Training programs can improve nurse communication with patients about care goals

NEW ORLEANS—A communication skills training program can help oncology nurses improve discussions with patients and families regarding goals of care, according to research presented at the Oncology Nursing Society 37th Annual Congress.

Oncology nurses play a pivotal role in goals of care discussions, and the quality of communication influences patient satisfaction, compliance, and clinical outcomes. Despite this knowledge, research studies indicate that nurses tend to keep communications at a superficial, nontherapeutic level.

Processes for teaching better communication skills during goals of care conversations and implementing these skills into clinical practice are not clearly defined. However, the introduction of educational content followed by continuous skills assessment and mentored feedback has proven to be effective in improving communication skills.

At Seidman Cancer Center, University Hospitals Case Medical Center,

Cleveland, OH, staff devised a voluntary program to improve nurse communication skills about goals of care. The content was tailored to nurses and social workers providing care to patients in a busy, urban outpatient oncology setting at an academic medical center.

The educational series, developed by Linda Baer, RN, BSN, OCN, and Elizabeth Weinstein, MD, MS, was based on an adaptation of Oncotalk, a communication skills training program for oncology fellows and focused on improving therapeutic communication skills in oncology nurses during goals of care discussions.

Education sessions, delivered by a palliative care physician with extensive communication skills training and education, took place during three hour-long presentations held one month apart from each other. The presentations were scheduled from 7 am until 8 am, prior to the opening of the clinic. Topics discussed included exploring the patient's world, eliciting hopes and concerns, and dealing with conflict over goals.

Two nurses were educated about two models of communication: SPIKES (Get the Setting right, Patient Perception, Invitation, Give Knowledge, Address Emotions (See NURSE), and Summary and Strategy) and NURSE (Name an emotion, any emotion, Understand fears and concerns, Respect patient's experiences and emotions, Support: continue to help patient and identify resources, and Explore: clarify). The nurses then identified questions that they could use to elicit patient values for goals of care conversation, potential conflicts, and patient responses to the questions.

Participants were encouraged to share and discuss difficult questions throughout the program. After each meeting, participated were asked to complete an evaluation form in which they rated their perceived communication skills before and after the presentation using a likert scale. A second evaluation was completed for CEUs.

The sessions were well attended, with more than 20 participants at each meeting. Offering the class early before the clinic opened facilitated participation, the authors noted. Evaluations revealed that the nurses felt their communication abilities had improved after each session and that they were motivated and receptive to enhancing these skills. They stated that they felt more prepared to discuss goals of care and deliver bad news.

“This series of presentations provided opportunities for outpatient oncology nurses and social workers to enhance effective communication skills in the setting of goals of care and giving bad news. Improving communication skills takes time, practice, persistence, and reflection on the part of each individual nurse,” the authors concluded.

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