Provider Communication Skill Training

To assess the impact of communication skills training programs on changes in patients’ and relatives’ anxiety following a three-person consultation

Prior to a three-person consultation (physician/patient/caregiver), physicians who had earlier completed a basic training program were randomly assigned to complete a consolidation workshop or to a wait-list for the workshop. To gain study data, patients and relatives completed an anxiety questionnaire and a physiologic distress questionnaire (depression and anxiety) the week before and repeated the anxiety questionnaire one week after the three-person consultation. Physicians chose patients with cancer and their accompanying relatives for an audiotaped consultation. Transcription of the consultations occurred to allow a measurement of quality of consultations. Trained psychologists assessed physician skills in assessment, information, and supportive skills according to a French national rating system used in three previous studies.

• The sample was comprised of 56 physicians and 56 patient/relative pairs (27 with physician basic training and consolidated workshops; 29 with physician basic training but no workshops).
• Mean physician age was 42.6 years, mean patient age was 61.2 years, and mean relative age was 58.3 years.
• No statistically significant difference was found between patient and relative groups receiving consultation from a physician with basic training or basic training with consolidation workshops.
• Females represented 24 physicians (43%), 32 patients (57%), and 30 relatives (54%); males represented 32 physicians (57%), 24 patients (43%), and 26 relatives (46%).
• Patients needed to have a cancer diagnosis to be included in the study. No identification of stage or type of cancer was given.
• Physicians had to be specialty (cancer) doctors, work either full- or part-time, and have completed the basic training program.
• Patients and relatives needed to speak French, be older than age 18, have no cognitive dysfunction, and provide informed consent.

• Inpatient setting (inferred)
• Brussels, Belgium

A pre/post-test design was used.

• Hospital Anxiety and Depression Scale (HADS): Used to assess the patient’s anxiety and depression the week before the consultation. HADS contains 14 self-report items, each scaled on a one to four value. The instrument was translated into French and validated in a sample of French patients, but no reliability or validity statistics appeared in the article.
• State Trait Anxiety Inventory–State (STAI-S): Used to measure anxiety of the relative and the patient before and after the three-person consultation. STAI-S contains 20 items and four response options to yield scores between 20 and 80. The instrument was translated into French and validated, but no reliability and validity indices appeared in the article.
• Patients and relatives completed a sociodemographic data tool preconsultation.
• Doctors completed a sociodemographic and socioprofessional questionnaire preconsultation.

No statistically significant differences were found between patients’ and relatives’ sociodemographic characteristics and disease and over time with basic training consultation and the basic training added to the consolidation workshops. A multivariate analysis of variance assessment showed significant change between time in changes in patients’ anxiety following the three-person consultation (p = 0.027). Although anxiety decreased for both patients and relatives following the consultation, none of these changes was significant. There were no significant correlations between changes in patients’ and relatives’ anxiety and physician assessment, information, and supportive skills. In further analyses (mixed-effects modeling), physician communication skills had no influence on changes in patients and relatives following a three-person consultation. Only contextual variables (e.g., type of bad news, type of information transmitted by physicians and self-reported before the consultation) had an effect on changes in anxiety and distress.

The physician training program described did not diminish patient or relative anxiety about cancer following the consultation.

• The sample was small, with less than 100 participants.
• The study had a heterogeneous nature of the types of consultations.
• Physicians chose the patients to be studied.

The concept of nurse/patient/caregiver conversations as part of routine nursing care seems appropriate in the U.S. healthcare system that seeks to increase primary care. Although relatives’ and patients’ needs may vary, nurses have strong assessment, information-gathering, and supportive skills to promote health and coping of patients, caregiver relatives, and families either in group formats or individual forums.