Virtual Communication Training for Telemedicine

Overseen By Rache l M Lacy, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Virginia

Disqualifiers: Under 18, Inability to consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

16 Participants Needed

Trial Summary

What is the purpose of this trial?

Resident education on breaking bad news and conducting end of life conversations has been shown to improve comfort levels with having these conversations. Interventions with OB/GYN residents specifically have used a combination of didactics, resident role-playing and ultimately interaction with standardized patients with feedback from palliative care specialists. These interventions can be costly and also are not practical during the pandemic training environment where resident has transitioned to a virtual curriculum. While the didactics portions of this previously proven curriculum can be done virtually, the standardized patient interactions are challenging to replicate. Additionally, one of the key changes to patient care that has emerged during the pandemic is restrictive hospital and clinic visitor policies. Care providers must now have the ability to have difficult conversations and break bad news to family members over the phone rather than in person. Additionally, there has been an increasing reliance on telehealth visits. There are no currently studied training interventions in obstetrics and gynecology that address these skills.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of this treatment for virtual communication training in breaking bad news remotely?

Research shows that virtual patients are effective in teaching clinical skills, including difficult communication tasks like breaking bad news, as they allow practice without risk to real patients. Additionally, a study found that a patient-centered approach, which includes empathy and coordination of care, is preferred by patients receiving difficult news over the phone, suggesting that virtual training could enhance these skills. ^{1 2 3 4 5}

Is virtual communication training for telemedicine safe for participants?

The research does not provide specific safety data for virtual communication training in telemedicine, but it emphasizes the importance of training healthcare professionals in communication skills to improve patient interactions and reduce misunderstandings. ^{6 7 8 9 10}

How is the treatment 'Virtual Communication Training for Telemedicine' unique for teaching breaking bad news remotely?

This treatment is unique because it uses virtual patients to help healthcare professionals practice breaking bad news remotely, allowing them to improve their communication skills without risking real patient interactions. It addresses the specific challenges of remote communication, such as the absence of body language, by providing structured training and feedback in a simulated environment. ^{1 5 11 12 13}

Eligibility Criteria

This trial is for OB/GYN residents at the University of Virginia who can give informed consent. It's not open to those under 18 or anyone unable to agree to participate understandingly.

Inclusion Criteria

residents in University of Virginia's residency in Obstetrics and Gynecology

able to provide informed consent

Exclusion Criteria

I am unable to understand and agree to the study's details.

I am under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Didactic Sessions

Residents participate in virtual didactic sessions reviewing strategies for breaking bad news, including lectures and discussions.

2 months

2 sessions (virtual)

Role-Playing and Feedback

Residents engage in role-playing scenarios with faculty feedback to practice breaking bad news in different medical contexts.

1 month

Multiple sessions (virtual)

Follow-up

Residents are assessed on changes in comfort with end-of-life conversations 3 months after the intervention.

3 months

Treatment Details

Interventions

• Education on breaking bad news to family members remotely

Trial Overview The study tests a virtual training program teaching OB/GYN residents how to deliver bad news and handle end-of-life conversations by phone or telehealth, due to pandemic restrictions.

Participant Groups

Group I: Residents Experimental Treatment 1 Intervention

All residents will participate in the activity

Who Is Running the Clinical Trial?

University of Virginia

Lead Sponsor

Trials

802

Recruited

1,342,000+

Findings from Research

Virtual patients are effective tools for teaching healthcare professionals how to break bad news, showing better outcomes compared to no intervention and comparable results to traditional simulated patients.

Despite their benefits, virtual patients have limitations, such as a lack of emotional interaction, indicating that while they are valuable, they should complement rather than replace existing educational methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The use of virtual patients for breaking bad news: A rapid review. Kang, W.[2023]

A study involving 29 first-year pediatric residents showed significant improvement in their ability to deliver bad news after training with the 'GRIEV_ING Death Notification Protocol', assessed at three different time points.

The improvement in communication skills was sustained over time, highlighting the effectiveness of the educational intervention and the importance of ongoing training in communication for pediatric residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Breaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention. Reed, S., Kassis, K., Nagel, R., et al.[2016]

Patients receiving difficult prenatal news by telephone prefer a patient-centered approach that includes empathy and continuity of care, aligning with the SPIKES protocol for delivering such news.

Participants suggested improvements like discussing the mode of result disclosure during pretest counseling and providing personalized resources, indicating a desire for better communication and support during these challenging conversations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prenatal patient perceptions of receiving difficult news over the telephone. Douglas, TC., May, C., Dent, K., et al.[2023]

There is a significant lack of research on how to effectively communicate bad news in clinical settings in India, despite the high incidence of serious health issues and socioeconomic disparities.

The article identifies key areas for future research, including how much bad news to share, cultural and ethical considerations, managing psychological distress, and training healthcare professionals to communicate effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A synthesis of the literature on breaking bad news or truth telling: potential for research in India. Martis, L., Westhues, A.[2021]

A study involving 41 healthcare professionals assessed satisfaction with two formats of a course on breaking bad news over the phone, revealing that both fully streamed and blended formats were well-received, with a slight preference for the fully streamed format due to better interaction activities.

The findings highlight the importance of such training courses, which are requested by professionals, and emphasize the value of interprofessional education, including administrative staff, to enhance the overall care experience for families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching (remotely) to communicate (remotely) with relatives of patients during lockdown due to the COVID-19 pandemic. Ayora, A., Nogueras, C., Jiménez-Panés, S., et al.[2023]

A review of 23 studies highlighted that healthcare professionals face challenges in effectively disclosing adverse events, indicating a need for better communication strategies and training.

Implementing specific interpersonal communication skills and fostering an open organizational culture can help healthcare professionals provide more effective and tailored disclosures to patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disclosing Adverse Events in Clinical Practice: The Delicate Act of Being Open. Myren, BJ., de Hullu, JA., Bastiaans, S., et al.[2022]

Patients expect full and timely disclosure of adverse events in medical care, which can strengthen trust in the patient-physician relationship and reduce the likelihood of litigation.

Barriers to disclosure include fear of retribution and a culture of blame; therefore, establishing a nonpunitive environment in healthcare settings is crucial for encouraging honest reporting and improving patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Committee Opinion No. 681: Disclosure and Discussion of Adverse Events. [2021]

Patients expect timely and full disclosure of adverse events in medical care, which can strengthen the patient-physician relationship and reduce the likelihood of litigation if handled transparently.

Barriers to disclosure include fear of retribution and a culture of blame; therefore, establishing a nonpunitive environment in healthcare settings is crucial for encouraging reporting and improving patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Committee Opinion No. 681 Summary: Disclosure and Discussion of Adverse Events. [2021]

Patients and family members desire clear information and sincere regret from healthcare professionals (HCPs) when adverse events occur, while HCPs face barriers such as a blame culture and fear of litigation that hinder effective disclosure.

To improve disclosure practices, training for HCPs and fostering a transparent organizational culture are essential, as both patients and HCPs have different needs and expectations regarding the disclosure of adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The views and experiences of patients and health-care professionals on the disclosure of adverse events: A systematic review and qualitative meta-ethnographic synthesis. Sattar, R., Johnson, J., Lawton, R.[2023]

Both patients and healthcare professionals agree on the importance of disclosing adverse events, with patients specifically wanting timely communication, apologies when necessary, and reassurances about their ongoing care.

There is a significant gap between the ideal practices of disclosure and what actually occurs, highlighting the need for improved policies that include the roles of all healthcare team members in the disclosure process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disclosure of patient safety incidents: a comprehensive review. O'Connor, E., Coates, HM., Yardley, IE., et al.[2018]

The COVID-19 pandemic has necessitated remote communication of bad news by healthcare professionals, primarily through telephone calls, which presents unique challenges due to the lack of body language and limited training in such communication skills.

The manuscript provides structured recommendations for effectively delivering bad news remotely, aimed at improving the experience for patients, families, and caregivers while also supporting healthcare professionals in managing the emotional impact of these conversations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Recommendations for communicating bad news by phone during the SARS-CoV-2 pandemicRecomendações para a comunicação de más notícias por telefone durante a pandemia do SARS-CoV-2]. Belli, LF.[2020]

A new training package was developed to help healthcare staff deliver bad news over the phone during the COVID-19 pandemic, consisting of a 15-minute eLearning session and a 1-hour role-play with feedback from a professional actor.

Key strategies for effective communication included ensuring the recipient's safety during the call, allowing for silence after delivering bad news, and providing written notes and the option for a follow-up call to enhance understanding and support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic. Edwards, S., Keillor, L., Sandison, L., et al.[2022]

A study involving 33 Ob/Gyn residents revealed that 77% lacked the necessary skills to effectively break bad news to patients, highlighting a significant training gap in this area.

The implementation of a virtual training program based on the ADDIE model resulted in improved cognitive and attitudinal scores among residents, with a satisfaction rate of 96.5%, indicating the program's effectiveness in enhancing communication skills.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Virtual Instructional Design Improved Breaking Bad News in Obstetrics and Gynecology Residents. Rezayof, E., Akhavan, S., Afshar, L., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

The use of virtual patients for breaking bad news: A rapid review. [2023]

2. Ireland pubmed.ncbi.nlm.nih.gov

Breaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Prenatal patient perceptions of receiving difficult news over the telephone. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

A synthesis of the literature on breaking bad news or truth telling: potential for research in India. [2021]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Teaching (remotely) to communicate (remotely) with relatives of patients during lockdown due to the COVID-19 pandemic. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Disclosing Adverse Events in Clinical Practice: The Delicate Act of Being Open. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Committee Opinion No. 681: Disclosure and Discussion of Adverse Events. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Committee Opinion No. 681 Summary: Disclosure and Discussion of Adverse Events. [2021]

9. England pubmed.ncbi.nlm.nih.gov

The views and experiences of patients and health-care professionals on the disclosure of adverse events: A systematic review and qualitative meta-ethnographic synthesis. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Disclosure of patient safety incidents: a comprehensive review. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

[Recommendations for communicating bad news by phone during the SARS-CoV-2 pandemicRecomendações para a comunicação de más notícias por telefone durante a pandemia do SARS-CoV-2]. [2020]

12. England pubmed.ncbi.nlm.nih.gov

Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic. [2022]

13. Iran pubmed.ncbi.nlm.nih.gov

A Virtual Instructional Design Improved Breaking Bad News in Obstetrics and Gynecology Residents. [2023]