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Effect of a Coaching Intervention to Improve Cardiologist Communication: A Randomized Clinical Trial.

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Date
2023-04
Authors
Pollak, Kathryn I
Olsen, Maren K
Yang, Hongqiu
Prose, Neil
Jackson, Larry R
Pinheiro, Sandro O
Dunbar, T Kayla
Johnson, Kimberly S
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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 article
Permalink
https://hdl.handle.net/10161/27247
Published Version (Please cite this version)
10.1001/jamainternmed.2023.0629
Publication 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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Scholars@Duke

Jackson

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
Johnson

Kimberly Sherell Johnson

Professor of Medicine
Olsen

Maren Karine Olsen

Professor of Biostatistics & Bioinformatics
Health services research, longitudinal data methods, missing data methods
Pinheiro de Oliveira

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
Pollak

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
Prose

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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