Ya-Hui Cheng1, Chih-Hung Chen2, Fen-Ju Chen3, Eng-Yen Huang4, Po-Ming Liu5, Chia-Te Kung6, Hsien-Li Huang7, Li-Hui Yang8, Peng-Chen Chien9, Ching-Hua Hsieh10. 1. Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: yahui1726@cgmh.org.tw. 2. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan; Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, 802, Taiwan. Electronic address: totoro631105@yahoo.com.tw. 3. Department of Healthcare Administration, I-Shou University Medical Campus, 824, Taiwan. Electronic address: fenjuchen@gmail.com. 4. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: hey1200@cgmh.org.tw. 5. Department of Emergency Medicine, Yuan's General Hospital, 802, Taiwan. Electronic address: erlpm123@gmail.com. 6. Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: kungchiate@gmail.com. 7. Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, 802, Taiwan; Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: s7428206@cgmh.org.tw. 8. Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: amy1123@cgmh.org.tw. 9. Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: VENU_CHIEN@hotmail.com. 10. Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 833, Taiwan. Electronic address: m93chinghua@gmail.com.
Abstract
BACKGROUND: Communication skills may be an important skill for the front-line emergency physicians. AIM: This study aimed to investigate the effect of training in a SHARE communication course by emergency physicians on patient notification and signing of do-not-resuscitate (DNR) orders for critical patients in the emergency room. DESIGN: From a total of 29 attending physicians in the emergency department, 19 physicians had been trained in the SHARE communication course. An observation form designed based on the SHARE training was completed by two observers who noted the communication process between physicians and patients and family members during patient notification and signing a DNR order. To assess the influence of physicians trained in a SHARE communication course on the signing of DNR orders, a propensity score-matched population was created to reduce the potential selection bias of patients and family members. SETTING: Level 1 trauma medical center in southern Taiwan. RESULTS: There were 145 individuals enrolled in the study, of which 93 signed the DNR order, and 52 did not sign it. Analysis from 23 matched pairs from this population revealed that significantly more family members would sign a DNR order if the physician had been trained in the SHARE communication course than when they did not receive this training (78.3% vs. 39.1%, respectively, p = 0.017). The overall score of the observation form for physicians was higher in those individuals who had signed a DNR order than in those who did not sign it (29.48 ± 3.72 vs. 26.13 ± 3.52, respectively, p = 0.003), especially when the physician had chosen a quiet environment (1.35 ± 0.65 vs. 0.87 ± 0.69, respectively, p = 0.020), understood the patient's wishes and confirmed them (1.78 ± 0.42 vs. 1.30 ± 0.70, respectively, p = 0.008), and expressed concern (1.48 ± 0.79 vs. 0.96 ± 0.77, respectively, p = 0.028). In addition, a feedback survey about the feelings experienced by these physicians during the process of patient notification did not reveal a significant difference during the communication with those who had or had not signed DNR orders. CONCLUSION: The training in a SHARE communication course can improve the communication skills of emergency physicians in patient notification and signing of DNR orders for critical patients.
BACKGROUND:Communication skills may be an important skill for the front-line emergency physicians. AIM: This study aimed to investigate the effect of training in a SHARE communication course by emergency physicians on patient notification and signing of do-not-resuscitate (DNR) orders for critical patients in the emergency room. DESIGN: From a total of 29 attending physicians in the emergency department, 19 physicians had been trained in the SHARE communication course. An observation form designed based on the SHARE training was completed by two observers who noted the communication process between physicians and patients and family members during patient notification and signing a DNR order. To assess the influence of physicians trained in a SHARE communication course on the signing of DNR orders, a propensity score-matched population was created to reduce the potential selection bias of patients and family members. SETTING: Level 1 trauma medical center in southern Taiwan. RESULTS: There were 145 individuals enrolled in the study, of which 93 signed the DNR order, and 52 did not sign it. Analysis from 23 matched pairs from this population revealed that significantly more family members would sign a DNR order if the physician had been trained in the SHARE communication course than when they did not receive this training (78.3% vs. 39.1%, respectively, p = 0.017). The overall score of the observation form for physicians was higher in those individuals who had signed a DNR order than in those who did not sign it (29.48 ± 3.72 vs. 26.13 ± 3.52, respectively, p = 0.003), especially when the physician had chosen a quiet environment (1.35 ± 0.65 vs. 0.87 ± 0.69, respectively, p = 0.020), understood the patient's wishes and confirmed them (1.78 ± 0.42 vs. 1.30 ± 0.70, respectively, p = 0.008), and expressed concern (1.48 ± 0.79 vs. 0.96 ± 0.77, respectively, p = 0.028). In addition, a feedback survey about the feelings experienced by these physicians during the process of patient notification did not reveal a significant difference during the communication with those who had or had not signed DNR orders. CONCLUSION: The training in a SHARE communication course can improve the communication skills of emergency physicians in patient notification and signing of DNR orders for critical patients.