Serious Illness Communication Tool for Palliative Care Fellows: Development, Implementation, and Lessons Learned

Abstract

Introduction: Learning expert communication skills is a core educational goal within palliative care training, yet there are few communication-based educational tools specifically designed for specialty-trained palliative care providers. Objective: To develop and implement a tool to facilitate effective learning of serious illness communication for hospice and palliative medicine fellows. Methods: A novel formative assessment tool was developed within the UCLA Palliative Care Fellowship program, and utilized throughout the academic year on a weekly basis. Focus groups were held for fellows and faculty separately at the end of the academic year in order to gain insight into the experience and effectiveness of the tool. Focus group transcripts were analyzed through thematic analysis. Results: There was a 47% participation rate in the focus groups (n = 7). Qualitative analysis demonstrated positive impact of the tool in identifying learning goals, improving quality of feedback, and in standardizing language around advanced communication skills, with most value in the first half of the fellowship year. Some aspects of the tool were found to increase feedback anxiety, including the competency scoring component, frequency of use, and utilization with individual patient encounters. Conclusion: This novel communication tool provides an important addition to serious illness communication training of specialist palliative care providers, in creating a shared mental model for naming and organizing skills, as well as generating specific high quality learning goals and feedback. Preliminary feedback from our pilot implementation phase provided important information about how to refine the tool and remove components that unnecessarily added to feedback anxiety.