Communication Skills in Action: End-of-Life Discussions
Communication Skills in Action: End-of-Life Discussions
End-of-life discussions can be stressful and can elicit strong emotions in the provider as well as the patient and family. In palliative care, understanding and effectively addressing emotions is a key skill that can enhance professional competency and patient/family satisfaction with care. Role-play is a method of simulation used commonly to teach communication skills. Role-play methods can be enhanced by action techniques that come from psychodrama and sociodrama, including warm-ups, role-creation, doubling, and role reversal. These techniques prepare learners to take on the role of others in a role-play; to develop insight into unspoken attitudes, thoughts, and feelings of the patient and families, which often determine the behavior of others; and to enhance communication skills as participants practice effective responses and experience what it feels like to be on the receiving end of empathic and clear communication.
The following are article summaries related to communication, care and end-of-life conversations.
Teaching communication skills: using action methods to enhance role-play in problem-based learning.Baile WF, Blatner A. Simulation in Healthcare. 2014 Aug;9(4):220-7.
SUMMARY:Role-play is a method of simulation used commonly to teach communication skills. Role-play methods can be enhanced by techniques that are not widely used in medical teaching, including warm-ups, role-creation, doubling, and role reversal. The purposes of these techniques are to prepare learners to take on the role of others in a role-play; to develop an insight into unspoken attitudes, thoughts, and feelings, which often determine the behavior of others; and to enhance communication skills through the participation of learners in enactments of communication challenges generated by them. In this article, we describe a hypothetical teaching session in which an instructor applies each of these techniques in teaching medical students how to break bad news using a method called SPIKES [Setting, Perception, Invitation, Knowledge, Emotions, Strategy, and Summary]. We illustrate how these techniques track contemporary adult learning theory through a learner-centered, case-based, experiential approach to selecting challenging scenarios in giving bad news, by attending to underlying emotion and by using reflection to anchor new learning.
Applying sociodramatic methods in teaching transition to palliative care.Baile WF, Walters R. Journal of Pain and Symptom Management. 2013 Mar;45(3):606-19.
SUMMARY: We introduce the technique of sociodrama, describe its key components, and illustrate how this simulation method was applied in a workshop format to address the challenge of discussing transition to palliative care. We describe how warm-up exercises prepared 15 learners who provide direct clinical care to patients with cancer for a dramatic portrayal of this dilemma. We then show how small-group brainstorming led to the creation of a challenging scenario wherein highly optimistic family members of a 20-year-old young man with terminal acute lymphocytic leukemia responded to information about the lack of further anticancer treatment with anger and blame toward the staff. We illustrate how the facilitators, using sociodramatic techniques of doubling and role reversal, helped learners to understand and articulate the hidden feelings of fear and loss behind the family’s emotional reactions. By modeling effective communication skills, the facilitators demonstrated how key communication skills, such as empathic responses to anger and blame and using “wish” statements, could transform the conversation from one of conflict to one of problem solving with the family. We also describe how we set up practice dyads to give the learners an opportunity to try out new skills with each other. An evaluation of the workshop and similar workshops we conducted is presented.