Simulation-based communication training does not improve the patient-reported quality of communication (QOC) about end-of-life care or the quality of end-of-life care (QEOLC), according to randomized trial results published in the Dec. 3 issue of the Journal of the American Medical Association.  In fact, the training was associated with a modest increase in patients' depressive symptoms.

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The study randomized 391 internal medicine practitioners and 81 nurse practitioners to an eight-session, simulation-based communications skills workshop (n=232) or usual education (n=240). The primary endpoint was the patient-reported QOC measured. Secondary outcomes included the patient-reported QEOLC, depressive symptoms and family-reported QOC and QEOLC. Skills were evaluated during the 10 months following the workshop.

A total of 1,866 patients and 936 families participated in the study. The education intervention was not associated with any significant improvements in patient- or family-reported QOC or QEOLC. There was a small but statistically significant increase in depressive symptoms (p=0.006) associated with the intervention.

The authors note that the increase in depressive symptoms was greatest among first-year residents, which "suggests this increase might be associated with the skill level of the clinician."

In an accompanying editorial, Jeffrey Chi, MD, and Abraham Verghese, MD, Stanford University School of Medicine, Stanford, CA, wrote, "There are many possible reasons for the unexpected results. Patients and families are not formally trained to evaluate communication skills. … It is possible that the improvement in participants' skills was not enough to make a measurable difference to patients; conversely, it is possible that trainees did not recall training and so were not able to apply the communication skills."

They add that this study, "Provides an important lesson about the nature of pedagogy in medicine: new and innovative ways are needed to teach skills, and continued measurement, reassessment and validation are needed to determine if those teaching methods have succeeded. … Much work remains to be done."

Keywords: Physicians, Depression, Nurse Practitioners, Terminal Care, Communication

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