J Hosp Med. 2026 Jan 15. doi: 10.1002/jhm.70241. Online ahead of print.
ABSTRACT
BACKGROUND: Medical training often omits systematic approaches to prognostication and goals of care (GOC) communication, leading to end-of-life (EOL) hospital care misaligned with patients’ values, lower clinician self-efficacy, and greater clinician distress.
OBJECTIVE: This communication training intervention aimed to improve clinician knowledge and self-efficacy and to reduce distress in conducting GOC discussions.
METHODS: We developed and implemented GOComm, a 4-h serious illness communication training program across eight campuses of a large health system. Utilizing a train-the-trainer model, facilitators taught GOComm to inpatient clinicians, primarily hospitalists, intensivists, physician assistants (PAs), and trainees. Topics included prognosticating, conveying serious news, managing emotions, creating values-informed medical recommendations, and discussing hospice. Simulations included a clinician and simulated patient (SP) role play and a family meeting, in which a clinical dyad encountered an SP dyad. Mixed methods evaluation included pre- and postsurveys.
RESULTS: Three hundred and ninety-three clinicians participated: 322 provided demographics, with a mean of 5.57 years in practice; 71.7% were women, 50% were White, and 29.5% were Asian. Of 315 listing roles: 41% were physicians, 41% were PAs. Two hundred and forty-two completed both pre- and postsurveys. Clinicians had statistically significant gains in GOC knowledge, self-efficacy, and distress tolerance. GOComm had high clinician acceptability: 96.2% indicated they would recommend GOComm to a colleague, and 83.2% credited it with changing how they will manage patients.
CONCLUSIONS: GOComm is an effective train-the-trainer curriculum for hospital-based clinicians to gain knowledge and confidence in empathic communication skills. Clinician distress tolerance can be mitigated by enhancing skills training and social support through team simulations.
PMID:41537361 | DOI:10.1002/jhm.70241
