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Cited by 426Palliative Care and End-of-Life IssuesPatient-Provider Communication in HealthcareEmpathy and Medical Education

Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients With Serious Illness: A Randomized Trial

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Curtis, J. Randall, Back, Anthony L., Ford, Dee W., Downey, Lois, Shannon, Sarah E., Doorenbos, Ardith Z., Kross, Erin K., Reinke, Lynn F. +5 more·2013·JAMA
DOI 10.1001/jama.2013.282081PMC PMC4310457
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Abstract

IMPORTANCE: Communication about end-of-life care is a core clinical skill. Simulation-based training improves skill acquisition, but effects on patient-reported outcomes are unknown. OBJECTIVE: To assess the effects of a communication skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial conducted with 391 internal medicine and 81 nurse practitioner trainees between 2007 and 2013 at the University of Washington and Medical University of South Carolina. INTERVENTION: Participants were randomized to an 8-session, simulation-based, communication skills intervention (N = 232) or usual education (N = 240). MAIN OUTCOMES AND MEASURES: Primary outcome was patient-reported quality of communication (QOC; mean rating of 17 items rated from 0-10, with 0 = poor and 10 = perfect). Secondary outcomes were patient-reported quality of end-of-life care (QEOLC; mean rating of 26 items rated from 0-10) and depressive symptoms (assessed using the 8-item Personal Health Questionnaire [PHQ-8]; range, 0-24, higher scores worse) and family-reported QOC and QEOLC. Analyses were clustered by trainee. RESULTS: There were 1866 patient ratings (44% response) and 936 family ratings (68% response). The intervention was not associated with significant changes in QOC or QEOLC. Mean values for postintervention patient QOC and QEOLC were 6.5 (95% CI, 6.2 to 6.8) and 8.3 (95% CI, 8.1 to 8.5) respectively, compared with 6.3 (95% CI, 6.2 to 6.5) and 8.3 (95% CI, 8.1 to 8.4) for control conditions. After adjustment, comparing intervention with control, there was no significant difference in the QOC score for patients (difference, 0.4 points [95% CI, -0.1 to 0.9]; P = .15) or families (difference, 0.1 [95% CI, -0.8 to 1.0]; P = .81). There was no significant difference in QEOLC score for patients (difference, 0.3 points [95% CI, -0.3 to 0.8]; P = .34) or families (difference, 0.1 [95% CI, -0.7 to 0.8]; P = .88). The intervention was associated with significantly increased depression scores among patients of postintervention trainees (mean score, 10.0 [95% CI, 9.1 to 10.8], compared with 8.8 [95% CI, 8.4 to 9.2]) for control conditions; adjusted model showed an intervention effect of 2.2 (95% CI, 0.6 to 3.8; P = .006). CONCLUSIONS AND RELEVANCE: Among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education did not improve quality of communication about end-of-life care or quality of end-of-life care but was associated with a small increase in patients' depressive symptoms. These findings raise questions about skills transfer from simulation training to actual patient care and the adequacy of communication skills assessment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00687349.

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  • Prior interventions to address family surrogates' distress have had limited success, and some may even exacerbate surrogates' traumatic stress responses.

    “However, prior research has shown these interventions not only have limited success but that some may even exacerbate surrogates' traumatic stress responses (14-20).”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [14]

    The Results report no significant improvement in family-rated communication or end-of-life care, supporting limited success for this intervention. They also report increased depressive symptoms in patients, but not in family respondents; the paper does not report that surrogates’ traumatic stress worsened. Page numbers were not available in our copy. (LLM, conf=0.88)

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  • Several interventions have not observed strong effects on psychological outcomes.

    “distinguishing it from several interventions that have not observed strong effects on psychological outcomes (14-20)”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [14]

  • In medical education, it is crucial for students to gain extensive exposure to real-world clinical scenarios.

    “In medical education, it is crucial for students to gain extensive exposure to real-world clinical scenarios3,4.”

    From A large language model digital patient system enhances ophthalmology history taking skills (2025) · cites this paper as [4]

    The Methods (Trial Design and Participants; page unavailable) describe trainees’ real patient encounters, but do not evaluate how much clinical exposure students need. The Discussion (page unavailable) considers whether skills learned in simulation transfer to patient care; it does not say that extensive real-world exposure is crucial. Searches for clinical experience, real patients, and repeated exposure found no passage making that claim. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

  • The majority of prior trials of surrogate interventions did not target surrogates who are anxious and/or emotionally dependent on the patient.

    “which the majority of prior trials of surrogate interventions did not do (14-20)”

    From EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU (2024) · cites this paper as [14]

    The Methods describe a communication-skills intervention for clinician trainees, with family members serving as evaluators. The passages found when searching for anxious or emotionally dependent surrogates and prior surrogate interventions do not assess whom prior surrogate-intervention trials targeted. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Training programs involving communication theory classes and self-assessment tools have had convincingly positive results.

    “Training programs involving, for example, communication theory classes (Kruijver et al. 2000) and self-assessment tools that can be used in specific situations (Curtis et al. 2013; Rider and Keefer 2006) have had convincingly positive results.”

    From Creativity, Critical Thinking, Communication, and Collaboration: Assessment, Certification, and Promotion of 21st Century Skills for the Future of Work and Education (2023) · cites this paper as Curtis et al. 2013

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Authors
Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., Kross, E. K., Reinke, L. F., Feemster, L. C., Edlund, B., Arnold, R. W., O’Connor, K., & Engelberg, R. A.
Affiliations
  • University of Washington (US)
  • Seattle Cancer Care Alliance (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2013-12-04
Volume
310
Issue
21
Pages
2271
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2013.282081
PMC
PMC4310457
OpenAlex
W2032135060
Cited by
426
References
43
Citations by year
2026: 11 · 2025: 24 · 2024: 28 · 2023: 23 · 2022: 34 · 2021: 34 · 2020: 34 · 2019: 41 · 2018: 37 · 2017: 40 · 2016: 52 · 2015: 37 · 2014: 27 · 2013: 4
FWCI
40.90
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (K23HL111116)
  • National Institute of Nursing Research (R01NR009987)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
Keywords
communication skills training, serious illness communication, end-of-life care, simulation-based training, internal medicine residents, nurse practitioners, physician-patient communication, patient-reported outcomes, depressive symptoms, communication quality, quality of end-of-life care, family satisfaction, physician-patient relationship, physician-family relationship, physician-family communication
MeSH terms
Adult, Clinical Competence, Communication, Depression, Education, Patient Care, Humans, Internal Medicine, Internship and Residency, Nurse Practitioners, Patients, Physician-Patient Relations, Quality of Health Care, Terminal Care, Patient Satisfaction, Young Adult, Self Report

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