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4 Professional Training
Pages 41-50

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From page 41...
... An open discussion was moderated by Renee McLeod-Sordjan, a nurse practitioner and Medical Ethics Attending for the Department of Medicine at North Shore–Long Island Jewish Health System and Clinical Assistant Professor in the Graduate Department at Lienhard School of Nursing. TEACHING COMMUNICATION SKILLS TO CLINICIANS1 After remarking how angry he was about the state of the American health care system after listening to the last panel presentations, Robert 1  This section is based on the presentation by Robert Arnold, Chief of the Section of P ­ alliative Care and Medical Ethics, Director of the Institute for Doctor–Patient Communication, and Medical Director of the Palliative and Supportive Institute at the University of Pittsburgh Medical Center, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
From page 42...
... "We ought to just call it good health care." He also remarked that getting American health care to embrace palliative care seems to him to be a culture change problem and not really about any one system, and that this culture change is just not happening. He recalled reading a book (Mishler, 1985)
From page 43...
... The oncologists then received a lecture on how to improve their communication skills, and 1 year later half of them received the CD-ROM, included didactic information, video demonstrations, and audio clips from the oncologist's own recorded conversations (see Figure 4-1)
From page 44...
... In addition, nurses are often asked to translate what the physician has said or what a patient or family member has read on the Internet, and in fact, one of the key roles nurses play is to educate and promote communication among team members, patients, and family members. Nurses provide an immense amount 2  This section is based on the presentation by Elaine Wittenberg, Associate Professor in the Division of Nursing Research and Education at City of Hope Comprehensive Cancer Center, and the statements are not endorsed or verified by the Academies.
From page 45...
... Regardless, the health care system puts a great deal of pressure on oral literacy skills because the most common method for getting information from patients and family members is by asking them to provide the patient's medical history orally. Over the past 5 years, Wittenberg has been working with Debra Parker Oliver at the University of Missouri to record hospice teams talking with patients and family caregivers and measure caregiver outcomes for anxiety and quality of life.
From page 46...
... According to the National Library of Medicine, the appropriate level of educational health information should range between a sixth and seventh grade reading level, which Wittenberg acknowledged, based on her experience with her sixth grade daughter, is not easy to achieve. Nonetheless, training for nurses in palliative care is needed to develop this communication skill, and toward that end, she and colleagues Joy Goldsmith, Betty Ferrell, and Sandra Ragan have developed the COMFORT communication curriculum (Wittenberg-Lyles et al., 2015)
From page 47...
... The next step, she said is to conduct quality research on communication strategies that can be used to train providers in all areas of medicine. She also said interprofessional education should be prioritized as a key component of this effort to drive home the point that it is the entire health care team's responsibility to provide information to patients and family members at the appropriate health literacy level.
From page 48...
... "It would be like every week having a different band because you took kids from different schools and put them together every week and expected them to play well." Though there are many opportunities, he said, the health care enterprise still needs to figure out which systems will work better for patients and how to create a health care system that better meets patient needs. One advantage of working with a palliative care team, said Wittenberg, is that its members stay fairly constant.
From page 49...
... commented that while there have been several mentions of the need for culture change, the two panelists both spoke about stand-alone interventions to intervene with specific clinicians, which she said does not sound like a recipe for culture change. She then asked the panelists if either of them had any experience trying to change an entire institution or health care system and sustain change.
From page 50...
... As an example, she said she would like all health care providers to receive spiritual care communication training and more interprofessional training. She would also like to see training for family caregivers and noted that ELNEC is about to run a trial that offers a communication guide for caregivers that aims to ease the burden placed on caregivers to relay hard news to, and mediate among, family members.


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