Serious Illness Education
Communication is one of the most important aspects of care for patients living with serious illness. How members of the care team communicate about a new diagnosis, treatment options, goals of care, and changes in daily living activities can have a major impact on patients, their families, and caregivers. When it comes to breaking serious news and having difficult conversations every word carries meaning. Health care professionals should approach these conversations intentionally, compassionately, and with humility. By practicing patient-centered communication clinicians do more than treat the illness—they help heal a patient physically, emotionally, and spiritually.
The Ronald W. Naito Directorship in Serious Illness Education was established in 2019 with a $1 million endowment from the Ronald W. Naito MD Foundation. Dr. Naito's nearly 40-year career as an internist and geriatrician came to an abrupt end when he was diagnosed with advanced pancreatic cancer in 2018. Dr. Naito described his two-part experience in receiving a diagnosis as "suboptimal," as the first physician wouldn't acknowledge the results of a blood test and the second physician spoke with a medical student outside his open exam room door about his biopsy results, inadvertently allowing Dr. Naito to overhear before coming to speak with him directly.
As a physician who was dedicated to being fully present with each patient, and who gained a reputation for his thoughtfulness and compassionate communication skills, Dr. Naito was inspired to devote his retirement to teaching these skills to others. The Ronald W. Naito Directorship in Serious Illness will carry Dr. Naito's legacy of mindfulness in treating patients and ensure that health care students and practicing professionals receive the serious illness communication training that didn't exist when he was in medical school.
"When you are fully present you bring all of your senses and powers of observation to learning about the patient and their concerns. Patients feel your compassion. They trust you. They sense that you are really listening and available. And they are therefore more likely to tell you what you need to know and be active partners in their treatments. All of this results in better care."
The Challenge of Serious Illness Conversations
Breaking bad news, such as sharing diagnosis of a new serious illness or telling a patient they are dying, doesn't happen in a "suboptimal" way because clinicians are careless. It happens because, historically, teaching communication skills for difficult conversations hasn't been emphasized in medical training. When members of the health care team haven't been taught these specific skills navigating serious illness conversations can feel uncomfortable and become a challenge for both health care professionals and patients.
It's estimated that up to three-quarters of patients with serious illness receive this news in a suboptimal way1. Sometimes physicians will avoid these types of conversations with their patients or speak in a way that is difficult for patients to understand, such as using medical jargon2. This can lead to patients being unable to follow the conversation or becoming too overwhelmed with emotion to fully take in and retain the information, resulting in ill-informed patients who don't accurately understand their illness1.
Communication Skills for Serious Illness
Most doctors believe open communication about death is vital in health care1. Although most all physicians in a 2018 study said that end-of-life care conversations with patients were important, less than one-third of them said they had been trained how to have end-of-life conversations3.
Communicating effectively about serious illness requires a set of specific communication skills that can be learned. Learning and practicing these skills can help health care professionals improve their self-efficacy in navigating these conversations with patients and can help them engage in effective, empathetic, and honest conversations about serious illness, life changes, and death. Our TalkOregon program provides a series of evidence-based workshops to teach serious illness communication skills for sharing serious news, discussing goals of care, prognostication, advanced care planning, and facilitating family meetings.
Communication in the Curriculum
Medical Student Testing
Since 2018, the Center for Ethics has collaborated with the School of Medicine to require every graduating medical student to be tested in their compassionate communication skills before transitioning to the next step of their academic and professional journey. Students are tested in two simulated medical encounters with actors where they must show their abilities to use clear communication skills and empathy to deliver bad news to patients. Testing also gives the opportunity for students to review their recorded sessions with faculty and receive personalized coaching in their skills before moving on to residency. This student testing allows Drs. Katie Stowers and Cliff Coleman to identify what's working well in the curriculum, and also areas that should be researched more in order to continue raising the bar for excellence in compassionate communication. To date more than 1,000 students have been tested.
Medical Education Training
Our Serious Illness program offers communication skills training in undergraduate and graduate medical and health professions programs. Through our TalkOregon program, we offer a serious of workshops that can be incorporated into the curriculum over the course of the educational program. This effective training model allows learners to gain new skills that build upon one another while reinforcing previously learned skills. Workshops include a small didactic session followed by role play with skilled actors to practice the material, and real time feedback by communication coaches and trained facilitators.
Our TalkOregon workshops also help residency programs meet required Professionalism and Interpersonal and Communication Skills core competencies set by the Accreditation Council for Graduate Medical Education, such as:
- demonstrating competence in compassion, integrity, and respect for others;
- responsiveness to patient needs that supersedes self-interest;
- cultural humility;
- respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation;
- communicating effectively with patients and patients' families, as appropriate, across a broad range of socioeconomic circumstances, cultural backgrounds, and language capabilities;
- establishing a trusted relationship with patients and patients' caregivers and/or families to elicit shared prioritization and decision-making;
- communicate with patients and patients' families to partner with them to assess their care goals;
- address end-of-life goals and align with patient treatment preferences for advanced or serious illness.
Expanding Access to Communication Skills Training
The Center for Ethics is committed to expanding access to quality training for serious illness communication skills around the state of Oregon. We offer virtual workshops, complete with continuing medical education credits, open to any Oregon health care professional. These workshops focus on how to share medical information clearly, recognize and respond to emotion, and elicit patient values and goals. Our work with Oregon communities and these CME workshops has taught us that a variety of health care professionals work with patients of serious illness in a number of different ways, and they too find the skills in these courses valuable and applicable to their work. As our TalkOregon program continues to grow, we continue to develop our workshops to be a meaningful and engaging experience for health care professionals of all disciplines.