| Literature DB >> 31437262 |
Communication interventions in adult and pediatric oncology: A scoping review and analysis of behavioral targets.
Bryan A Sisk1, Ginny L Schulz1, Jennifer W Mack2, Lauren Yaeger3, James DuBois4.
Abstract
BACKGROUND: Improving communication requires that clinicians and patients change their behaviors. Interventions might be more successful if they incorporate principles from behavioral change theories. We aimed to determine which behavioral domains are targeted by communication interventions in oncology.METHODS: Systematic search of literature indexed in Ovid Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov (2000-October 2018) for intervention studies targeting communication behaviors of clinicians and/or patients in oncology. Two authors extracted the following information: population, number of participants, country, number of sites, intervention target, type and context, study design. All included studies were coded based on which behavioral domains were targeted, as defined by Theoretical Domains Framework.
FINDINGS: Eighty-eight studies met inclusion criteria. Interventions varied widely in which behavioral domains were engaged. Knowledge and skills were engaged most frequently (85%, 75/88 and 73%, 64/88, respectively). Fewer than 5% of studies engaged social influences (3%, 3/88) or environmental context/resources (5%, 4/88). No studies engaged reinforcement. Overall, 7/12 behavioral domains were engaged by fewer than 30% of included studies. We identified methodological concerns in many studies. These 88 studies reported 188 different outcome measures, of which 156 measures were reported by individual studies.
CONCLUSIONS: Most communication interventions target few behavioral domains. Increased engagement of behavioral domains in future studies could support communication needs in feasible, specific, and sustainable ways. This study is limited by only including interventions that directly facilitated communication interactions, which excluded stand-alone educational interventions and decision-aids. Also, we applied stringent coding criteria to allow for reproducible, consistent coding, potentially leading to underrepresentation of behavioral domains.
Entities:
Mesh：
Year: 2019 PMID： 31437262 PMCID： PMC6705762 DOI： 10.1371/journal.pone.0221536
Source DB: PubMed Journal: PLoS One ISSN： 1932-6203 Impact factor: 3.240
Introduction
Methods
Data sources and searches
Table 1
Full search strategies.
Study selection
Data synthesis and analysis
Table 2
Definitions of communication functions and behavioral domains.
| Fostering healing relationships | Intervention aims to support the fostering of a healing relationship. Such a relationship is based on rapport and trust, and will provide guidance, and understanding. Studies focused on the role of active listening would fall into this category. Ideally, this outcome would focus specifically on the relationship, rather than topics, which might affect a relationship. |
| Exchanging information | Intervention aims to improve the exchange of information about the cause, diagnosis, treatment, prognosis and psychosocial aspects of the illness. These studies may take into account information needs of the patient or family. |
| Responding to emotions | Intervention aims to support clinicians in recognizing and/or responding to the patient's/family's emotional states: including fear, humor, nervousness, worry, sadness, or fatalistic thinking. These interventions may aim to support clinicians in recognizing a patient's emotional state, asking the appropriate questions to understand it, communicating that understanding to the patient/family, and responding. Alternatively, these interventions could support patients/families in expressing their emotions. These interventions should specifically focus on the role of emotions in the physician/parent/patient relationship, or how one party responds to emotions within this relationship. |
| Managing uncertainty | Intervention aims to support patients in managing uncertainty. This is distinct from exchanging information because more information in itself can lead to more uncertainty at times. Specifically, these interventions could target the manner in which a clinician deals with uncertainty when communicating with a family, how the clinician supports a patient/family in uncertainty, or the intervention could aim to directly support a patient's/family's response to uncertainty. |
| Making decisions | Intervention aims to support decision-making that is based on the patient's/family's needs, values, and preferences. |
| Enabling patient self-management | Intervention aims to support the patient's/family's ability to solve health-related problems and to take actions to improve their health. Examples of self-management include ability to find information outside the clinical encounter, cope with treatment effects, and seek appropriate care when needed. |
| Knowledge | Interventions that aim to improve knowledge about communication skills or communication challenges. |
| Skills | Interventions that aim to improve communication skills, competence, ability, or provide opportunity to practice communication skills. |
| Social/professional role and identity | Interventions that aim to improve communication by targeting professional identity, professional role, social identity, leadership skills, group identity, or perceived professional boundaries. |
| Beliefs about capabilities | Interventions that aim to modify communication-related self-confidence, self-efficacy, perceived behavioral control, self-esteem, or empowerment, often through directed or systematic feedback to clinicians. |
| Beliefs about consequences | Interventions that aim to modify beliefs about consequences or outcomes of communication. This might include examples of communication going poorly, rather than only focusing on communication going well. |
| Reinforcement | Interventions that aim to reinforce certain communication behaviors with rewards, incentives, punishments, or sanctions. |
| Intentions | Interventions that aim to modify the will or intentions of participants. This should be a specific aim, as opposed to providing knowledge and skills that might indirectly affect the intentions. |
| Goals | Interventions that aim to support the development of communication goals, such as distal or proximal goal setting, goal priority, action planning. This can be exemplified by question prompt lists. While intentions can be formed from general information about the patient (e.g. needs assessments or other surveys), goals should be particularized. |
| Environmental context and resources | Interventions that aim to improve communication by targeting environmental stressors, resources, barriers, facilitators, organizational culture, and person/environment interaction. |
| Social influences | Interventions that aim to improve communication by targeting social pressures, norms, group conformity, social support, and power. |
| Emotion | Interventions that aim to improve communication by targeting emotions such as anxiety, fear, stress, depression, or burnout. |
| Behavioral regulation | Interventions that aim to improve communication by supporting breaking of habits and self-monitoring. This might include reflective checklists. |
Role of the funding source
Results
Fig 1PRISMA flow diagram.
Study characteristics
Table 3
Characteristics of studies.
| Variable | % Yes (n) | References |
|---|---|---|
| United States + Canada | 33 (29) | [ |
| Western Europe | 47 (41) | [ |
| Europe + Australia/New Zealand | 1 (1) | [ |
| Australia/New Zealand | 11 (10) | [ |
| Asia | 8 (7) | [ |
| 1 | 34 (30) | [ |
| 2 | 6 (5) | [ |
| 3 | 6 (5) | [ |
| 4 | 7 (6) | [ |
| 5 to 10 | 11 (10) | [ |
| 11 or more | 11 (10) | [ |
| Multiple, but not specified | 25 (22) | [ |
| 30 or fewer | 24 (15) | [ |
| 31 to 60 | 34 (21) | [ |
| 61 to 90 | 11 (7) | [ |
| 91 to 120 | 18 (12) | [ |
| >120 | 13 (8) | [ |
| 100 or fewer | 31 (15) | [ |
| 101–200 | 19 (9) | [ |
| 201–300 | 25 (13) | [ |
| 301–400 | 8 (4) | [ |
| 401–500 | 2 (1) | [ |
| >500 | 15 (7) | [ |
| Adult oncology | 97 (85) | [ |
| Adult and pediatric oncology | 3 (3) | [ |
| Attending physician | 26 (23) | [ |
| Fellow | 5 (4) | [ |
| Nurse | 20 (18) | [ |
| Combined healthcare team | 15 (13) | [ |
| Combined patient/healthcare team | 15 (13) | [ |
| Patient | 18 (16) | [ |
| Patient and family | 1 (1) | [ |
| Quasi-experimental pre/post | 38 (33) | [ |
| RCT | 59 (52) | [ |
| Other | 3 (3) | [ |
| Communication skills training/educational curriculum | 68 (59) | [ |
| Question prompt list | 3 (3) | [ |
| Patient-directed educational intervention | 6 (5) | [ |
| Communication or shared decision-making coaching | 4 (3) | [ |
| Patient Needs/Symptom/Preference Assessment | 8 (8) | [ |
| Multimodal combination of interventions | 7 (6) | [ |
| Other | 4 (4) | [ |
| General | 50 (43) | [ |
| End of life/palliative care | 14 (13) | [ |
| Cancer treatment/decision making | 12 (11) | [ |
| New diagnosis/prognosis | 9 (8) | [ |
| Pain/symptom management | 8 (7) | [ |
| Clinical trial enrollment | 7 (6) | [ |
*Not all studies targeted clinicians and patients, therefore total numbers in each category are less than the total number of studies.
Communication functions targeted
Fig 2Percentage of interventions targeting each communication function.
Each study was considered a single intervention; therefore, percentage represents percentage of total studies included in this review.
Percentage of interventions targeting each communication function.
Behaviors and behavioral domains
Fig 3Percentage of interventions targeting each behavioral domain.
Each study was considered a single intervention; therefore, percentage represents percentage of total studies included in this review.
Percentage of interventions targeting each behavioral domain.
Table 4
Outcomes and targets of individual studies.
| Study | Type of intervention | Whose behavior targeted | Study design | Time point of evaluation (in addition to baseline) | Positive outcomes | Negative outcomes | Behavioral domains targeted | Communication functions targeted |
|---|---|---|---|---|---|---|---|---|
| Back et al. 2007[ | Communication skills training/educational curriculum | Fellow | Quasi-experimental pre/post | Immediately post-training | Skill acquisition for “perception,” “invitation,” “knowledge,” | No significant skill acquisition for “summarizing” or “understanding.” | Knowledge, skills, beliefs about capabilities, behavioral regulation. | Fostering healing relationship, exchanging information, making decisions, managing uncertainty |
| Banerjee et al. 2017[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | Immediately post-training | Improvement in nurse self-efficacy in the following domains: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. | No significant improvement in the following skills: agenda setting (declaring agenda, inviting agenda, negotiating agenda, taking stock), checking (checking understanding, checking preference), questioning (asking open questions, restating, endorsing question asking, inviting questions), information organization (previewing, summarizing, transitioning, and reviewing next steps), acknowledging, and validating. | Knowledge, skills, beliefs about capabilities. | Fostering healing relationship, making decisions, responding to emotions |
| Baughcum et al. 2007[ | Communication skills training/educational curriculum | Fellow | Quasi-experimental pre/post | Immediately post-training | Increase in fellows’ knowledge of grief/bereavement, pediatric issues, pain, and symptom management | No change in fellows’ knowledge of ethics or communication. | Knowledge and skills | Unclear/not enough information |
| Bernhard et al. 2012[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after consultation, 2 weeks post-consultation, and 4 months post-consultation | None | No improvement in decisional conflict, patient involvement in decision making, or satisfaction with doctor’s consultation skills | Knowledge and skills | Exchanging information, making decisions |
| Bialer et al. 2011[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately post-training | Increase in participants’ confidence in responding to patient anger | None | Knowledge, skills, beliefs about capabilities, emotion | Fostering healing relationships, responding to emotions |
| Brown et al. 2010[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately post-training | Increase in participants’ confidence in discussing prognosis | None | Knowledge, skills, beliefs about capabilities | Fostering healing relationships, exchanging information, responding to emotions, managing uncertainty |
| Brown et al. 2010[ | Communication skills training/educational curriculum | Fellow | Quasi-experimental pre/post | Immediately post-training | Increase in participants’ confidence related to the following modules: breaking bad news, shared treatment decision making, responding to patient anger, discussing prognosis, discussing the transition to palliative care, discussing dnr orders. On videorecording, participants demonstrated more skill usage than prior to training. | None. | Knowledge, skills | Fostering healing relationship, exchanging information, making decisions, responding to emotion, managing uncertainty |
| Brown et al. 2007[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately post-training | Increase in number of behaviors from the shared decision-making domain (4 of 14 domains significantly improved). Also, increase in percentage of oncologists demonstrating “enactment,” describing standard treatment, non-maleficence, discussion of randomization related to bias, providing information about other trials suitable for the patient. Decrease in physician demonstrating favoring one option. | Of 58 behaviors recorded, 48 had no significant change pre/post-intervention. | Knowledge, skills, beliefs about capabilities, goals | Exchanging information, making decisions |
| Brown et al. 2004[ | Patient-directed educational intervention | Patient | Rct | Audiotape analysis immediately post-intervention; satisfaction survey immediately after intervention and 2 weeks post-intervention | Increase in patients’ declaration of cost perspectives and benefit perspectives. | No change in patient preferences for information, involvement in decision making, decisional conflict, anxiety, or depression. Also, no change 31 of 33 coded communication behaviors. | Knowledge, beliefs about consequences, intentions, goals | Exchanging information, making decisions |
| Bruera et al. 2003[ | Question prompt list | Patient | Rct | Immediately post-intervention | Increase in rating of “helpfulness of written material” and “written material helped to communicate with the doctor.” Also, increase in number of questions asked about diagnosis for intervention group. | No increase in ratings of “overall satisfaction with communication with the doctor,” “satisfaction with the consult,” “doctor was able to answer my questions,” or “will use similar written material in the future.” No difference in duration of consultation, number of questions asked by the patient, minutes the patient spoke, minutes the doctor spoke, number of questions on treatment, prognosis, or other issues. | Intentions, goals | Exchanging information |
| Butow et al. 2004[ | Other–cancer consultation preparation package | Patient | Rct | Immediately post-intervention and 1 month post-intervention | Increase in number of questions asked by patients, which was driven by questions about prognosis. | No difference in number of clarification questions. No difference in summed active patient behaviors. No difference in number of critical information items provided by physician, physician rapport building behaviors, encouraging patient participation, consultation length, or amount of time physician and patient spent speaking. | Knowledge, intentions, goals, environmental context and resources | Exchanging information, making decisions, enabling self-management |
| Bylund et al. 2018[ | Communication skills training/educational curriculum | Fellow | Quasi-experimental pre/post | 1 month post-training | Increase in physician self-confidence for each of the following modules: breaking bad news, shared decision making, responding to patient anger, discussing prognosis, transition to palliative care, end of life goals of care discussions, working with interpreters, and responding to adverse events. Of 27 skills measured, significant uptake of 18 skills in in interaction with standardized patients, but only uptake of 4 skills in actual patient encounters. | No increased uptake of skills in 9 of 27 skills in interaction with standardized patients, but no uptake in 23 of 27 skills in actual patient encounters. No increase in 27 patient evaluative items after interaction with physician. | Knowledge, skills, social / professional role and identity | Exchanging information, making decisions, responding to emotion |
| Bylund et al. 2011[ | Patient-directed educational intervention | Patient | Quasi-experimental pre/post | Immediately post-training | Increase in scores on patient report of communication behaviors (prcb) | None reported | Knowledge, skills, beliefs about capabilities | Exchanging information, making decisions, managing uncertainty |
| Canivet et al. 2014[ | Communication skills training/educational curriculum | Nurse | Rct | Immediately post-training and 3 months post-training | Increase in nurses asking questions about emotional component of cancer pain, assessment of cognitions associated with cancer pain medication, fewer paternalistic statements about cancer pain management. Also, increase in overall assessment of psychological aspects of cancer pain medication and overall conclusions about cancer pain management decisions. | No difference in 18 of 22 cancer pain management communication strategies | Knowledge, skills, beliefs about capabilities, emotion | Exchanging information |
| Clayton et al. 2007[ | Question prompt list | Combined patient / healthcare team strategy | Rct | Within 24 hours of intervention, and 3 weeks after intervention | Increased number of questions asked by patients, and total number of issues raised by patients as either question or concern. Seven of 9 topics were discussed significantly more often in intervention group. Physician endorsement associated with more questions asked. | No increase in concerns raised about specific topics, or in general. Two of 9 topics were not discussed significantly more in intervention group. No difference in anxiety scores. | Social / professional role and identity, intentions, goals | Exchanging information, enabling self-management, managing uncertainty |
| Cornbleet et al. 2002[ | Other–patient held medical record | Patient | Rct | 4 to 6 months post-intervention | None reported. | No difference in 10 communication outcomes. | Behavioral regulation | Exchanging information |
| Davison et al. 2002[ | Patient needs / symptom / preference assessment | Patient | Rct | Immediately after intervention | Patients in intervention group preferred less active role in decision making. | None reported. | Intentions, goals | Exchanging information, making decisions, responding to emotion |
| Davison et al. 2014[ | Patient needs / symptom / preference assessment | Combined patient / healthcare team strategy | Quasi-experimental pre/post | Immediately after intervention | Increase patient report of assuming more active role in decision making than previously reported. Decrease in report of decision conflict related to uncertainty, being informed, values clarity, and support. | None reported. | Knowledge | Exchanging information, making decisions |
| Delvaux et al. 2005[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention and 5 months post-intervention | Improvement in 2 of 16 communication skills in simulated interviews, and 11/16 communication skills in actual patient interviews. | No difference in physicians’ utterances to patients, relatives, or combination in 3-person interviews. | Knowledge, skills, beliefs about capabilities | Exchanging information, responding to emotion |
| Delvaux et al. 2004[ | Communication skills training/educational curriculum | Nurse | Rct | Immediately after intervention, 3 months post-intervention, and 6 months post-intervention | Increase in sdaq (measure of psychosocial aspects of cancer) total mean score, and the following subscale scores: attitudes toward oneself, attitudes toward cancer and death, and occupational attitudes. Decrease in stress related to inadequate preparation, caring, and overall stress. | No difference in personal growth or professional relationships. No difference in stress related to lack of support, professional conflicts, death and dying, or workload. | Knowledge, skills, emotion | Responding to emotion, managing uncertainty |
| Detmar et al. 2002[ | Patient needs / symptom / preference assessment | Combined patient / healthcare team strategy | Rct | Longitudinal, crossover study with minimum of 10 consecutive patients enrolled and interviews recorded and coded | Increase in mean composite communication score. More frequent discussion of social functioning, fatigue, and dyspnea. | No increase in frequency of discussion of the following domains: physical functioning, role functioning, emotional functioning, cognitive functioning, pain, insomnia, nausea, appetite loss, and constipation or diarrhea. | Intentions, goals | Exchanging information, responding to emotion |
| Durey et al. 2017[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention and 2 months post-intervention | Increase in cultural safety confidence scores for relationships, communication, and awareness immediately after intervention and 2 months after intervention. Also, increased confidence in applying culturally safe practices in 9 of 14 items. | No increased confidence in applying culturally safe practices in 5 of 14 items. | Knowledge, skills, social / professional role and identity, beliefs about capabilities, beliefs about consequences | Fostering healing relationship, exchanging information, making decisions |
| Eggly et al. 2017[ | Multimodal–question prompt list and patient coaching | Combined patient / healthcare team strategy | Rct | Immediately after intervention | Intervention did not prolong interaction length. | No difference in talk time ratios, patient perception of role in treatment decisions, or trust in physician. Intervention (qpl + coaching) arm rated as less patient-centered than control arm. | Intentions, goals | Exchanging information, enabling self-management |
| Epstein et al. 2017[ | Multimodal–question prompt list, physician communication training, and patient coaching | Combined patient / healthcare team strategy | Rct | Immediately after intervention | Improvement in composite communication score, and improved engagement of patient. | No difference in quality of life measures, response to emotions, prognostic or treatment information provision. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, goals, behavioral regulation | Fostering healing relationship, exchanging information, making decisions, responding to emotion, managing uncertainty |
| Fallowfield et al. 2012[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention | Improvement in presence of the following information in audiotaped conversations: symptoms / palliative care, prognosis, aims of trial, medical benefit. | No difference in the presence of the following information in audiotaped conversations: voluntary nature, unknown side effects, extra effort, and right to withdraw. | Knowledge, skills, goals | Exchanging information, making decisions, managing uncertainty |
| Fallowfield et al. 2002[ | Communication skills training/educational curriculum | Attending physician | Rct | 3 months after intervention | Greater number of focused questions, expressions of empathy, and appropriate responses to patients’ cues in “communication skills training” group. Also, fewer leading questions. | No difference in odds of summarizing information, interruptions, checking understanding. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, goals, emotion | Unclear/not enough information |
| Finset et al. 2003[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention and 2 to 6 years after intervention | Significant long term increase in self-reported skills in communicating with severely ill patients, and improvement in self-reported ability to cope with emotional factors for female physicians. | No association of course completion with knowledge of psychological factors. | Knowledge, skills, beliefs about capabilities, emotion | Exchanging information, responding to emotion, managing uncertainty |
| Fleissig et al. 2001[ | Patient needs / symptom / preference assessment | Combined patient / healthcare team strategy | Rct | Immediately after intervention | Consultations not longer in intervention vs control group. | No difference in satisfaction with consultation after intervention | None clearly targeted. | Exchanging information, making decisions |
| Fujimori et al. 2003[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention and 3 months after intervention | 21 items on self-rating confidence scale for communication all significantly improved after intervention. | No difference in participants’ psychological distress, depersonalization, or personal accomplishment after intervention. Increase in emotional exhaustion. | Knowledge, skills, beliefs about capabilities, beliefs about consequences | Fostering healing relationship, exchanging information, responding to emotion |
| Fujimori et al. 2014[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | Improvement in performance scales for the following skills: setting up supportive environment, considering how to deliver bad news, and providing reassurance and addressing patient’s emotions with empathic responses. Decreased patient report of depression at follow-up. | No difference in discussing additional information. No difference in patient report of anxiety at follow-up. | Knowledge, skills, beliefs about capabilities | Fostering healing relationship, exchanging information, responding to emotion |
| Fukui et al. 2008[ | Communication skills training/educational curriculum | Nurse | Rct | 1 week, 1 month, and 3 months after intervention | Decrease in patient report of depression and total distress. | No difference in patient report of anxiety. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, behavioral regulation | Fostering healing relationship, exchanging information, responding to emotion |
| Fukui et al. 2009[ | Communication skills training/educational curriculum | Nurse | Rct | 1 week, 1 month, and 3 months after intervention | Improvement in nurse’s ability to detect patient’s distress after intervention. | No difference in nurse’s ability to detect patient’s distress in mixed-effects models comparing control vs. Experimental groups. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, behavioral regulation | Fostering healing relationship, exchanging information, responding to emotion |
| Gibon et al. 2013[ | Communication skills training/educational curriculum | Combined healthcare team | Rct | Immediately after intervention | Increase in frequency of the following utterances: directive questions, checking questions, other types of questions, total “assessment” utterances, empathy, negotiation, and emotional words. | No difference in frequency of the following utterances: open questions, open directive questions, leading questions, acknowledgment, reassurance, total “support” utterances, procedural information, other types of information, total “information” utterances, medical words, social words, total “contents” utterances. | Knowledge, skills, social / professional role and identity, beliefs about capabilities | Exchanging information, enabling self-management, responding to emotion |
| Girgis et al. 2009[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention, 1 week and 3 months after intervention | Small difference in anxiety change from baseline at 1 week, but not 3 months. | No significant difference in patients’ emotional functioning, depression, or perceived needs. | Knowledge, skills, beliefs about capabilities | Fostering healing relationship, responding to emotion |
| Goelz et al. 2011[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | Improvement in skills specific to palliative care, global communication skills, and involvement of significant others. | None reported. | Knowledge, skills, goals | Fostering healing relationship, exchanging information, responding to emotion |
| Griffiths et al. 2015[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | Immediately after intervention and 2 months after intervention | Nurses more likely to report that asking about concerns and emotions benefits patients, they will not get too close to their patients, their work will not become unmanageable, exploring concerns is helpful and will not distress patients, and the nurse will not become overwhelmed by the patients emotions. Improved confidence in communication on 16 items in measure. | 12 of 19 items on perceptions of outcomes measure were not different pre/post-intervention. Motivation and perceived usefulness of intervention not significantly changed after intervention. | Knowledge, skills, beliefs about capabilities | Fostering healing relationship, responding to emotion |
| Guadagnoli et al. 2000[ | Other–engaging institutional medical opinion leaders and providing performance feedback | Attending physician | Rct | Immediately after intervention | None reported | No difference in discussions of surgical options between two interventions | Social / professional role and identity, intentions, goals | Exchanging information, making decisions |
| Härter et al. 2015[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention and 3 months after intervention | Improved physician confidence in shared decision making. Patients in intervention group reported lower anxiety and depression scales. | No difference in patient report of confidence in decision or satisfaction with decision. | Knowledge, skills, beliefs about capabilities, behavioral regulatoin | Making decisions |
| Henoch et al. 2013[ | Communication skills training/educational curriculum | Nurse | Rct | Immediately after intervention and 5 to 6 months after intervention | Increase in confidence in communication. | No change in attitudes toward care for the dying. | Knowledge | Fostering healing relationship, responding to emotion |
| Heyn et al. 2012[ | Patient needs assessment | Combined patient / healthcare team strategy | Other—non-randomized control trial | Immediately after intervention | Increase in emotional cues and concerns voiced by patients in intervention group. | Increase in length of consultations by 4 minutes on average. | Intentions, goals, behavioral regulation | Exchanging information, enabling self-management, responding to emotion, managing uncertainty |
| Hietanen et al. 2007[ | Communication skills training/educational curriculum | Combined healthcare team | Other—case-controlled intervention study | Immediately after intervention | Increased patient perception of sufficient time given for decision making, and that physician offered therapeutic treatments outside of trial enrollment. Patients in intervention group better understood study aims of potential clinical trial. | No difference in perception of having received enough information to make a decision, making decisions independently, or expectations of toxicity severity. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, behavioral regulation | Exchanging information |
| Hulsman et al. 2002[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | 4 weeks and 8 weeks after intervention | Increased ratings of physicians’ quality of performance in behavioral assessment. | No difference in assessment of physicians behaviors or patient satisfaction. | Knowledge, consequences | Fostering healing relationship, exchanging information, responding to emotion, managing uncertainty |
| Jenkins et al. 2002[ | Communication skills training/educational curriculum | Combined healthcare team | Rct | 3 months after intervention | Improved physician attitudes towards psychosocial issues. On recorded videotape analysis, increased use of empathic expressions, open questions, appropriate responses to patient cues, and psychosocial probing. | None reported. | Knowledge, skills, beliefs about consequences, beliefs about capabilities, intentions, emotion | Unclear/not enough information |
| Jenkins et al. 2005[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention | Improved scores for the following behaviors: research nurse or doctor referred to, randomization explained, patient’s understanding of randomization checked, standard treatments discussed, treatments explained, side effects discussed, patients encouraged to discuss options with family. | Decrease in use of analogy to describe randomization. No difference in scores for the following behaviors: purpose of interview defined, study defined as research, voluntary participation explained, withdrawal from study explained, uncertainty about treatment expressed, participant summarized discussion, patients encouraged to ask questions and read information sheet, or use of 6 specifically recommended phrases. | Knowledge | Exchanging information, managing uncertainty |
| Johnson et al. 2013[ | Communication skills training/educational curriculum | Combined healthcare team | Other—non-randomized control study | Immediately after intervention | None reported. | No difference in the consultation and relational empathy (are) measure completed by patients. | Knowledge, skills, beliefs about capabilities | Unclear/not enough information |
| Jones et al. 2011[ | Communication or shared decision-making coaching | Patient | Rct | 8 weeks after intervention. | Increased report of discussions with professionals or family and friends about the future | Happiness with communication was unchanged or worse, and satisfaction with services decreased. | Emotion | Making decisions, responding to emotion |
| Kruijver et al. 2001[ | Communication skills training/educational curriculum | Nurse | Rct | Immediately after intervention | Increased verbal instrumental communication behaviors in the following categories: psychosocial / feelings, psycho-social items / feelings, total open questions, medical / therapeutic items, and fewer total closed questions. | No change in 12 of 17 instrumental communication behaviors. No differences in 14 of 14 affective communication behaviors. | Knowledge, skills, emotion, behavioral regulation | Fostering healing relationship, exchanging information, responding to emotion |
| Langewitz et al. 2010[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | 6 months after intervention, but immediately after booster session | Increase in empathic responses, professional reassurance, and optimistic utterances. Decrease in amount of medical or therapeutic information mentioned by nurses, and decrease in counselling about medical or therapeutic issues. Increased attention to psychosocial issues. Increased length of uninterrupted speech. | No change in 53 of 63 other communication behaviors that were coded. | Knowledge, skills | Fostering healing relationship, |
| Lenzi et al. 2011[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention | Increase in self-efficacy, knowledge of communication skills, favorable changes in attitudes towards disclosure of medical information and assessing patients’ concerns and fears. | No difference in “got right to the point and delivered news immediately,” challenging a patient’s denial about incurable nature of cancer, downplaying gravity of a patient’s condition in order not to destroy hope, or emphasizing the high chances of controlling pain to foster hope in a dying patient. | Knowledge, skills, beliefs about capabilities, emotion | Fostering healing relationship, exchanging information, responding to emotion |
| Liénard et al. 2008[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | None reported | No difference in report of patients’ or relatives’ anxiety. | Knowledge, skills, beliefs about capabilities | Exchanging information, responding to emotion, managing uncertainty |
| Liénard et al. 2006[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | None reported | No difference in report of patients’ anxiety. | Knowledge, skills, beliefs about capabilities | Exchanging information, responding to emotion, managing uncertainty |
| Liu et al. 2007[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | 1 month and 6 months after intervention | Improvement in scales for basic communication skills, self-efficacy, outcome expectancy beliefs, and perceived support in the training group. | None reported. | Knowledge, skills, social / professional role and identity, beliefs about capabilities, beliefs about consequences, environmental context and resources, social influences | Unclear/not enough information |
| Lubrano di Ciccone et al. 2010[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention | Increase in participants’ confidence in conducting an interview via interpreters. | None reported. | Knowledge, skills, goals, environmental context and resources | Fostering healing relationship, exchanging information |
| Merckaert et al. 2015[ | Communication skills training/educational curriculum | Combined healthcare team | Rct | Multiple time points throughout intervention | Increased clinicians assessment skills, supportive skills and provided more setting information. Patients interacting with members of the trained teams asked more open questions, expressed more emotional words, and exhibited a higher satisfaction level regarding nurses’ interventions. | No change in information utterances, or contents of clinician utterances. No change in patients’ use of medical words, radiotherapy words, or social words. | Knowledge, skills, social / professional role and identity, beliefs about capabilities | Exchanging information, enabling self-management, responding to emotion |
| Merckaert et al. 2005[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | None reported. | No difference in physicians’ ability to assess patients’ distress. | Knowledge, skills | Exchanging information, responding to emotion, managing uncertainty |
| Meropol et al. 2013[ | Multimodal—assessment of patient values, goals, and communication preferences; patient communication skills training; and a preconsultation physician summary report | Combined patient/healthcare team strategy | Rct | Immediately after intervention | Patient communication skill training led to increase in patients reporting that treatment decisions were easier to reach, that they were satisfied with these decisions. Patients in intervention arms also reported higher levels of satisfaction with physician communication format and discussion regarding support services and quality of life concerns. | Patient communication skill training did not increase patient report of satisfaction with discussion about diagnosis / prognosis, overall satisfaction. Also, no effect of physician summary report on outcomes. | Knowledge, intentions, goals | Exchanging information, making decisions |
| Meystre et al. 2013[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention | None reported. | No improvement in working alliance as a result of intervention. | Knowledge, skills | Fostering healing relationship, making decisions, responding to emotion |
| Mishel et al. 2009[ | Communication or shared decision-making coaching | Patient | Rct | Immediately after intervention | Increase in patient report of uncertainty management (cancer knowledge, problem-solving, and patient-clinician communication, driven), medical communication competence, umber and helpfulness of resources for information, and decisional regret. | No difference in how much the patient tells nurses, how much the nurses tell the patient, mood disturbances, or quality of life. | Knowledge, skills, intentions, goals | Exchanging information, making decisions, managing uncertainty |
| Morasso et al. 2015[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | 1 to 2 months after intervention | Decrease in state-anxiety levels in intervention group. | None reported. | Knowledge, skills, beliefs about capabilities, emotion | Exchanging information, responding to emotion |
| Morita et al. 2014[ | Communication skills training/educational curriculum | Nurse | Rct | 2 to 4 months after intervention | Increase in nurse-reported confidence in caring for terminally ill and nurse perceived value of patients inner power. | No difference in nurses’ self-reported practice score, willingness to help, positive appraisal, helplessness, nurse-perceived value of being, or burnout, emotional exhaustion, depersonalization, meaning of life, or knowledge scales. | Knowledge, skills | Responding to emotion |
| Ong et al. 2000[ | Other—patients provided with audiorecording of initial consultation | Patient | Rct | 1 week and 3 months after intervention | Increase in patient satisfaction with consultation and recall of information. | No difference in quality of life. | None directly targeted | Exchanging information |
| Paladino et al. 2019[ | Multimodal–question prompt list and communication skills training | Combined patient / healthcare team strategy | Rct | Every 2 months for 2 years or until death | Decreased anxiety symptoms reported in intervention group at 14 weeks and 24 weeks post-intervention. | No difference in median number of goals met by patients, peace scale, human connection scale, or depressive symptoms. | Knowledge, skills, beliefs about capabilities, intentions, goals, environmental context and resources | Fostering healing relationship, exchanging information, making decisions, responding to emotion |
| Parker et al. 2013[ | Communication skills training/educational curriculum | Nurse | Rct | 2 months after intervention | Increase in nurse report of discussing complementary and alternative medicine with patients. | No difference in patient report of discussing complementary and alternative medicine with nurses. | Knowledge, intentions, goals | Exchanging information |
| Post et al. 2013[ | Multimodal—patient needs / symptom / preference assessment and patient-directed communication training | Combined patient / healthcare team strategy | Rct | Weekly during intervention and immediately after intervention | Lower average pain severity over time in intervention group. | No difference in mean pain interference scores, mean depression, or fatigue scores. | Knowledge, skills, behavioral regulation | Exchanging information, enabling self-management, managing uncertainty |
| Quinn et al. 2011[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention | Higher proportion of participants reporting comfort with cultural communication skills, but no statistical tests performed. | None reported | Knowledge | Unclear/not enough information |
| Rask et al. 2009[ | Communication skills training/educational curriculum | Nurse | Rct | 1 week and 3 months after intervention | None reported. | No differences in scores on measures related to communication or work-related stress. | Knowledge, skills, beliefs about capabilities | Exchanging information, responding to emotion |
| Razavi et al. 2002[ | Communication skills training/educational curriculum | Nurse | Rct | Immediately after intervention and 3 months after intervention | Increased use of emotional words by trained nurses. | None reported. | Knowledge, skills | Fostering healing relationship, responding to emotion |
| Razavi et al. 2003[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | In simulated interviews, increase in use of open and open directive questions, and utterances alerting patients to reality. Also, decrease in premature reassurance. In actual patient interviews, increase in acknowledgments, empathic statements, educated guesses, and negotiations. | In simulated interviews, no difference in 11 of 22 communication skills evaluated. In actual patient interviews, no difference in 18 of 22 communication skills evaluated. | Knowledge, skills, beliefs about capabilities | Exchanging information, responding to emotion, managing uncertainty |
| Sargeant et al. 2011[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention and unclear additional follow-up | Improvement in self-reported communication skills after workshops. | None reported. | Knowledge, skills, beliefs about capabilities | Exchanging information |
| Schofield et al. 2013[ | Patient needs / symptom / preference assessment | Patient | Rct | Immediately after intervention | None reported. | No difference in unmet needs, psychological morbidity and distress, or healthcare-related quality of life. | Knowledge, intentions, goals, emotion | Fostering healing relationship, exchanging information, enabling self-management, responding to emotion |
| Sheppard et al. 2013[ | Communication or shared decision-making coaching | Patient | Quasi-experimental pre/post | Within 3 months after intervention | Increased self-efficacy in communicating with clinicians and making treatment decisions (not statistically tested). Increased participant rating of involvement in their care. | “no other factors were associated with pics scores.” | Knowledge, skills, beliefs about capabilities, intentions, social influences | Exchanging information, making decisions, enabling self-management |
| Smith et al. 2010[ | Communication skills training/educational curriculum | Patient | Rct | Immediately after intervention, and 4 weeks and 12 weeks post-baseline assessment | Decrease in patient report of pain barriers. | No difference in patient report of pmi index, pain relief, quality of life–mental component, quality of life–physical component, distress, or satisfaction with care. | Knowledge, skills, behavioral regulation | Exchanging information, enabling self-management |
| Stewart et al. 2007[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | Subanalysis for family physicians had increased communication scores. | No difference in patient centeredness of the visit, satisfaction, psychological distress, or patient feeling better. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions | Unclear/not enough information |
| Street et al. 2010[ | Communication or shared decision-making coaching | Patient | Rct | Immediately after intervention | Increased discussion of pain concerns and increased pain-specific participation | No increase in total patient participation. | Knowledge, skills, beliefs about capabilities, intentions, goals, behavioral regulation | Exchanging information, enabling self-management |
| Sutherland et al. 2007[ | Communication skills training/educational curriculum | Attending physician | Quasi-experimental pre/post | Immediately after intervention | Increased physician confidence in using techniques to deliver bad news (10 of 10 techniques evaluated). Increase in self-report of using 3 of 8 strategies to deliver bad news. | No increase in self-report of using 5 of 8 strategies to deliver bad news. | Knowledge, skills, beliefs about capabilities | Exchanging information |
| Tang et al. 2014[ | Communication skills training/educational curriculum | Combined healthcare team | Quasi-experimental pre/post | Immediately after intervention | Increase in healthcare clinicians’ truth-telling preference, as well as increases in the following subscores: method of disclosure, emotional support, additional information, and setting. | None reported. | Knowledge, skills, beliefs about capabilities | Exchanging information |
| Tulsky et al. 2011[ | Communication skills training/educational curriculum | Attending physician | Rct | Immediately after intervention | Increased in physician’s use of empathic statements and increase in likelihood of responding to negative emotions empathically. Patients of intervention physicians reported greater trust in the physician. | No difference in perceived empathy, therapeutic alliance scale, perceived knowledge of the patient, perceived belief that the physician cared about the patient, or perceived belief that the physician understood the patient as a whole person. | Knowledge, beliefs about capabilities, intentions, goals, behavioral regulation | Fostering healing relationship, exchanging information, responding to emotion |
| Turner et al. 2009[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | Immediately after intervention | Improvement in the following subscores for somatic subscale of ghq psychological morbidity test. Increase in item about “taking an active role in caring for myself emotionally and spiritually.” Increase in 4 of 5 confidence measures related to emotional support for patients. | No difference in maslach burnout inventory or overall ghq psychological morbidity scores. No difference in perception of stress at work or outside of work (4 of 4 items), 4 of 5 items related to attitudes, or 1 of 5 items related to confidence. | Knowledge, skills, social/professional role and identity, beliefs about capabilities | Fostering healing relationship, responding to emotion, managing uncertainty |
| van Bruinessen et al. 2016[ | Patient-directed educational intervention | Patient | Rct | Immediately after intervention and 3 months after intervention | None reported. | No significant improvement in communication self-efficacy resulting from the intervention. | Knowledge, skills, intentions, goals, emotion, behavioral regulation | Exchanging information, responding to emotion |
| van Weert et al. 2011[ | Multimodal—communication skills training with web-enabled video feedback and a question prompt sheet | Combined patient / healthcare team strategy | Other—randomized pre-test/post-test control group study | Immediately after intervention | Increase in discussing realistic expectations. Increase in overall information and recommendation communication behaviors. Within information behaviors, increases in 7 of 14 evaluated behaviors. Within recommendation behaviors, increase in 4 of 11 evaluated behaviors. | No difference in tailored communication, affective communication, interpersonal communication, treatmet-related information, or coping information. Decrease in rehabilitation information. | Knowledge, skills, beliefs about capabilities, intentions, goals | Exchanging information, responding to emotion |
| Velikova et al. 2004[ | Patient needs assessment | Combined patient / healthcare team strategy | Rct | Immediately after intervention | Increase in patient quality of life measurement, but significance lost when time incorporated into mixed-effects model. | None reported. | Intentions, goals | Exchanging information, responding to emotion |
| Walczak et al. 2017[ | Question prompt list | Patient and family | Rct | Immediately after intervention and 1 month after intervention | Increase in patient for discussion of prognosis, end-of-life care, future care options and general issues not targeted by the intervention. Increased patient self-efficacy in knowing what questions to ask their doctor. | No difference in asking questions about these issues or overall question asking, patients’ health-related quality-of-life, or the likelihood that health information or shared decision-making preferences were met. | Social / professional role and identity, beliefs about capabilities, intentions, goals, behavioral regulation | Exchanging information, making decisions |
| Walker et al. 2005[ | Patient-directed educational intervention | Patient | Rct | 1 to 2 weeks after intervention | In exploratory subgroup analyses, minority patients in intervention group were more satisfied with the overall clinic appointment. Unmarried patients in intervention group had lower distress. Patients with history of mental health treatment in intervention group reported higher quality of life. | No overall difference in outcomes. | Knowledge, intentions, goals, social influences, emotion | Exchanging information |
| Wilkie et al. 2010[ | Patient-directed educational intervention | Patient | Rct | Immediately after intervention | Small increase in providing unsolicited sensory pain information, and mentioning it before their clinicians asked for it. Increase in mean number of pain parameters discussed. | No differences in scores for analgesic adequacy, all pain indices except one, anxiety, depression, or catastrophizing coping. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, goals, behavioral regulation | Exchanging information, enabling self-management |
| Wilkinson et al. 2002[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | Immediately after intervention | Improvement in 9 of 9 areas of communication assessment: introduction, admission, diagnosis, present illness, previous illness, physical, social, psychological, closure. | None reported. | Knowledge, skills, beliefs about capabilities, emotion | Fostering healing relationship, exchanging information, responding to emotion |
| Wilkinson et al. 2003[ | Communication skills training/educational curriculum | Nurse | Quasi-experimental pre/post | 6 weeks after intervention | Improvement in 8 of 9 areas of communication assessment: introduction, admission, diagnosis, present illness, previous illness, social, psychological, closure. Improved confidence reported in 44 of 44 items. | No change in physical assessment of the patient. | Knowledge, skills, beliefs about capabilities, beliefs about consequences, emotion | Exchanging information, responding to emotion |
| Wilkinson et al. 2008[ | Communication skills training/educational curriculum | Nurse | Rct | 12 weeks after intervention | Increase in nurses’ communication scores, and increase in nurses’ report of confidence in communication skills. | None reported | Knowledge, skills, beliefs about capabilities, beliefs about consequences | Exchanging information, responding to emotion, managing uncertainty |
| Wuensch et al. 2017[ | Communication skills training/educational curriculum | Attending physician | Rct | 2 weeks after intervention | Increase in communication score on all items, for the subgroup of content-specific items, and for the global rating of communication competence. Communication confidence improved in 9 of 10 domains. | No difference in subgroup of general communication skills. No difference in confidence in 1 off 10 domains: respect of information needs. | Knowledge, skills, goals | Exchanging information |
Characteristics of study outcomes
Discussion
PRISMA scoping review checklist.
119 in total
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