Describing the Impact of Physician End-of-Life Communication Training on Simulated Stress Using a Novel Stress Marker

IntroductionEmpathetic end-of-life (EOL) communication is important for high quality pediatric patient and family outcomes. Trainees may have limited exposure and training in caring for patients at EOL which may impact communication-related stress. This study had 2 aims: (1) describe pediatric resident physician EOL exposure and training (2) measure objective and subjective stress during simulated critical communication encounters and the impact of prior communication training/exposures on stress responses.MethodsWe performed a prospective, pilot observational cohort study measuring physician exposure to caring for patients/families at EOL and simulated communication stress. Simulated stress was measured subjectively using the state-trait anxiety inventory (STAI) and objectively using heart rate variability (HRV) during a communication training intervention.Results85.7% (18/21) of residents reported seldom/never caring for patients at EOL and universally felt ill-prepared to provide care. Subjective and objective stress increased when directly communicating with the simulated parent/patient actor compared to baseline in all HRV domains. Residents with limited exposure to patients/families at EOL had a smaller stress response than those who cared for a substantial number.ConclusionsPediatric residents report limited opportunities to communicate with patients/families at EOL, which may impact stress responses when communicating life-altering news to families. Simulated communication encounters can be designed to evoke subjective and objective stress which can be measured using novel technology and may help address limited EOL opportunities.