Principles & Evidence
A variety of principles lay the foundation for the need to improving communication with seriously ill patients.
These are the principles that have shaped the Pathfinder portal
- Communication skills can be learned, provided that effective learning methods are used.
- Clinician communication training must reach clinicians who are not specialists in palliative care, because there will be insufficient numbers of trained palliative care clinicians to meet the need in the U.S. for at least another decade.1
- Improving clinician communication skills is a necessary step in improving care for patients with serious illness.
These foundational principles are supported by empirical findings
- Physicians who discuss goals of care with seriously ill patients commonly fail to discuss values, and instead focus on procedures such as CPR.2 3
- Patients who wish to be informed (the large majority of patients) commonly fail to understand their true prognosis,4 their erroneous beliefs are associated with end-of-life treatment that results in unwanted CPR, unwanted death in the hospital, and burdensome interventions in the last month of life, including chemotherapy, feeding tubes, and mechanical ventilation.5
- Patients who report conversations with their physicians about their values and preferences are more likely to accept that their illness is incurable, more likely to want to make decisions about invasive treatments, and less likely to have unwanted treatments in the last week of life.6 7 8
- Physicians who have not had evidence-based communication training commonly overrate their skill level when compared with patients and trained raters who look for effective behaviors 9
- Untrained physicians fail to use the communication skills most important for goals of care conversations. For example, untrained oncologists make empathic statements in only 10% of their conversations with patients who have incurable cancers.10 Yet other studies show that the number of empathic statements made by clinicians correlates positively with information retention by patients.11
- Evidence-based communication training changes clinician behaviors in audiotaped encounters with standardized and real patients vis-à-vis sharing serious news, discussing prognosis, and discussing goals of care.12 13 These changes correlate with increased patient trust.14
- Medical centers with a high concentration of communication-trained clinicians have cultures that support serious illness care in ways that are noticeably different in observational studies.15