Table 1 Study characteristics
Study ID | Design | Intervention group, n | Control group, n | Learner description | Country | Intervention | Comparator | Outcome |
|---|---|---|---|---|---|---|---|---|
Alexander 2006 [38] | Cohort | 37 | 19 | Ambulatory care rotator residents in Duke University Medical Centre | USA | The two-day retreat involving small-group lecture/ discussion, audio-visual materials, recordings of actual physician–patient encounters, and scripted “trigger tapes.” Learners practiced through supervised role-play. | No intervention | Communication Behaviour |
Back 2007 [39] | Pre/Post | 100 Participants | Oncology fellows from 62 different institutions who applied for the specialized workshop | USA | The Oncotalk curriculum involved a 4 day retreat, taught in small groups of 5 participants and 1 faculty facilitator. The curriculum was organized around 5 simulated patients. Learning activities included overviews, skills practice sessions, and reflective discussions. | Pre-intervention | Communication Behaviour | |
Bristowe 2014 [30] | Pre/Post | 16 Participants | Hemodialysis Nurses/Physicians | UK | Communication workshop with following sessions: fact session; patient and carer experience session; professional and personal experience session; communication, role-playing and feedback | No intervention | Self-Efficacy | |
Clayton 2012 [31] | Pre/Post | 21 Participants | Residents at large tertiary-referral teaching-hospital in Sydney, Australia, voluntary participation | Australia | Three 1 hour, onsite teaching sessions and a follow-up telephone call, spread out over 4 weeks. Sessions included interactive presentation of evidence-based strategies for conversations with patients expected to die within days/weeks and their caregivers and practice with standardized patients and feedback from an expert facilitator. Follow-up phone call one week after final session reinforced and extended learning, and offered further support and feedback. Written and audio take-home learning materials provided. | Pre-intervention | Self-Efficacy | |
Communication Behaviour | ||||||||
Fischer 2007 [35] | Pre/Post | 29 Participants | Primary care internal medicine residents, voluntary participation | USA | Workshop included a brief lecture, group discussions, role-playing, and videotape review. Topics included included breaking bad news, advance care planning, ethics. | Pre-intervention | Knowledge | |
Furman 2006 [5] | Pre/Post | 8 Participants | Internal Medicine and medicine-paediatric Residents at Louisville Veterans Affairs Medical Center | USA | One morning report session consisting of both didactic training and three-person role-played discussion. | Pre-intervention | Patient AD Document | |
Green 2011 [34] | RCT | 60 | 56 | Second year medical student in Penn State College of Medicine | USA | Students help patients create advance directives using a multimedia decision-aid which helps patients clarify their values, explain end-of-life conditions, help users choose and communicate with their surrogate decision makers and translate their wishes and goals. | Students using Standard AD | Patient Satisfaction with EoL and EoL Care planning |
Student Knowledge | ||||||||
Greenberg 1993 [28] | RCT | 46 | 47 | Medical Students beginning their clerkship | USA | The high-intervention received the same reading as low intervention group as well as a small group seminar on topics of historical development of advance directives, students' experiences with death and dying, contents of a durable power of attorney for health care (DPAHC). Students also viewed a videotape illustrating important aspects of discussing the DPAHC. They were finally assigned to initiate a discussion about advance directives with a patient, family member, or friend. | Provided Self-study readings | Self-Efficacy |
Knowledge | ||||||||
Hales 2008 [4] | Pre/Post | 18 Particiants | Multidisciplinary critical care practitioners (MD, RN, SW, RT) | Canada | Workshop participants were assigned to practice groups of three to six members of varying disciplines and institutions. Groups rotated through the six 45-minute stations, enacting scenarios with standardized colleagues and families on topics ranging from the role of the substitute decision maker to approaching families about organ and tissue donation | Pre-intervention | Self-Efficacy | |
Holloran 1995 [42] | Cohort | Sample size of learners not recorded, outcomes were patient based | Surgical residents rotating through the Surgical ICU (SICU). Outcomes collected for patients who spent more than 30 days in SICU. | USA | Four weekly 60 minute case study discussion groups. Groups led by SICU attending physician and nursing director. Cases designed to force discussion of issues of withholding or withdrawing treatment, eliciting patient and family wishes, incompetent patients and conflict with families | No intervention | Patient AD document | |
Health Care Utilization | ||||||||
Lorin 2006 [40] | Cohort | 53 | 53 | All 4th year Medical Students rotating through mandatory ICU rotation | USA | Didactic teaching session on ICU communication framework, followed by practice with standardized patients | No intervention | Communication Behaviour |
Pekmezaris 2011 [6] | Cohort | 77 | 73 | Residents rotating through internal medicine inpatient service in New York | USA | The training was composed of six sessions discussing importance of advance care planing, palliation and life sustaining therapies and interventions. The learners and were involved in role playing with standardized patients and received feedback from expert moderators. | No intervention | Self-Efficacy |
Perron 2002 [36] | Pre/Post | 9 participants | Residents in Internal Medicine Ward of university affiliated community hospital | Switzer-land | Detailed information was given to all physicians in the department about the meaning of a 'Do not resuscitate' (DNR) order, its ethical dimension, the right of patients to make their own decision , and the concept of medical futility. Ethical aspects addressed only DNR measures and did not cover other measures such as life sustaining treatments. | No intervention | Knowledge | |
Schell 2013 [32] | Pre/Post | 22 Participants | Nephrology Fellows at Duke University and University of Pittsburgh | USA | Session consisting of large group didactic session to highlight the communication skills for breaking bad news and eliciting patient preferences, faculty role-play demonstrating these skills, then the fellows were divided into small groups of five to six members each for skills practice using standardized patients. Fellows had an opportunity to be a practicing fellow or an active observer. | Pre-intervention | Self-Efficacy | |
Sharma 2014 [37] | RCT | 23 | 28 | Residents rotating through internal medicine inpatient service | USA | The intervention group residents completed a multimodality code status discussion (CSD) educational intervention including didactic content, deliberate skills practice and self-study (e.g., online modules and maintenance of a log). In a follow-up intervention, residents received a 2-hour CSD skills “booster” session where they discussed themes from CSD logs, reviewed the CSD framework, and again observed a role play | No intervention | Communication Behaviour |
Smith 2013 [33] | Pre/Post | 38 Participants | Internal Medicine residents at UCSF | USA | The curriculum consisted of two one-hour lunch conference sessions and six one-hour morning reports at each hospital site, integrated into the regularly scheduled teaching sessions for residents on inpatient rotations. Residents explored challenging patient interactions and to discuss ways for conflict resolution and respond to their own emotional reactions to these scenarios. | No intervention | Self-Efficacy | |
Szmuilowicz 2010 [29] | RCT | 21 | 28 | Second year internal medicine residents at Brigham and Women’s Hospital | USA | One day retreat covering conversations of ‘Breaking Bad News” and “Discussing the Direction of Care”, and skills related to responding to emotions. Every participant had the opportunity to interview a standardized patient and receive feedback from trained faculty at least once during the retreat. | No intervention | Self-Efficacy |
Communication Behaviour | ||||||||
Szmuilowicz 2012 [7] | RCT | 19 | 19 | Internal Medicine Residents at Northwestern University | USA | Intervention included a 2 hour seminar discussing advance care planning and framework for EoL conversations, observing a code-status discussion modeled by faculty, and exploration of past experiences. Intervention also included self-study materials, internet communication skills teaching modules and reflective portfolios. | No intervention | Communication Behaviour |
Williams 2011 [41] | Pre/Post | 24 Participants | All first year internal resident at Thomas Jefferson University Hospital | USA | 3-hour workshop began with a review of the evidence behind good communication skills, a discussion of barriers to proper communication, and an in-depth explanation of the SPIKES protocol. Critique and discussion of a communication transcript of actual encounters and 5 minute video highlighting poor communication. | Pre-intervention | Communication Behaviour | |