews • “Cathy” with recurrent ovarian cancer • “Thomas” with recurrent colon cancer

7. Interviews • Resident task: Deliver results of a CT scan: • Recurrent cancer (colon and ovarian) with metastases • Patient task: Stay in character! • Provide 3 behaviors at any point during the interview • 20 second silence post bad news • “I have to tell you, I’m really scared” • “Is there any hope for a cure”

8. Analysis • Goals: • Identify and describe communication techniques utilized by residents in response to target statements • Develop a framework of “codes” to describe/evaluate communication techniques • Methods: • Team (n=3) established codes from 5 audios • Single investigator coded and compared subset of audiotapes to assess trustworthiness (n=25) • Trainees review subset (n=5-10) for validity

9. CODEBOOK

10. Is there any hope for a cure? • I can’t be a 100%. Right now it looks like your disease would actually be classified as stage 4. I don’t know if you know the stages of cancer, but stage 4 would be the end stage, meaning that it has spread from the colon to another part of the body. • I can’t really answer that question. I wish I could. I think it’s better if you talk to the oncologist. If they could offer you surgery, maybe there’s a small chance for a cure. I can’t comment on exactly what your prognosis is going to be.

11. I have to tell you, I’m really scared. • Tell me more about that. What is making you feel scared? • That’s very understandable. It is normal to be scared.

12. “The single biggest problem with communication is the illusion that it has taken place.” -George Shaw MANY THANKS: -Research Team -Randy Curtis -Ruth Engelberg -Erin Kross -GOOGLE images -Invaluable mountain of prior research