Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention
Authors: Adeyemi Oluwaseun , Ginsburg Alexander D. , Kaur Regina , Cuthel Allison M. , Zhao Nicole , Siman Nina , Goldfeld Keith S , Emlet Lillian Liang , DiMaggio Charles , Yamarik Rebecca Liddicoat , Bouillon-Minois Jean-Baptiste , Chodosh Joshua , Grudzen Corita R. ,   The PRIM-E. R. Investigators, Southerland Lauren T. , Gulker Peg , Johnston Andrew , Venkat Arvind , Chuirazzi David , O’Neill John , Szabo Kelly , Urosek Rachel , Deutsch Ashley , Schoenfeld Elizabeth , Shaw Melissa , Guerino Tricia , Perko Alayna , Comasco Lauren Cameron- , Banish Michael , Sloan Pamela , Swor Robert , Otero Ronny , Elliot Aaron , Reiner Kim , Hurd Nicole , Ballaron Brittany , Ouchi Kei , Egorova Natasha , Dundin Andrew , Troncoso Niza , Powell Robin , Debbage Barbara J. , Johnson Deborah , Powell John , Cooper Julie , Graham-Brekke Doretha , Zimny Erin , Tokarski Glenn , Miller Joseph , Sadia Olive , Richardson Christopher , Kroll Jennifer , Siller Jennifer , Fleischer-Black Jessica , Evelyn Karen , Stark Laura , Gordon Lauren , Richardson Lynne , Lin Michelle , Tan Audrey , Sommer Alicia , Loprinzi-Brauer Caitlin , Heaton Heather , Walker Laura , Bellolio MFernanda , Christenson Molly , Shelley Donna , Liametz Audie , Rosenthal Barry , Wittman Ian , Peterson Kathy , Hageman-Sheehan Lila , Gulati Rajneesh , Smeltz Robert , Mandola Staci , Stark Stephen , Datta Suchismita , Cohen Susan , Thompson Tisha , Lawrence Katharine , Brody Abraham A. , Horwitz Leora , Genes Nicholas , Shreves Ashley , Bolden Deidre , Hutchinson Kelly , Gang Maureen , Goett Rebecca , Lamba Sangeeta , Isaacs Eric , Harris Jennifer , Martinez Karen , Shaw Matthew , Murray Rebecca , Fernandez Rosemarie , Bledsoe Shannon , Wood Travis , Ryan Matthew , Abella Benjamin S. , Long Elizabeth , De Hoyos Gabriela , Uspal Julie , Falk M. Bradley , Landis Phillip , Elsayem Ahmed , Yniguez Cecilia , Milling Danielle , Langabeer Denise , Bourenane Sorayah , Cridge Terri , Madsen Troy , Boutsioulis Emilia , Nofsinger Hannah , Jubanyik Karen , Cohen Theresa , Elie Marie-Carmelle 
Published: February 2024

Abstract
Background
EM Talk is a communication skills training program designed to improve emergency providers’ serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness.

Methods
EM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients’ goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses.

Results
A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice.

Conclusion
Our study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers’ knowledge, attitude, and practice of SI communication skills.

Trial registration
Clinicaltrials.gov: NCT03424109; Registered on January 30, 2018.