Effect of individualized communication skills training on physicians' discussion of clinical trials in oncology: results from a randomized controlled trial

Abstract

Background: Discussing randomized clinical trials (RCTs) with cancer patients is one of the most challenging communication tasks a physician faces. Only two prior Communication Skills Trainings (CSTs) focused on RCTs in oncology have been reported. Their results demonstrated the need for further improvement. We developed and evaluated an enhanced, individually-tailored CST focused on improving physicians' communication during discussions of RCTs.

Methods: The CST focused on personal learning goals derived from video pre-assessment that were addressed in a 1.5-day group workshop and one-on-one coaching sessions. Forty physicians were recruited and randomly assigned to intervention and control groups. Video-recorded standardized consultations with actor-patients were utilized. As a primary outcome (1), training success was evaluated by blinded raters using a previously developed checklist. Change in checklist items was evaluated between pre- and post-training assessment and compared against control group results. As a secondary outcome (2), the physicians' feeling of confidence was assessed by a questionnaire.

Results: (1) Significant improvements in the intervention group were observed for the score on all items (p = 0.03), for the subgroup of content-specific items (p = 0.02), and for the global rating of communication competence (p = 0.04). The improvement observed for the subgroup of general communication skill items did not achieve significance (p = 0.20). (2) The feeling of confidence improved in nine out of ten domains.

Conclusion: While the individually-tailored CST program significantly improved the physicians' discussions of RCTs, specifically related to discussion content, what remains unknown is the influence of such programs in practice on participant recruitment rates. The study was registered retrospectively in 2010/07/22 under DRKS-ID: DRKS00000492 .

Keywords: CST; Communication skills training; Informed consent; Oncology; Randomized clinical trials.

Fig. 1

Flowchart of study design. Research design for the evaluation of the developed CST. Each assessment period included two randomized controlled trial (RCT) discussion sessions for each participant. The RCT discussion sessions utilized standardized RCT scenarios based on real-life RCTs and trained actor-patients. ⁺ An additional physician was initially recruited for the study but dropped out after the pre-assessment sessions due to scheduling difficulties. This early drop-out was not included in the analysis.* CG = Control Group, IG = Intervention Group. ^‡ Data of post-assessment t2 of intervention group was not analyzed in this study