INTRODUCTION:Communication training (CT) enhances the communication skills of oncology healthcare professionals. Kommunikative Kompetenz und Performanz in der Arzt-Patient Beziehung fördern (KPAP; fostering communicative competence and performance of physician-patient relation) is an intervention study that evaluates the long-term effects 3 years after the CTs in the context of a CT programme. It is supported by the German Cancer Aid and conducted at the University Hospital of Cologne. METHODS:The aim of the study will be to assess the long-term communicative competence of physicians using a multimodal approach through self-assessment and external evaluation by trained experts and trained patient raters. Prior to the study, physicians working with cancer patients underwent a structured CT. Self-reported questionnaires were completed at the beginning (T0), at the end (T1) of the 2.5-day CT, and during a 6-h refresher session (T2) several months later. Participants were recorded on video while breaking bad news (BBN) to standardised patients. As part of this study, participants will complete self-reported questionnaires at least 3 years after the 2.5-day CT (T3). At T3, a subsample of participants (at least n = 60) will be video-recorded again. These simulated BBN encounters at T0 and T3 will be rated by trained patient raters and trained experts using the Bad News Consultation Assessment Scale (AGBS) and the Consultation and Relational Empathy instrument. The primary outcome will be the difference between AGBS scores at T3 and T0. Furthermore, expert raters will analyse these videos using Discourse Coding Analysis Software and the ComOn Rating Scale. Additionally, the health literacy of patient raters will be assessed using the European Health Literacy Survey (HLS-EU). CONCLUSION:A more precise understanding of communicative competences, particularly by incorporating the patient's perspective, will enable the development of recommendations for future training and enhance the sustainability of CT.

Objectives: To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates.Methods: In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patientcenteredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. Results: Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility.Conclusions: Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. Practice implications: Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.

Objective Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care.Design Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups.Setting Three Swiss teaching hospitals.Participants Adult patients hospitalised for medical care.Interventions We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics.Primary and secondary outcome measures The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes.Results Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference −2.5 (95% CI −4.28 to −0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient–physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002).Conclusions A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients.Trial registration number NCT03210987.

Objective To explore patients’ experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/disorder (SCI/D).Design Qualitative design with semi-structured interviews and purposively sampled participants. Interviews were transcribed verbatim. Transcripts were analyzed for qualitative content analysis using the Mayring method.Setting Specialized acute care and rehabilitation center for SCI/D-patients.Participants Patients in initial rehabilitation after a newly acquired SCI/D.Interventions n.a.Outcome measures n.a.Results Ten participants were interviewed in the post-acute phase after a newly acquired SCI/D. Participants described individual patient characteristics as well as organizational elements influencing their experience with goal setting. Organizational elements comprised structural elements (e.g. ward rounds, rehabilitation meetings, etc.) and interaction with and among the interprofessional teams. Perspectives from various health care professionals (HCPs) were perceived as increasing adequate goal setting and motivation. Furthermore, the participants described their own involvement and motivation as crucial for goal achievement. The main point of the critique was the standardization of the goal setting process. Interviewees would have preferred individualized goal setting embedded in a clearly foreseeable rehabilitation plan.Conclusion Organization and collaboration with and among the HCPs should be geared towards identifying specific patient needs during the course of rehabilitation and deriving individually tailored goals from them. Communication plays an important role in the individual goal setting.

CONTEXT At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D). OBJECTIVE To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D. METHODS Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set. RESULTS The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL. CONCLUSION Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.

L'importance de la communication professionnelle est largement reconnue dans de nombreuses prises de position officielles et dans les sondages.Pourtant, il est difficile de motiver les collègues à participer aux formations idoines.Il y a plusieurs raisons à cela, pratiques ou liées au contenu.Dans la pratique, l' essor des formations en communication professionnelle dans le cadre hospitalier se heurte à un manque flagrant d' enseignants compétents.C' est particulièrement vrai pour les hôpitaux périphériques et pour le développement de ces formations dans les cabinets médicaux.Pallier cette lacune dans un délai raisonnable requiert l'utilisation de formes d'apprentissage basées sur Internet.En matière de contenu, les jeunes collègues ont souvent du mal à trouver un équilibre qui leur convienne entre la «conduite» d'un entretien et la mise en pratique auprès de leurs patients.Les deux requièrent une identité sûre -une attitude intérieure -en tant que médecin, que nous devons acquérir au cours de notre expérience professionnelle.

BACKGROUND: We recently compared the effects of bedside and outside the room ward rounds on patients’ knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds. METHODS: Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100. RESULTS: Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (± standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 ± 16.96 versus 68.25 ± 21.10 respectively; age-, gender- and centre-adjusted difference of –10.46, 95% confidence interval [CI] –12.73 to –8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 ± 20.32 versus 65.32 ± 20.92, respectively; adjusted difference 4.35, 95% CI –1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 ± 13.87 versus 66.59 ± 21.82; adjusted difference –16.51, 95% CI –20.29 to –12.72; p = 0.002). CONCLUSIONS: While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987