Effect of a Coaching Intervention to Improve Cardiologist Communication: A Randomized Clinical Trial.
Abstract
<h4>Importance</h4>Communication between cardiologists and patients can significantly
affect patient comprehension, adherence, and satisfaction. To our knowledge, a coaching
intervention to improve cardiologist communication has not been tested.<h4>Objective</h4>To
evaluate the effect of a communication coaching intervention to teach evidence-based
communication skills to cardiologists.<h4>Design, setting, and participants</h4>This
2-arm randomized clinical trial was performed at outpatient cardiology clinics at
an academic medical center and affiliated community clinics, and from February 2019
through March 2020 recruited 40 cardiologists and audio recorded 161 patients in the
preintervention phase and 240 in the postintervention phase. Data analysis was performed
from March 2022 to January 2023.<h4>Interventions</h4>Half of the cardiologists were
randomized to receive a coaching intervention that involved three 1:1 sessions, 2
of which included feedback on their audio-recorded encounters. Communication coaches
taught 5 skills derived from motivational interviewing: (1) sitting down and making
eye contact with all in the room, (2) open-ended questions, (3) reflective statements,
(4) empathic statements, and (5) "What questions do you have?"<h4>Main outcomes and
measures</h4>Coders unaware of study arm coded these behaviors in the preintervention
and postintervention audio-recorded encounters (objective communication). Patients
completed a survey after the visit to report perceptions of communication quality
(subjective communication).<h4>Results</h4>Analysis included 40 cardiologists (mean
[SD] age, 47 [9] years; 7 female and 33 male) and 240 patients in the postintervention
phase (mean [SD] age, 58 [15] years; 122 female, 118 male). When controlling for preintervention
behaviors, cardiologists in the intervention vs control arm were more likely to make
empathic statements (intervention: 52 of 117 [44%] vs control: 31 of 113 [27%]; P = .05);
to ask, "What questions do you have?" (26 of 117 [22%] vs 6 of 113 [5%]; P = .002);
and to respond with empathy when patients expressed negative emotions (mean ratio
of empathic responses to empathic opportunities, 0.50 vs 0.20; P = .004). These effects
did not vary based on patient or cardiologist race or sex. We found no arm differences
for open-ended questions or reflective statements and were unable to assess differences
in patient ratings due to ceiling effects.<h4>Conclusions and relevance</h4>In this
randomized clinical trial, a communication coaching intervention improved 2 key communication
behaviors: expressing empathy and eliciting questions. Empathic communication is a
harder-level skill that may improve the patient experience and information comprehension.
Future work should explore how best to assess the effect of communication coaching
on patient perceptions of care and clinical outcomes and determine its effectiveness
in larger, more diverse samples of cardiologists.<h4>Trial registration</h4>ClinicalTrials.gov
Identifier: NCT03464110.
Type
Journal articlePermalink
https://hdl.handle.net/10161/27247Published Version (Please cite this version)
10.1001/jamainternmed.2023.0629Publication Info
Pollak, Kathryn I; Olsen, Maren K; Yang, Hongqiu; Prose, Neil; Jackson, Larry R; Pinheiro,
Sandro O; ... Johnson, Kimberly S (2023). Effect of a Coaching Intervention to Improve Cardiologist Communication: A Randomized
Clinical Trial. JAMA internal medicine. 10.1001/jamainternmed.2023.0629. Retrieved from https://hdl.handle.net/10161/27247.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Larry Ronald Jackson II
Associate Professor of Medicine
Dr. Jackson is a physician-scientist with clinical expertise in adult clinical cardiac
electrophysiology. His research focuses on identifying determinants of racial/ethnic
differences in arrhythmia care and the development and implementation of patient-centered
interventions aimed at facilitating shared decision-making in populations that have
been systemically disadvantaged with abnormal heart rhythm conditions. Dr. Jackson
has an advanced degree (MHSc) in clinical and qualitative res
Kimberly Sherell Johnson
Professor of Medicine
Maren Karine Olsen
Professor of Biostatistics & Bioinformatics
Health services research, longitudinal data methods, missing data methods
Sandro Pinheiro de Oliveira
Professor in Medicine
Dr. Pinheiro directs faculty development activities for clinical and basic science
faculty, designs medical and interprofessional education curricula, coaches/mentors
medical faculty and fellows, and conducts evaluation and research in medical and interprofessional
education. His educational competencies are in the areas of adult learning, instructional
strategies, active learning, curriculum design and evaluation, and qualitative inquiry.
His research activities focus on medical and interpro
Kathryn IIonka Pollak
Professor in Population Health Sciences
Dr. Pollak is a social psychologist who designs and tests behavioral interventions
to promote smoking cessation, reduce health disparities, and improve clinician-patient
communication. She also is one of the Multiple Principal Investigators of the Palliative
Care Research Cooperative that supports multi-site palliative care trials. Finally,
Dr. Pollak serves as a Communication Coach where she teaches clinicians effective
communication techniques.Area of expertise: Health Behavior<br
Neil Stuart Prose
Professor of Dermatology
Research interests: My overall area of interest is pediatric dermatology. In the course
of providing patient care, my aim is to advance scientific knowledge in this field.
This goal is achieved through clinical observation, clinical trials, and collaboration
with laboratories exploring the molecular basis of disease. I am also interested
in providing care for skin disease in developing countries. In the course of a number
of projects in Latin America and Africa, I have d
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