D25-14 Trial of a Scalable, Technology-enhanced Training Program to Improve Clinicians’ Serious Illness Communication Skills in the Hospital Setting

Abstract Rationale Although effective goals of care conversations for seriously ill, hospitalized patients improve patient, family, and health system outcomes, many clinicians lack the complex communication skills needed for them, largely due to the absence of scalable, evidence-based training programs. Objectives To evaluate the feasibility, acceptability, usability, and efficacy of a scalable serious illness communication skills training program for hospital-based physicians and advanced practice providers (APPs). Methods We conducted a crossover trial of the Critical Conversations course among critical care fellows and APPs who work in the inpatient setting. The Critical Conversations course involves 7 hours of content completed over 3 weeks, grounded in Vital Talk’s REMAP framework. Each week, participants completed two self-paced, interactive digital lessons (approximately 25 minutes each), then participated in a 90-minute coaching session with 4-6 learners, a coach, and a trained actor playing the role of a patient/surrogate, delivered via videoconference. We assessed feasibility using the proportions of participants who completed the digital lessons and attended each coaching session. We assessed acceptability using internally developed post-course questionnaires. We assessed usability using the System Usability Scale (SUS). We assessed efficacy by conducting high-fidelity simulated goals-of-care (GOC) conversations with actors portraying surrogate decision-makers before and one week following the course. Participants were randomly assigned to one of two clinical scenarios, and sessions were audio/video recorded. Independent, blinded coders used a validated scoring system to evaluate participants’ performance on the simulated GOC conversations (score range 0-24, with higher scores indicating better performance). Results We enrolled 14 clinicians (10 CCM fellows, 4 APPs) from academic medical centers in Pennsylvania and New York. All (14/14, 100%) completed the six digital lessons, and 13 of 14 (93%) attended all three coaching sessions. Participants rated the course as highly acceptable (mean, 4.9/5 ± 0.3) and highly usable (mean SUS score: 88.8/100). Participants’ performance on high-fidelity simulation improved significantly after the intervention, with median scores increasing from 12 (IQR 9-15) to 20.5 (IQR 16-22; p = 0.002). The intervention resulted in improvement in key communication behaviors, including proposing meeting agendas (p = 0.025), reframing the medical situation (p = 0.046), responding empathically after delivering serious news (p = 0.011), summarizing information about the patient’s values and preferences (p = 0.011), asking permission to offer a recommendation (p = 0.003), making value-aligned recommendations (p = 0.034), and confirming agreement with the plan (p = 0.046). Conclusions The Critical Conversations course, a scalable, technology-enhanced training program, led to large improvements in clinicians’ serious illness communication skills and was highly rated by clinicians. This abstract is funded by: NIA R01AG068567-S1