A randomised trial of personal coaching was recently reported in JAMA Internal Medicine.[1] The authors claim that this is the first such study, and that previous studies have been small, non-randomised and lacking in objective assessment.
Cardiologists were chosen as the treatment group. How did the authors persuade well-paid, busy, heart specialists to take part? They paid them $200. Patients were also paid for their time but at a lower rate of $20. Only 40 cardiologists took part, along with 240 patients. A minimisation programme was used to maximise the balance of cardiologist characteristics across intervention and control groups.
Intervention cardiologists received three one-to-one instruction sessions on communication skills instruction. The basic curriculum was similar to that which we teach our medical students; establish eye contact, introduce yourself, ask open questions, gently test the patient’s grasp of essential points by encouraging ‘playback’, and so on. The educational model was based on strength-based practice, experiential learning, and feedback. Cardiologists audio recorded conversations with patients. They then went through these with the coach and provided self-criticism or self-praise. When the intervention was complete in the intervention arm, patient encounters were recorded from both the intervention and control arms.
Third party coding was used and, interestingly, the researchers who coded the encounters achieved excellent reliability, with a correlation coefficient of over 80%. Encounters were objectively coded based on cardiologist behaviours, and global ratings of communication for warmth and respect. Patient outcomes were recorded in terms of interpersonal processes, trust, and a care measure. Physician outcomes were burnout (using a validated scale) and feedback on the intervention.
Intervention cardiologists were objectively more likely to make empathetic statements, and to ask open questions than control cardiologists. Their patients also perceived empathy to a greater extent than patients of control cardiologists. As in previous studies, the authors were unable to study differences in patient ratings because of ceiling effects.
There exist a great number of decision rules and decision support programmes. According to these authors, however, much less work has been done on actually improving clinician communication performance. I was surprised the authors registered positive effects with a trial of only 40 cardiologists.
The NIHR Midlands Patient Safety Research Collaboration will work with our ARC West Midlands to improve communication in a maternity context, with special reference to presenting probabilistic information. This JAMA paper will be a useful reference as we design our detailed protocol.
— Richard Lilford, ARC WM Director
Reference:
- Pollak KI, Olsen MK, Yang H, et al. Effect of a Coaching Intervention to Improve Cardiologist Communication. A Randomized Clinical Trial. JAMA Intern Med. 2023.