The effectiveness of a computer-assisted instruction programme on communication skills of medical specialists in oncology.

Although doctor-patient communication is important in health care, medical specialists are generally not well trained in communication skills. Conventional training programmes are generally time consuming and hard to fit into busy working schedules of medical specialists. A computer-assisted instruction (CAI) programme was developed -'Interact-Cancer' - which is a time-efficient learning method and easily accessible at the workplace. To investigate the effect of the CAI training, 'Interact-Cancer', on the communication behaviour of medical specialists, and on satisfaction of patients about their physician interaction. Consultation of medical specialists with cancer outpatients were videotaped at 4 specific stages, 2 before and 2 after Interact-Cancer, with intervals of 4 weeks . Participants were 21 medical specialists, mainly internists, working in 7 hospitals, and 385 cancer outpatients. Communication behaviour was assessed on 23 observation categories derived from the course content. Frequencies were rated as well as judgments about the quality of the performance of each target skill. Satisfaction was measured by the Medical interview Satisfaction scale. Data were analyzed by means of multilevel statistical methods. The behavioural assessment showed course effects on ratings of the physicians' quality of performance. No course effects were found on the frequencies of physicians' behaviours and on the patient satisfaction ratings. CAI is a promising method to supply medical specialists with postgraduate training of communication skills. The application of judgement ratings of communication behaviour proved to be valuable to evaluate course effects in real-life patient encounters. (aut.ref.

Teaching clinically experienced physicians communication skills: a review of evaluation studies.

Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. Objective: this review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. Methods: CD-ROM searches were performed on Medline and Psychlit, with a focus on effect-studies dating from 1985. Results: fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate designs report the fewest positive training effects. Conclusion: several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice. (aut.ref.

The effect of the computer-assisted interactive video training interact-cancer on the communication skills of medical specialists in oncology.

Introduction. INTERACT-CANCER is an interactive course for training communication skills of medical specialists in oncology. The course aims at teaching patient-centred behaviour. It includes four main topics in doctor-patient communication: basic skills, communicating bad news, informing patients, and dealing with emotional reactions of the patient. The course program was developed to facilitate the access to learning of post-graduate physicians. Methods. The course is tested in and evaluated by 21 medical specialists in oncology, working in 7 hospitals. An assessment of their communication behaviour in real life consultations with cancer patients was made at 4 measurement moments; 2 pre-course measurements, and 2 post-course measurements. The physicians did the course between T2 and T3 at their workplace on an individual basis. Each measurement moment three sources of information were used to assess the communication behaviour of the participating physicians: 1) independent ratings of videotaped consultations, 2) satisfaction of the patients about the interaction, 3) satisfaction of the physician about the interaction. Results. Interact-Cancer was positively evaluated by the participating physicians. The computer-assisted training method was evaluated as attractive and pleasant. The course content was evaluated as being worthwhile, relevant, appropriate, and well-structured. Furthermore, the participants stated they are attended on inadequate behaviour, stimulated to think about own behaviour and stimulated to change behaviour. The measurements show an improvement in the quality of communication skills from pre to post training in a subgroup of physicians who state themselves that they put aspects of the training into practice. No training effects were found on the satisfaction ratings of the patients and the physicians. Conclusion. INTERACT-CANCER shows to be a very promising course. Especially among well motivated physicians an improvement in the quality of communication is achievable by means of a computer assisted course. (aut. ref.

Culturally sensitive care for elderly immigrants through ethnic community health workers: design and development of a community based intervention programme in the Netherlands.

BACKGROUND: In Western countries, health and social welfare facilities are not easily accessible for elderly immigrants and their needs are suboptimally addressed. A transition is needed towards culturally sensitive services to overcome barriers to make cure and care accessible for elderly immigrants. We developed an intervention programme in which ethnic community health workers act as liaisons between immigrant elderly and local health care and social welfare services. In this study we evaluate the effectiveness and the implementation of this intervention programme. METHODS/DESIGN: In a quasi experimental design, the effectiveness of introduction of community health workers, health needs assessment, and follow-up intervention programme will be evaluated in three (semi) urban residential areas in the Netherlands and compared with a control group. Community health workers are selected from local ethnic communities and trained for the intervention. Data on health perception, quality of life, and care consumption are collected at baseline and after the intervention programme. Elderly’s informal care givers are included to examine caregiver burden. The primary outcome is use of health care and social welfare facilities by the elderly. Secondary outcomes are quality of life and functional impairments. The target number of participants is 194 immigrant elderly: 97 for the intervention group and 97 for the control group. Implementation of the intervention programme will be examined with focus groups and data registration of community health worker activities. DISCUSSION: This study can contribute to the improvement of care for elderly immigrants by developing culturally sensitive care whereby they actively participate. To enable a successful transition, proper identification and recruitment of community health workers is required. Taking this into account, the study aims to provide evidence for an approach to improve the care and access to care for elderly immigrants. Once proven effective, the community health worker function can be further integrated into the existing local health care and welfare system. TRIAL REGISTRATION: Trial registration number: ISRCTN8944779