Communication skills training for dialysis decision-making and end-of-life care in nephrology

Abstract

Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh (n=22). Preand post-workshop surveys evaluated efficacy of the curriculumandmeasured changes in perceived preparedness on the basis on workshop training.Overall, 14%of fellowswere white and 50%weremale. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86%and 100%.Only 36%(8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skillswere important to being a "great nephrologist." Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5-1.14; P<0.01), including delivering bad news, expressing empathy, and discussing dialysis initiation and withdrawal. All respondents (21 of 21) reported theywould recommend this training to other fellows. Nephro Talk is successful for improving preparedness among nephrology fellows for having difficult conversations about dialysis decision-making and end-of-life care. © 2013 by the American Society of Nephrology.