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Development and feasibility of a communication training to assist caregivers with advanced care planning

Published online by Cambridge University Press:  14 September 2022

Allison J. Applebaum Open the ORCID record for Allison J. Applebaum [Opens in a new window] ,
Rebecca Gebert Open the ORCID record for Rebecca Gebert [Opens in a new window] ,
Mia Behrens ,
Morgan Loschiavo ,
Patricia A. Parker ,
Kelly M. Shaffer ,
Alan Carver  and
Eli L. Diamond
Allison J. Applebaum*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Rebecca Gebert
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Mia Behrens
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Morgan Loschiavo
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Patricia A. Parker
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Kelly M. Shaffer
Affiliation:
University of Virginia School of Medicine, Charlottesville, VA
Alan Carver
Affiliation:
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
Eli L. Diamond
Affiliation:
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Allison J. Applebaum, Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA. E-mail: applebaa@mskcc.org
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Abstract

Objective

Caregivers are critical in advanced care planning (ACP) discussions, which are difficult but necessary to carry out patients’ goals of care. We developed and evaluated the feasibility and acceptability of a communication training to equip caregivers of patients with malignant brain tumors with skills to navigate ACP conversations.

Method

Caregivers completed a 2-h virtual training addressing ACP Discussions with Your Loved One and ACP Discussions with the Medical Team. A pre-training assessment was completed at baseline and a training evaluation was completed one day post-training. A subset of participants completed semi-structured interviews 2 months post-training.

Results

Of 15 caregivers recruited, 9 attended the training and 4 completed qualitative interviews. Post-training, 40% felt confident in discussing ACP with loved ones and 67% felt confident doing so with healthcare professionals; 100% reported feeling confident in using skills learned in the training to facilitate these conversations. Data from qualitative interviews highlighted additional benefits of the training in empathic communication skills and fostering social support.

Significance of results

Our communication skills training shows promise in supporting caregivers’ skills and confidence in engaging in ACP discussions with patients and healthcare providers. A future randomized controlled trial with a larger and more diverse caregiving sample is needed to determine training efficacy.

Keywords

Advanced care planningCancer caregiversCaregiversCommunication skillsCommunication training
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 2 , April 2023 , pp. 188 - 195
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

REFERENCES

AARP National Alliance for Caregiving (2016) Cancer Caregiving in the U.S. An Intense, Episodic, and Challenging Care Experience. Available at: http://www.caregiving.org/wp-content/uploads/2016/06/CancerCaregivingReport_FINAL_June-17-2016.pdf.Google Scholar
Applebaum, AJ and Breitbart, W (2013) Care for the cancer caregiver: A systematic review. Palliative and Supportive Care 11(3), 231–252. doi:10.1017/s1478951512000594CrossRefGoogle ScholarPubMed
Baucom, DH, Porter, LS, Kirby, JS, et al. (2009) A couple-based intervention for female breast cancer. Psycho-Oncology 18(3), 276–283. doi:10.1002/pon.1395CrossRefGoogle ScholarPubMed
Bernacki, R, Hutchings, M, Vick, J, et al. (2015) Development of the serious illness care program: A randomised controlled trial of a palliative care communication intervention. BMJ Open 5(10), e009032. doi:10.1136/bmjopen-2015-009032CrossRefGoogle Scholar
Brown, RF, Bylund, CL, Gueguen, JA, et al. (2010) Developing patient-centered communication skills training for oncologists: Describing the content and efficacy of training. Communication Education 59(3), 235–248. doi:10.1080/03634521003606210CrossRefGoogle Scholar
Budin, WC, Hoskins, CN, Haber, J, et al. (2008) Breast cancer: Education, counseling, and adjustment among patients and partners: A randomized clinical trial. Nursing Research 57(3), 199–213. doi:10.1097/01.nnr.0000319496.67369.37CrossRefGoogle ScholarPubMed
Bylund, CL, Brown, RF, Bialer, PA, et al. (2011) Developing and implementing an advanced communication training program in oncology at a comprehensive cancer center. Journal of Cancer Education 26(4), 604–611. doi:10.1007/s13187-011-0226-yCrossRefGoogle Scholar
Campbell, LC, Keefe, FJ, Scipio, C, et al. (2007) Facilitating research participation and improving quality of life for African American prostate cancer survivors and their intimate partners. A pilot study of telephone-based coping skills training. Cancer 109(2 Suppl), 414–424. doi:10.1002/cncr.22355CrossRefGoogle ScholarPubMed
Catt, S, Chalmers, A and Fallowfield, L (2008) Psychosocial and supportive-care needs in high-grade glioma. Lancet Oncology 9(9), 884–891. doi:10.1016/s1470-2045(08)70230-4CrossRefGoogle ScholarPubMed
Connors, AF, Dawson, NV, Desbiens, NA, et al. (1995) A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 274(20), 1591–1598.CrossRefGoogle Scholar
Detering, KM, Hancock, AD, Reade, MC, et al. (2010) The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. BMJ 340, c1345. doi:10.1136/bmj.c1345CrossRefGoogle ScholarPubMed
Diamond, EL, Prigerson, HG, Correa, DC, et al. (2017) Prognostic awareness, prognostic communication, and cognitive function in patients with malignant glioma. Neuro-Oncology 19(11), 1532–1541. doi:10.1093/neuonc/nox117CrossRefGoogle ScholarPubMed
Doran, GT (1981) There's a S.M.A.R.T. Way to write management's goals and objectives. Management Review 70(11), 35–36.Google Scholar
Given, B, Given, CW, Sikorskii, A, et al. (2006) The impact of providing symptom management assistance on caregiver reaction: Results of a randomized trial. Journal of Pain and Symptom Management 32(5), 433–443. doi:10.1016/j.jpainsymman.2006.05.019CrossRefGoogle ScholarPubMed
Heyland, DK, Barwich, D, Pichora, D, et al. (2013) Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Internal Medicine 173(9), 778–787. doi:10.1001/jamainternmed.2013.180CrossRefGoogle ScholarPubMed
Kaplowitz, SA, Campo, S and Chiu, WT (2002) Cancer patients’ desires for communication of prognosis information. Health Communication 14(2), 221–241. doi:10.1207/s15327027hc1402_4CrossRefGoogle ScholarPubMed
Kent, EE, Mollica, MA, Buckenmaier, S, et al. (2019) The characteristics of informal cancer caregivers in the United States. Seminars in Oncology Nursing 35(4), 328–332. doi:10.1016/j.soncn.2019.06.002CrossRefGoogle ScholarPubMed
Kirkpatrick, DL (1967) Evaluation in training. In Craig, RL (ed.), Training and Development Handbook. New York: McGraw Hill, pp. 87–112.Google Scholar
Kissane, DW, Bylund, CL, Banerjee, SC, et al. (2012) Communication skills training for oncology professionals. Journal of Clinical Oncology 30(11), 1242–1247. doi:10.1200/jco.2011.39.6184CrossRefGoogle ScholarPubMed
Levin, TT, Moreno, B, Silvester, W, et al. (2010) End-of-life communication in the intensive care unit. General Hospital Psychiatry 32(4), 433–442. doi:10.1016/j.genhosppsych.2010.04.007CrossRefGoogle ScholarPubMed
Lichtenthal, WG, Corner, GW, Sweeney, CR, et al. (2015) Mental health services for parents who lost a child to cancer: If we build them, will they come? Journal of Clinical Oncology 33(20), 2246–2253. doi:10.1200/jco.2014.59.0406CrossRefGoogle ScholarPubMed
Locke, EA and Latham, GP (2006) New directions in goal-setting theory. Current Directions in Psychological Science 15(5), 265–268. doi:10.1111/j.1467-8721.2006.00449.xCrossRefGoogle Scholar
Lubrano, B, Brown, RF, Gueguen, JA, et al. (2010) Interviewing patients using interpreters in an oncology setting: Initial evaluation of a communication skills module. Annals of Oncology 21(1), 27–32. doi:10.1093/annonc/mdp289CrossRefGoogle Scholar
Lyon, ME, Jacobs, S, Briggs, L, et al. (2014) A longitudinal, randomized, controlled trial of advance care planning for teens with cancer: Anxiety, depression, quality of life, advance directives, spirituality. Journal of Adolescent Health 54(6), 710–717. doi:10.1016/j.jadohealth.2013.10.206CrossRefGoogle ScholarPubMed
Marwit, SJ and Datson, SL (2002) Disclosure preferences about terminal illness: An examination of decision-related factors. Death Studies 26(1), 1–20. doi:10.1080/07481180210144CrossRefGoogle ScholarPubMed
Nilsson, ME, Maciejewski, PK, Zhang, B, et al. (2009) Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children. Cancer 115(2), 399–409. doi:10.1002/cncr.24002CrossRefGoogle ScholarPubMed
Northouse, L, Kershaw, T, Mood, D, et al. (2005) Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. Psycho-Oncology 14(6), 478–491. doi:10.1002/pon.871CrossRefGoogle ScholarPubMed
Northouse, LL, Katapodi, MC, Song, L, et al. (2010) Interventions with family caregivers of cancer patients: Meta-analysis of randomized trials. CA: A Cancer Journal for Clinicians 60(5), 317–339. doi:10.3322/caac.20081Google ScholarPubMed
Pehrson, C, Banerjee, SC, Manna, R, et al. (2016) Responding empathically to patients: Development, implementation, and evaluation of a communication skills training module for oncology nurses. Patient Education and Counseling 99(4), 610–616. doi:10.1016/j.pec.2015.11.021CrossRefGoogle ScholarPubMed
Salander, P (1996) Brain tumor as a threat to life and personality. Journal of Psychosocial Oncology 14(3), 1–18. doi:10.1300/J077v14n03_01CrossRefGoogle Scholar
Scott, JL, Halford, WK and Ward, BG (2004) United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. Journal of Consulting and Clinical Psychology 72(6), 1122–1135. doi:10.1037/0022-006x.72.6.1122CrossRefGoogle ScholarPubMed
Siminoff, LA, Zyzanski, SJ, Rose, JH, et al. (2008) The cancer communication assessment tool for patients and families (CCAT-PF): A new measure. Psycho-Oncology 17(12), 1216–1224. doi:10.1002/pon.1350CrossRefGoogle ScholarPubMed
Smith, PD, Martin, B, Chewning, B, et al. (2018) Improving health care communication for caregivers: A pilot study. Gerontology & Geriatrics Education 39(4), 433–444. doi:10.1080/02701960.2016.1188810CrossRefGoogle ScholarPubMed
Temel, JS, Greer, JA, Muzikansky, A, et al. (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine 363(8), 733–743. doi:10.1056/NEJMoa1000678CrossRefGoogle ScholarPubMed
Wen, PY and Kesari, S (2008) Malignant gliomas in adults. New England Journal of Medicine 359(5), 492–507. doi:10.1056/NEJMra0708126CrossRefGoogle ScholarPubMed
Wright, AA, Mack, JW, Kritek, PA, et al. (2010) Influence of patients’ preferences and treatment site on cancer patients’ end-of-life care. Cancer 116(19), 4656–4663. doi:10.1002/cncr.25217CrossRefGoogle ScholarPubMed
You, JJ, Fowler, RA and Heyland, DK (2014) Just ask: Discussing goals of care with patients in hospital with serious illness. CMAJ 186(6), 425–432. doi:10.1503/cmaj.121274CrossRefGoogle ScholarPubMed