Communication Training for Surgery

Overseen By Margaret (Gretchen) L Schwarze, MD, MPP

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Lacking decision making, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

580 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve communication between surgeons and patients by testing a new training program called the "Training on Communication Framework." This program is designed to help patients better understand their treatment options, enabling informed decision-making. Participants may include surgical candidates, individuals with past surgery experience, or surgeons. Those considering surgery, who have decision-making ability, and speak English may be well-suited for the trial. As an unphased trial, this study offers a unique opportunity to enhance understanding of surgical options and improve decision-making skills.

Will I have to stop taking my current medications?

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

What prior data suggests that this communication training is safe?

Research has shown that the Best Case/Worst Case framework, part of the communication training under study, improves conversations between surgeons and patients. This tool helps patients understand possible surgery outcomes, including the best, worst, and most likely scenarios.

Studies have found that this framework shifts the focus of conversations, allowing patients to make treatment decisions that align with their personal values and preferences. Importantly, no safety issues or negative effects have been reported from using this communication tool.

Participants in this study will either join focus groups, fill out surveys, or receive training. Since this is not a medical treatment or drug, the usual safety concerns in clinical trials do not apply. Instead, this program aims to enhance understanding and decision-making in surgical settings. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it aims to transform how communication happens in surgical settings. Unlike traditional approaches that focus mainly on surgical techniques and outcomes, this trial emphasizes a communication framework involving surgical candidates, stakeholders with prior surgical experience, and surgeons themselves. This holistic approach seeks to improve the overall surgical experience by enhancing understanding and cooperation among all parties involved. By training surgeons in effective communication, the trial hopes to improve patient satisfaction and potentially lead to better surgical outcomes.

What evidence suggests that this communication training is effective for improving surgeon-patient interactions?

This trial will evaluate the "Best Case/Worst Case" communication framework, designed to help doctors communicate more effectively with patients. Participants include surgical candidates, stakeholders with previous surgery experience, and surgeons from the University of Wisconsin-Madison Department of Surgery. Research has shown that this approach aids in discussing treatment options, particularly for older patients facing difficult decisions, by focusing on what is most important to patients and their families. Studies have found that using this approach leads to better decision-making by providing clearer and more compassionate communication, helping patients and families make informed choices that align with their values. ^{2 3 4 6 7}

Who Is on the Research Team?

Margaret (Gretchen) Schwarze, MD, MPP

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

This trial is for patients undergoing surgery and surgeons in Wisconsin. It aims to improve how surgeons communicate with their patients about treatment options. Participants will be involved in surveys, focus groups, or receive communication training.

Inclusion Criteria

I am a surgeon at UW-Madison treating adults in an outpatient clinic.

Exclusion Criteria

I am a surgeon who only treats patients under 18.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Surgeons receive training on the Better Conversations framework, with audio recordings used for assessment and feedback

Up to 4 years

Multiple sessions (in-person and virtual)

Evaluation

Evaluation of surgeon communication through participant surveys and audio recordings

Up to 4 years

Surveys and focus groups

Follow-up

Participants are monitored for outcomes related to surgeon communication effectiveness

Up to 4 years

What Are the Treatments Tested in This Trial?

Interventions

• Training on communication framework

Trial Overview The study is testing a new program called 'Better Conversations' designed to enhance the dialogue between surgeons and patients. The effectiveness of this program will be measured through participant surveys and feedback from focus groups.

How Is the Trial Designed?

Group I: Surgical candidate Experimental Treatment 1 Intervention

Participants who are undergoing surgical consultation

Group II: Surgeons Experimental Treatment 1 Intervention

Surgeons from the University of Wisconsin-Madison Department of Surgery with an outpatient surgical clinic who treat adult patients at UW Health

Group III: Stakeholder Focus Group Experimental Treatment 1 Intervention

Participants have previous experience with surgery

Training on communication framework is already approved in United States for the following indications:

Approved in United States as Best Case/Worst Case framework for:

• High-stakes surgical decisions
• Serious illness discussions

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Published Research Related to This Trial

A communication skills course for academic general surgery residents and faculty led to high satisfaction rates, with 88% of faculty and 86% of residents participating, indicating strong engagement with the training.

The course resulted in a sustained increase in 'top box' HCAHPS scores, demonstrating its effectiveness in improving physician-patient communication and potentially enhancing patient care outcomes over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Communication Skills: A Course for Academic Medical Center Surgery Residents and Faculty. Raper, SE., Gupta, M., Okusanya, O., et al.[2022]

In a study of 1047 patients at a large teaching hospital, 17.7% experienced serious adverse events, with longer hospital stays increasing the likelihood of such events by about 6% for each additional day.

The majority of adverse events were linked to individual errors (37.8%) or interactive causes (15.6%), highlighting the need for healthcare providers to focus on these areas for proactive error prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An alternative strategy for studying adverse events in medical care. Andrews, LB., Stocking, C., Krizek, T., et al.[2022]

A study involving 322 clinicians at Nantes Teaching Hospital revealed significant gaps in the disclosure of serious adverse events, with 13.4% not disclosing initially, 24.5% not providing details, and 44.1% not explaining the cause of the events.

Surgeons were notably less likely than physicians to disclose details or causes of adverse events, with 72.9% of surgeons only providing information when asked, highlighting a need for targeted training to improve transparency and maintain patient trust.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Disclosing harmful adverse event: Assessment of medical practices from clinical vignettes]. Prud'homme, S., Dufresne, M., Abbey, H., et al.[2017]

A structured communication curriculum significantly improved surgical residents' case-specific communication skills, with median scores increasing from 65% to 84% after training, based on assessments from standardized patient simulations.

While the training enhanced specific communication abilities related to cancer diagnoses, it did not show a significant impact on overall general communication skills, highlighting the need for focused training in residency programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills. Chandawarkar, RY., Ruscher, KA., Krajewski, A., et al.[2022]

Surgeons recognize serious adverse events as a common part of surgery, but many feel that current strategies do not effectively support learning from these events while also caring for the surgeons involved.

Concerns about transparency and the potential negative impact on their careers hinder surgeons from openly discussing adverse events, highlighting the need for systemic changes in education and support to foster a culture of learning and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Learning from experience: a qualitative study of surgeons' perspectives on reporting and dealing with serious adverse events. Øyri, SF., Søreide, K., Søreide, E., et al.[2023]

Surgeons primarily focus on educating patients about surgical conditions and treatments, but often neglect to address patients' emotional concerns and the elements of informed decision-making.

Improving communication skills, particularly in expressing empathy and understanding patient emotions, can enhance patient satisfaction and outcomes, suggesting that training programs from primary care could be beneficial in surgical education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of surgeon-patient communication: strengths and opportunities for improvement. Levinson, W., Hudak, P., Tricco, AC.[2022]

Annual 2-hour communication skill-building workshops significantly improved surgical residents' self-reported preparedness for serious illness communication, with 71 participants providing positive feedback over four years.

More experience in the workshops correlated with higher preparedness scores, indicating that repeated practice enhances communication skills among surgical residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Annual Structured Communication Skills Training for Surgery Residents. Coleman, NL., Berlin, A., Fischkoff, K., et al.[2023]

Effective communication in veterinary medicine is crucial for improving clinician-client interactions and care outcomes, and should be taught with the same rigor as clinical skills.

The article presents a three-part framework for teaching communication, emphasizing the importance of specific skills, evidence-based goals, and various teaching methods like simulated patients and feedback to enhance communication competence in veterinary practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching and learning communication in veterinary medicine. Kurtz, S.[2019]

Effective communication skills training is increasingly recognized as essential in surgical residency programs, with a focus on topics like breaking bad news and empathy, as highlighted in a review of 33 studies involving surgical residents in North America.

Despite the growing importance of communication training, only half of the reviewed programs included multiple training sessions, which are crucial for reinforcing these skills over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training Surgical Residents to Communicate with Their Patients: A Scoping Review of the Literature. Kapadia, MR., Lee, E., Healy, H., et al.[2021]

In a review of 6,236 perioperative incident reports from 2018 to 2020, 1,049 were identified as communication failures, with the most common issues being shared knowledge deficits (46%) and inaccurate communication (44%).

The study found that the weakest area in communication, according to a Relational Coordination survey, was shared knowledge, which aligns with the incident report findings, suggesting that improving shared knowledge could help reduce adverse clinical events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Thematic mapping of perioperative incident reporting data to relational coordination domains. Duffy, CC., Bass, GA., Yura, C., et al.[2023]

A study involving 150 patients undergoing cholecystectomy revealed that only 50% could complete a comprehension test on doctor-prepared materials, with over 40% showing poor understanding, highlighting a gap in effective communication.

By analyzing patient narratives, the research identified that materials written in a style similar to those best understood by patients—typically from individuals with medium educational levels—could significantly improve comprehension, suggesting that patient involvement in creating educational content is crucial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving comprehension of informed consent. Kusec, S., Oresković, S., Skegro, M., et al.[2015]

In a study analyzing 16 video-recorded oncology patient interviews, both resident trainees and attending physicians missed 70% of identified empathic opportunities, indicating a significant gap in effective patient-physician communication.

The study suggests that targeted feedback and training on recognizing empathic opportunities could enhance communication skills for both residents and attending physicians, potentially improving patient satisfaction in clinical encounters.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Competent patient care is dependent upon attending to empathic opportunities presented during interview sessions. Easter, DW., Beach, W.[2008]

Integrating communication training into clinical rotations, known as Communication-Intensive Rotations (CIRs), can enhance medical students' real-life communication skills and reduce the burden of parallel curricula, which often neglects practical application.

CIRs offer benefits such as role modeling by expert communicators, real-time feedback, and the development of relationship-centered communication skills, which can help decrease burnout and promote effective communication habits in future physicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Creating a culture of communication in undergraduate medical education. England, JA., Howell, M., White, BAA.[2020]

Patients want to be informed about adverse events in healthcare, and this transparency is supported by safety experts and policymakers.

Enhancing the disclosure process through better policies and training can lead to increased patient satisfaction, improved relationships between patients and physicians, and ultimately a higher quality of healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ACOG Committee Opinion No. 380: Disclosure and discussion of adverse events. [2009]

In a study observing 150 hours of surgical procedures, 76 communication errors were identified, primarily related to equipment issues (36%) and team updates on operation progress (24%).

The introduction of a Team Training curriculum significantly reduced communication errors from 737 errors per hour to 270 errors per hour, indicating that training in teamwork and communication can effectively enhance communication in the operating room.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Communication failure in the operating room. Halverson, AL., Casey, JT., Andersson, J., et al.[2011]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4747100/

“Best Case/Worst Case”: Qualitative evaluation of a novel ... The BC/WC tool is a novel decision support intervention that may help facilitate difficult decision making for older adults and their physicians.

2. hipxchange.org hipxchange.org/toolkit/bcwc/

Best Case/Worst Case: High-Stakes Surgical Decisions This framework is designed to help physicians discuss options with frail older patients and their families to achieve treatment decisions that align with ...

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Best Case/Worst Case Communication Tool for Trauma ICUs This quality improvement study implements a tool supporting prognostic communication in 8 trauma intensive care units and assesses the reach ...

4. facs.org facs.org/media/qvubthqj/best-case-worst-case-framework-for-communicating-bad-news.pdf

Worst Case Framework for Communicating Bad News This chapter will explore how surgeons can effectively use the best- case/worst-case approach to provide clear, compassionate, and patient-centered ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5479749/

A Framework to Improve Surgeon Communication in High ... Using the Best Case/Worst Case framework changed surgeon communication by shifting the focus of decision-making conversations from an isolated ...

6. patientpreferences.org patientpreferences.org/best-case-worst-case/

Best Case/Worst Case The Best Case/Worst Case framework is a communication tool for discussing treatment options, using scenarios to help patients imagine best, worst, and most ...

7. youtube.com youtube.com/watch?v=FnS3K44sbu0

Best Case/Worst Case (BC/WC) SURGEON Communication ... A communication tool developed by our research group to help surgeons discuss difficult treatment decisions with patients and their families.