King's College London

Context: As most end of life care is provided by healthcare providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential.

Objectives: To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviours. Methods Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS and OpenGrey), plus hand-searching. Randomised controlled trials of training interventions intended to enhance generalists’ communication skills in end of life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random effects model. PRISMA guidelines were followed.

Results: 19/11,441 papers were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n=3144, trainees n=791). Meta-analysis showed little effect on patient outcomes (SMD=0.10, 95%CI -0.05 to 0.24) and high levels of heterogeneity (Chi2=21.32, df=7, p=0.003; I2=67%). The effect on trainee behaviours in simulated interactions (SMD=0.50, 95%CI 0.19-0.81) was greater than in real patient interactions (SMD=0.21, 95%CI -0.01-0.43); moderate heterogeneity (Chi2=8.90, df=5, p=0.11; I2=44%; Chi2=5.96, df=3, p=0.11; I2=50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalised feedback on recorded interactions.

Conclusions: The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians’ ability to show empathy and discuss emotions, at least in simulated consultations. Personalised feedback on recorded patient interactions may be beneficial. Registration number CRD42014014777