Provider communication skill training is an approach in which the healthcare professional who provides services to the patient is trained to improve communication skills. Improved communication with the patient is proposed to have a positive effect on the patient’s symptoms and outcomes. Improved provider communication skills may improve assessment of the patient and the provider’s ability to facilitate effective communication by the patient, thereby enhancing symptom management. The effect of communication skill training to providers in cancer care has been examined for its effect on patient anxiety and depression and on caregiver strain and burden.
Moore, P.M., Rivera Mercado, S., Grez Artigues, M., & Lawrie, T.A. (2013). Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database of Systematic Reviews, 2013(3).
Two studies evaluated patient anxiety using the Spielberger State-Trait Anxiety Inventory. Anxiety declined in both study groups, but the reduction in anxiety was significantly greater in the control group (n = 169, SMD = .4, p = .02). Other results of training explored were sensitivity of communications, display of empathy, patient trust, quality of life, and patient recall of information, distress, and satisfaction. One study showed no impact on patient depression.
Provider communication skill training was not shown to have a positive effect on patients' level of anxiety or depression. Physician training was more likely to result in communications showing empathy.
Type, duration, and timing of training interventions were very diverse, making the synthesis of findings difficult. Similarly, the timing of study follow-up assessments varied. For the individual outcomes examined, the number of available studies was small.
Communication skill training is likely to improve some communication skills of providers, but evidence regarding any impact of this on patient outcomes is lacking, and long-term effects are unknown. The most effective training method also is unclear. Given the current emphasis on shared decision-making and patient-centered care, the importance of provider communication and information-giving skills is evident. The content of training should be aimed at achieving these aspects and empowering patients. Further research is needed to determine the best approaches to achieve these goals.
Fukui, S., Ogawa, K., Ohtsuka, M., & Fukui, N. (2008). A randomized study assessing the efficacy of communication skill training on patients' psychologic distress and coping: Nurses' communication with patients just after being diagnosed with cancer. Cancer, 113, 1462–1470.
To investigate whether a communication skill training program for nurses would reduce psychological distress and improve coping among patients newly diagnosed with cancer
The communication skill training (CST) program involved two workshops, one at the start of the study and the other after three months. Workshops lasted six hours and were structured in a six-step approach (SPIKES) involving (1) setting up the interview, (2) assessing the patient’s perception of his or her illness, (3) obtaining a patient invitation to disclose information, (4) giving information and knowledge to the patient, (5) addressing the patient's emotion with empathic responses, and (6) strategy and summary. The program involved a large group meeting on theoretic content followed by small facilitated group work in which nurses worked through various scenarios using the SPIKES steps. Study patients were randomly assigned to be interviewed three times by nurses who attended the CST program (experimental group) or interviewed the same three times by nurses in the control group. Interviews were scheduled on the day of diagnosis, and one week and one month after diagnosis. Study measurements were done at one week after diagnosis (T1), one month after diagnosis (T2), and three months after (T3). Nurses were randomly assigned to either CST or usual care provision.
Patients were undergoing the diagnostic phase of care.
A randomized controlled trial design was used.
There was a significant different in HADS depression and total scores over time associated with group (p = 0.03). These scores declined over time in both groups; however, the decline was greater for the experimental group. There was no group interaction or for anxiety. There were no significant changes in any other HADS data. MAC score changes over time showed mixed results. The only consistent directional change in the experimental group, as compared to the control group, was in the area of fatalism, with decline over time in the experimental group and increase over time in the control group (p = 0.04).
CST appears to have a positive effect on psychological distress and some areas of coping for patients newly diagnosed with cancer.
Study findings support the idea that providing information, support, and empathic responses to patients can positively influence patient coping and emotional distress, and suggest that nurse training in communication skills of this nature can be useful. Further research in this area needs to demonstrate actual differences in communications between nurses and patients as a result of such training. It would be useful to see if such training can be beneficial in various groups of nurses based on differences in nursing education level and experience.
Morasso, G., Caruso, A., Belbusti, V., Carucci, T., Chiorri, C., Clavarezza, V., . . . Di Leo, S. (2015). Improving physicians' communication skills and reducing cancer patients' anxiety: A quasi-experimental study. Tumori, 101, 131–137.
To determine the effectiveness of a physician-centered communication skills training program on anxiety levels in patients with cancer. A three-phrase, multicenter, quasi-experimental study was used.
The intervention phase of the study invited physician participants in the treatment group to attend a skills program to improve communications knowledge and strategies. The intent of the communications training was to improve communication with patients with cancer and families. The training sessions, taught by psycho-oncologists, were held at each study center and were scheduled in three-hour sessions for three weeks to total nine hours of training. Each physician participant was emailed relevant scientific papers (two published, one unpublished) five days in advance of each three-hour session. The treatment group physician participants were asked to read the materials in preparation for sharing during the training. Each session included didactic, experiential learning, and group discussion including clinical cases and role play. There was no communications training for physician participants from the control group.
Multi-center, quasi-experimental, three-phase study. Of note, the phases of the study, as described, are not phases as used in North American scientific study. Rather, they are components of the methodology. Specifically, the authors describe phase 1 as recruitment, phase 2 as intervention, and phase 3 is evaluation.
Suggestion of effectiveness of a communication skills training program with reference to patient anxiety levels. Further research needed.
Implications were difficult to ascertain because the intervention was physician-based. The authors indicated a need to explore if nurse training in communication would be beneficial. Also discussed was the difference in communication styles between oncologists and oncology nurses and the effect on anxiety.