Wednesday, December 5, 2012

Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology

Communication is an essential component of nephrology care, yet nephrologists receive little training in communication. We developed a communication workshop for nephrology fellows, NephroTalk, to address common communication topics encountered including:  giving a diagnosis; discussing the risks and benefits of treatment options; and addressing end-of-life decision-making, especially in elderly, medically complex patients. Our curriculum, modeled after OncoTalk a successful communication skills program for oncology fellows, was comprised of didactic and practice sessions with simulated patients and nephrology cases.

The workshop consisted of one-half day divided into two sessions. Sessions addressed common communication scenarios in nephrology: delivering bad news and defining goals of care when the patient is doing poorly. For each session, an overview presentation highlighted the skills to be practiced including a faculty demonstration of the skills. After each overview presentation, fellows were divided into small groups each led by a facilitator for skills practice using standardized patients. For each practice session, the facilitator followed a reflective process-oriented framework that focused on identifying the practicing fellow’s goal and providing the tools to accomplish this goal.

The skills taught included the following: giving information using Ask-Tell-Ask; recognizing and responding to emotion using the NURSE acronym; open-ended questions to elicit care goals and end-of-life preferences; and using “wish” statements to respond to unrealistic goals.

Twenty-two fellows participated in the workshop from University of Pittsburgh and Duke University. We measured perceived preparedness using pre- and post- workshop surveys. Overall, perceived preparedness following training increased for all communication challenges including; delivering bad news, expressing empathy, and discussing dialysis initiation and withdrawal. Fellows rated the course highly and recommended it to other fellows. Qualitative comments highlighted how the training would impact future practice: “Listen more intently, limit use of medical terminology further, give patients more opportunity to express feelings.”

NephroTalk is an interactive communication workshop to enhance nephrology fellow communication skills using didactics and practice sessions to address common communication tasks in nephrology. From this work, future direction would involve disseminating our curriculum to other institutions and enhancing the education of nephrology educators and attendings. 

For the a full article on this, check out: 

Special post by
Jane Schell MD

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