Exploring the value of structured narrative feedback within the Serious Illness Conversation-Evaluation Exercise...

Area of Science:

• Medical Education
• Oncology
• Palliative Care

Background:

• Serious Illness Conversation Guide (SICG) provides a framework for patient-physician communication.
• Assessing resident physicians' skills in conducting serious illness conversations (SICs) is crucial in oncology outpatient settings.

Purpose of the Study:

• To evaluate the utility of a novel assessment tool, the Serious Illness Conversation-Evaluation Exercise (SIC-Ex), for appraising resident-led SICs.
• To analyze narrative comments from SIC-Ex to understand resident performance in serious illness communication.

Main Methods:

• A qualitative study employing template analysis was conducted.
• Resident physicians conducted videotaped SICs with cancer patients.
• Preceptors evaluated conversations using SIC-Ex and the Calgary-Cambridge Guide (CCG).
• Independent coders analyzed narrative comments for themes related to SICG and CCG.

Main Results:

• Template analysis identified four key themes: adherence to SICG, patient/family engagement, conversation management, and demeanor.
• Narrative comments highlighted specific verbal and non-verbal communication elements crucial for SICs.
• Some comments aligned with both CCG and SICG, while others were specific to SICG, such as advance care planning.

Conclusions:

• The SIC-Ex generates rich, nuanced qualitative data on resident SIC competence.
• Narrative feedback from SIC-Ex offers deeper insights than numerical ratings alone.
• This tool can contribute to a more comprehensive assessment of serious illness communication skills.