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Critical conversations in gynecologic oncology: Pilot study of communication skills training for fellows and advanced practice providers
Abstracts / Gynecologic Oncology 145 (2017) 2–220
recommendation regarding CPR (22%), suggesting a follow-up plan (28%), and summarizing the discussion (6%). Post-intervention, residents felt more prepared for CSDs (3.7/5) and end-of-life care (3.9/5). Overall, 72% of respondents felt that the educational intervention changed the way they communicate with patients. Conclusion: The majority of participants believe they have a role in counseling patients at the end of life, yet many residents had never done so and lacked explicit direction. Participants felt more prepared to lead a CSD after the intervention. Future attempts at improving CSD skills should include more intensive mentoring and ongoing practice.
doi:10.1016/j.ygyno.2017.03.475
448 - Poster Session Critical conversations in gynecologic oncology: Pilot study of communication skills training for fellows and advanced practice providers C. Lefkowitsa, K.S. Bevisb, E. Careyc, J. Sheederd, R. Arnolde, L. Podgurskif. aUniversity of Colorado Denver, Denver, CO, USA, b University of Alabama at Birmingham, Birmingham, AL, USA, cMayo Clinic, Rochester, MN, USA, dUniversity of Colorado Denver, Aurora, CO, USA, eUniversity of Pittsburgh Medical Center, Pittsburgh, PA, USA, f University of Pittsburgh/Magee-Women's Hosiptal, Pittsburgh, PA, USA Objective: Effective communication improves patient outcomes and satisfaction and is crucial to good patient care. Challenging communication scenarios abound in oncology, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition in nongynecologic oncology providers; we sought to test CST with gynecologic oncology providers. Method: We conducted a 2-day CST workshop based on the VitalTalk model with 4 faculty (2 gynecologic oncologists, 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows, 5 advanced practice providers). Acceptability, preparedness to address challenging communication scenarios, and impact on clinical practice were assessed by self-report. Using Fisher’s exact test, we compared prevalence of score of 4 or 5/5 on a Likert scale of preparedness to handle 13 challenging communication scenarios preworkshop, immediately postworkshop, and 1 month postworkshop. Results: Participants showed a statistically significant increase in preparedness for 10 out of 13 challenging communication scenarios immediately postworkshop (all P b 0.05). Improvements were sustained or increased at 1 month (Table 1). One month postworkshop, 89% of participants reported using skills learned in the course at least weekly. All participants rated the educational quality as very good or excellent, and all rated the training as important or very important to the development of their clinical skills. All strongly agreed they would recommend the course to others and that this training should be required of all gynecologic oncology clinicians. Conclusion: Participants felt strongly that the workshop provided high-quality education that changed their clinical practice. As a result of the workshop, participants reported statistically significant, sustained improvement in preparedness to handle challenging communication scenarios. CST for gynecologic oncology providers is feasible, with high rates of perceived effectiveness and impact on clinical practice. Formal CST should be integrated into gynecologic oncology training.
207
Table 1 How prepared do you feel to…
Convey serious news about a patient’s illness to the patient or family Convey prognosis to a patient or family member Express empathy Discuss code status with a patient or family member Respond to patients who deny the seriousness of their illness Respond to patients or family members who want treatments you believe are not indicated Discuss religious or spiritual issues with a patient or family member Elicit a patient or family member’s concerns about death & dying Manage conflict that arises during a family meeting Describe comfort-focused care Explore patient values to develop a treatment plan in a seriously ill patient Conduct a family conference Counsel a patient or family member in what to expect in the dying process How prepared do you feel to…
Convey serious news about a patient’s illness to the patient or family Convey prognosis to a patient or family member Express empathy Discuss code status with a patient or family member Respond to patients who deny the seriousness of their illness Respond to patients or family members who want treatments you believe are not indicated Discuss religious or spiritual issues with a patient or family member Elicit a patient or family member’s concerns about death & dying Manage conflict that arises during a family meeting Describe comfort-focused care Explore patient values to develop a treatment plan in a seriously ill patient Conduct a family conference Counsel a patient or family member in what to expect in the dying process
Percent of Participants Rating 4 or 5 on 5 Point Likert Scale (5=Very prepared) Preworkshop (n =10)
Immediate Postworkshop (n =10)
1 month Post workshop (n = 9)
0%
100%
100%
10%
100%
100%
60% 0%
100% 50%
100% 89%
10%
80%
78%
10%
80%
100%
10%
70%
78%
0%
90%
100%
0%
60%
78%
0% 0%
40% 100%
89% 100%
0% 0%
50% 30%
78% 56%
Percent of Participants Rating 4 or 5 on 5 Point Likert Scale (5=Very prepared) p-value Pre vs Immediate Post
p-value Pre vs 1 month Post
b 0.001
b 0.001
b 0.001
b 0.001
0.09 0.03
0.09 b 0.001
0.005
0.005
0.005
b 0.001
0.02
0.005
b 0.001
b 0.001
0.01
0.001
0.09 b 0.001
b 0.001 b 0.001
0.03 0.21
0.001 0.01
doi:10.1016/j.ygyno.2017.03.476
449 - Poster Session Comparison of longitudinal patient reported outcomes on an enhanced recovery pathway in patients with ovarian cancer undergoing primary vs interval cytoreductive surgery L.A. Meyera, A.M. Nickb, Q. Shia, M.D. Iniestaa, J.D. Lasalaa, M. Harrisa, C.C.L. Suna, K.H. Lua, P.T. Ramireza. aThe University of Texas MD Anderson Cancer Center, Houston, TX, USA, bSt. Thomas Medical
recommendation regarding CPR (22%), suggesting a follow-up plan (28%), and summarizing the discussion (6%). Post-intervention, residents felt more prepared for CSDs (3.7/5) and end-of-life care (3.9/5). Overall, 72% of respondents felt that the educational intervention changed the way they communicate with patients. Conclusion: The majority of participants believe they have a role in counseling patients at the end of life, yet many residents had never done so and lacked explicit direction. Participants felt more prepared to lead a CSD after the intervention. Future attempts at improving CSD skills should include more intensive mentoring and ongoing practice.
doi:10.1016/j.ygyno.2017.03.475
448 - Poster Session Critical conversations in gynecologic oncology: Pilot study of communication skills training for fellows and advanced practice providers C. Lefkowitsa, K.S. Bevisb, E. Careyc, J. Sheederd, R. Arnolde, L. Podgurskif. aUniversity of Colorado Denver, Denver, CO, USA, b University of Alabama at Birmingham, Birmingham, AL, USA, cMayo Clinic, Rochester, MN, USA, dUniversity of Colorado Denver, Aurora, CO, USA, eUniversity of Pittsburgh Medical Center, Pittsburgh, PA, USA, f University of Pittsburgh/Magee-Women's Hosiptal, Pittsburgh, PA, USA Objective: Effective communication improves patient outcomes and satisfaction and is crucial to good patient care. Challenging communication scenarios abound in oncology, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition in nongynecologic oncology providers; we sought to test CST with gynecologic oncology providers. Method: We conducted a 2-day CST workshop based on the VitalTalk model with 4 faculty (2 gynecologic oncologists, 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows, 5 advanced practice providers). Acceptability, preparedness to address challenging communication scenarios, and impact on clinical practice were assessed by self-report. Using Fisher’s exact test, we compared prevalence of score of 4 or 5/5 on a Likert scale of preparedness to handle 13 challenging communication scenarios preworkshop, immediately postworkshop, and 1 month postworkshop. Results: Participants showed a statistically significant increase in preparedness for 10 out of 13 challenging communication scenarios immediately postworkshop (all P b 0.05). Improvements were sustained or increased at 1 month (Table 1). One month postworkshop, 89% of participants reported using skills learned in the course at least weekly. All participants rated the educational quality as very good or excellent, and all rated the training as important or very important to the development of their clinical skills. All strongly agreed they would recommend the course to others and that this training should be required of all gynecologic oncology clinicians. Conclusion: Participants felt strongly that the workshop provided high-quality education that changed their clinical practice. As a result of the workshop, participants reported statistically significant, sustained improvement in preparedness to handle challenging communication scenarios. CST for gynecologic oncology providers is feasible, with high rates of perceived effectiveness and impact on clinical practice. Formal CST should be integrated into gynecologic oncology training.
207
Table 1 How prepared do you feel to…
Convey serious news about a patient’s illness to the patient or family Convey prognosis to a patient or family member Express empathy Discuss code status with a patient or family member Respond to patients who deny the seriousness of their illness Respond to patients or family members who want treatments you believe are not indicated Discuss religious or spiritual issues with a patient or family member Elicit a patient or family member’s concerns about death & dying Manage conflict that arises during a family meeting Describe comfort-focused care Explore patient values to develop a treatment plan in a seriously ill patient Conduct a family conference Counsel a patient or family member in what to expect in the dying process How prepared do you feel to…
Convey serious news about a patient’s illness to the patient or family Convey prognosis to a patient or family member Express empathy Discuss code status with a patient or family member Respond to patients who deny the seriousness of their illness Respond to patients or family members who want treatments you believe are not indicated Discuss religious or spiritual issues with a patient or family member Elicit a patient or family member’s concerns about death & dying Manage conflict that arises during a family meeting Describe comfort-focused care Explore patient values to develop a treatment plan in a seriously ill patient Conduct a family conference Counsel a patient or family member in what to expect in the dying process
Percent of Participants Rating 4 or 5 on 5 Point Likert Scale (5=Very prepared) Preworkshop (n =10)
Immediate Postworkshop (n =10)
1 month Post workshop (n = 9)
0%
100%
100%
10%
100%
100%
60% 0%
100% 50%
100% 89%
10%
80%
78%
10%
80%
100%
10%
70%
78%
0%
90%
100%
0%
60%
78%
0% 0%
40% 100%
89% 100%
0% 0%
50% 30%
78% 56%
Percent of Participants Rating 4 or 5 on 5 Point Likert Scale (5=Very prepared) p-value Pre vs Immediate Post
p-value Pre vs 1 month Post
b 0.001
b 0.001
b 0.001
b 0.001
0.09 0.03
0.09 b 0.001
0.005
0.005
0.005
b 0.001
0.02
0.005
b 0.001
b 0.001
0.01
0.001
0.09 b 0.001
b 0.001 b 0.001
0.03 0.21
0.001 0.01
doi:10.1016/j.ygyno.2017.03.476
449 - Poster Session Comparison of longitudinal patient reported outcomes on an enhanced recovery pathway in patients with ovarian cancer undergoing primary vs interval cytoreductive surgery L.A. Meyera, A.M. Nickb, Q. Shia, M.D. Iniestaa, J.D. Lasalaa, M. Harrisa, C.C.L. Suna, K.H. Lua, P.T. Ramireza. aThe University of Texas MD Anderson Cancer Center, Houston, TX, USA, bSt. Thomas Medical