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Educational Interventions to Train Healthcare Professionals in End-Of-Life Communication: A Systematic Review and Meta-Analysis

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Review

Educational Interventions to Train Healthcare Professionals in End-Of-Life Communication: A Systematic Review and Meta-Analysis

Han-Oh Chung et al. BMC Med Educ.

Abstract

Background: Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum.

Methods: We searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE.

Results: Of 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95% confidence interval [CI] 0.40-0.75; P < 0.001; very low quality evidence), more knowledge (4 studies, SMD 0.76;95% CI 0.40-1.12; p < 0.001; low quality evidence), and improvements in communication scores (8 studies, SMD 0.69; 95% CI 0.41-0.96; p < 0.001; very low quality evidence). There was insufficient evidence to determine whether these educational interventions affect patient-level outcomes.

Conclusion: Very low to low quality evidence suggests that end-of-life communication training may improve healthcare professionals' self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes.

Trial registration: PROSPERO CRD42014012913.

Keywords: Advance care planning; Advance directives; Communication; Communication training; End of life care; Medical education.

Figures

Fig. 1
Fig. 1
Flow diagram of study screening and eligibility. aMarked ‘other’ due to unclear documentation whether study excluded due to duplication or non-relevance. bOne educational study overlapped with the inpatient studies and two overlapped with the ICU studies
Fig. 2
Fig. 2
Effect of educational interventions on a self-efficacy b knowledge and c communication scores with standardized patient encounters
Fig. 3
Fig. 3
Sensitivity analysis restricting to studies of higher methodologic quality (RCTs only, higher quality MERSQI and NOS-E) for a self-efficacy b knowledge and c communication score

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