Clinical trial NCT06606470: All Providers Better Communication Skills Program' (ABCs)
Official title: All Providers Better Communication Skills Program' (ABCs) Interprofessional Provider Education Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Education of Primary Care Clinicians
Palliative Care
Communication
Keywords: Palliative Care
Education
seriously ill communication
Observed Structured Clinical Examination (OSCE)
Provider Training
Virtual learning
Lead sponsor: McMaster University
Sponsor class: OTHER
Collaborators: name: Health Canada
First posted: 2024-09-23
Enrollment: 350
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: The study design is a prospective stepped wedge group - randomized controlled trial (SWGRT) of interprofessional health care providers (HCPs) who enroll in the ABCs program. In this trial design, half of the participants begin the study in the control condition as randomly assigned, and cross-over to the intervention condition at a pre-determined time points, so that both the intervention and control groups eventually receive the intervention. The primary comparison will be between the trial arms upon completion of a program by the initial intervention group.
Primary purpose: OTHER

Brief summary: High quality, person-centered communication for those living with serious illness benefits patients, families and clinicians. Evidence shows that clinicians rarely engage patients in these, sometimes challenging, discussions. Current education programs to build health care provider competency in serious illness communication are often inconsistent in defined purpose and use of terms. This education also tends to be oriented to treatments, not a person or do not cover the full range of difficult conversations between diagnosis and delivery of end-of-life care.

The ABCs program is an education intervention for health care providers that features a blended format of online modules and interactive virtual workshops, relevant to clinicians at all levels of training and practice. This study will examine the effectiveness of this training (over no training) for impacting provider competency and behavior change in serious illness communication. All participants in this study will receive the full ABCs training, but at different times. The overall intended impact of this program is to improve clinician confidence and satisfaction in having conversations with patients and families about serious illness. The ultimate goal of the ABCs program is to increase access to early palliative care by empowering more providers to initiate this care.

Detailed description: Evidence shows that clinicians rarely engage patients in discussions about their serious illness and that there is a lack of training options to help health care providers develop these communication skills. By developing these skills, these conversations will be made easier, allowing patients to access a palliative approach to care earlier in their illness journey, providing them with the support and resources they need to manage their symptoms, alleviate their suffering, and improve their physical and mental health. This study will examine the ABCs education intervention that features a blended format of online modules and interactive virtual workshops, relevant to clinicians at all levels of training and practice, to build provider competency and comfort in serious illness communication.

The investigators developed the 'All providers: Better Communication Skills program' (ABCs), a virtual, person-centred education curriculum for interprofessional health care providers. This curriculum is a product of the collaboration among a large interdisciplinary team of palliative and end-of-life care clinicians, researchers, and educators, based on years of teaching advance care planning and goals of care discussions workshops with Hospice Palliative Care Ontario. The ABCs program adopts a blended format (i.e., participants engage in both asynchronous online modules \[five\] and synchronous interactive workshops \[three\]) that has relevance to learners and clinicians at all levels of training and practice. The investigators piloted this education program with medical learners and interdisciplinary health care providers with prior palliative care experience and still found that completion on the ABCs improved these participants self-reported confidence in initiating this communication and external rater assessments of their competency.

The ABCs program focuses on four essential elements of being a skillful communicator: principles of effective communication, conversation structure, communication skills, and reflective practice. The program consists of virtual modules that provide any clinician with practical tools, tips, and strategies to implement when communicating with seriously ill patients and their families. The ABCs program is intended to increase HCPs (particularly primary care providers) and medical learners' competency and comfort in having these, often difficult, conversations, while also encouraging them to initiate these discussions earlier in their patient's disease trajectory - moving a palliative approach to care further upstream. Terminology is clarified and consistent, the complexities of conversations are simplified and the fundamental approach and structure can be applied to different contexts.

The objective of this study is to complete a rigorous trial evaluating the impact of a communication skills curriculum for health care providers that addresses difficult conversations with seriously ill patients. The investigators aim to develop sustainable educational resources that can be administered virtually. Specially, the investigators will assess the impact of the ABCs education program on participant skill acquisition in communication and objective behavior change in simulated patient encounters. Secondly, the investigators will assess the impact of the education program on participant competency in communication from their own perspective and that of standardized patients with whom the participant has simulated encounters. The investigators will also measure participant satisfaction and perceived usefulness of the ABCs education program.

Potential participants across Canada will be informed about ABCs through advertising by the investigators partner stakeholders and organizations. The study design is a prospective stepped wedge group - randomized controlled trial (SWGRT) of interprofessional health care providers (HCPs) who enroll in the ABCs program. In this trial design, half of the participants begin the study in the control condition as randomly assigned, and cross-over to the intervention condition at a pre-determined time points, so that both the intervention and control groups eventually receive the intervention. The primary comparison will be between the trial arms upon completion of a program by the initial intervention group. This study will also measure the change among all participants from pre to post intervention.

Eligibility criteria: Inclusion Criteria:

All individuals that work in a health care provision capacity including health care professionals, care coordinators and administrators are eligible to enroll and participate in the ABCs study.

Exclusion Criteria:

Individuals, including patients, that do not work in a health care provision capacity.

Primary outcomes:
measure: Assessment of Clinical Encounter-Communications Tool (ACE-CT)
timeFrame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).
Secondary outcomes:
measure: Self-Efficacy Questionnaire (SE-12)
timeFrame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).
measure: End-of-life Professional Caregiver Survey (EPCS)
timeFrame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).
measure: Blended Learning Usability Evaluation - Questionnaire (BLUE-Q)
timeFrame: Post ABCs education, at 4 months for Intervention Group, at 8 months for Control Group
measure: Qualitative Interviews
timeFrame: Post ABCs education, at 4 months for Intervention Group, at 8 months for Control Group
measure: Questionnaire on Quality of Physician-Patient Interaction (QQPPI)
timeFrame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).
measure: Feeling Heard and Understood scale
timeFrame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).
Other outcomes:
Locations:
city: Hamilton
country: Canada
facility: McMaster University
state: Ontario
Study officials:
affiliation: McMaster University
name: Hsien Seow, PhD
role: PRINCIPAL_INVESTIGATOR
References: