Exploring Palliative Care Team Communication: An Interprofessional Simulation Study

Background: It is vital for health care providers to have knowledge and competency in palliative care, which focuses on caring for and communicating with patients diagnosed with serious, terminal illnesses. However, many new graduates in health care fields feel uncomfortable and under-prepared to care for patients with life-limiting illnesses, much less provide end-of-life (EOL) care. In order to provide competent care, providers must manage physical, social, psychological, and spiritual needs of patients and families through “person-centered, family-oriented, and evidence-based” care (Institute of Medicine, 2014). It is imperative that health care students be taught critical competencies, such as communication and interprofessional teamwork, so that all patients may receive competent care. Simulations have been shown to be an effective mechanism to teach EOL care, particularly for nursing students.

Purpose: The purpose of the study was to evaluate how an interprofessional simulation experience would affect nursing, medical, and social work students’ communication skills when caring for a seriously ill patient and his family.

Methods: An interprofessional simulation was created with three phases. Phase One focused on the interprofessional team’s communication with the patient and family members. Phase Two focused on the communication between the team members regarding a sudden change in the patient’s condition. Phase Three focused on family communication during the withdrawal of life-sustaining measures. Each phase included a pre-briefing and debriefing with all students. In each simulation, the team was comprised of nursing (n=7-8) and social work (n=1-2) students, and medical residents (n=1-2). Participants not actively participating in the simulation observed on a live video feed. During the first and third phase of the simulation, participants interacted with actors portraying family members of the patient.

The simulation was conducted throughout three semesters (Fall 2017, Spring 2018, and Fall 2018), and modifications were made each semester in response to student feedback. Modifications included the actor roles (spouse versus child) or the length of the simulation (1.5 hours versus 1 hour).

Following the simulation, trained research assistants viewed video recordings of the simulations. Communication was assessed using the Gap Kalamazoo Communication Skills Assessment Form, which assesses team communication on several attributes from poor to excellent (Peterson, Calhoun, & Rider, 2014). The research assistants independently evaluated the simulations, evaluated communication skills, and discussed discrepancies in evaluations until an agreement was reached.

Results: With regard to communication, most simulation teams scored “good” through “excellent” in the categories of sharing information and communicating accurate information. These skills were explored in the pre-briefing and debriefing. Teams varied in their incorporation of empathy, which could be due to variations in team dynamics or actor performance. Longer simulations (1.5 hours) tended to foster more empathy and the provision of closure than shorter simulations (1 hour). Additionally, participants that had previous experiences with simulations appeared more willing to participate than participants who had not been in a simulation before. The nursing students and medical residents were typically more engaged in the simulation than many of the social work students who lacked previous exposure to simulated learning experiences.

Conclusion: The simulation had a positive impact on the interprofessional team’s communication skills. In the future, other interprofessional team members that are closely involved with care of seriously ill patients should be included, such as chaplains. Future simulations will incorporate modifications to foster more opportunities to demonstrate empathy or provide closure.