Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare

Figures & data

Table

Practice points

Implementing the PERCS in Italy has demonstrated that it is possible to culturally adapt learning opportunities that embrace the relational and ethical experience of learners. Participants appreciated the innovative pedagogy of the program based on group feedback, experiential and interdisciplinary learning, and the patient's perspective. The increased sense of preparation and confidence inspired by PERCS might improve clinicians’ willingness to engage more directly in difficult conversations rather than avoiding or delegating them. PERCS is a continuing educational offer that hospitals could implement to assist clinicians to reflect on and nurture their professional practice.

Table 1.  Socio-demographic characteristics of participants

Characteristics	All of the participants N = 146	Participants who completed pre- and post- questionnaires N = 129
Discipline
Physicians	46 (32%)	42 (32%)
Nurses	60 (41%)	54 (42%)
Psychosocial professionals^a	24 (16%)	19 (15%)
Others^b	16 (11%)	14 (11%)
Valid N	146 (100%)	129 (100%)
Years of experience
Mean (SD)	15.48 (9.726)	14.96 (9.535)
Valid N	132	118
Age
Mean (SD)	41.87 (9.667)	41.31 (9.607)
Valid N	143	129
Gender
Female	116 (80%)	105 (81%)
Valid N	145 (100%)	129 (100%)
Ethnicity
Italians	144 (99%)	128 (99%)
Other	1 (1%)	1 (1%)
Valid N	145 (100%)	129 (100%)
Previous learning experiences in communication
Coursework	4 (3%)	4 (4%)
Practicum experience	36 (29%)	33 (32%)
Residency	9 (7%)	8 (5%)
Continuing education	10 (8%)	10 (9%)
Multiple of the above	49 (40%)	44 (40%)
Other	10 (8%)	11 (10%)
Valid N	122 (100%)	110 (100%)
Had a role model in communication
Yes	71 (51%)	66 (52%)
Valid N	140 (100%)	128 (100%)
Number of difficult conversations observed
None	2(2%)	2 (2%)
1–10	40(33%)	35 (31%)
11–24	11 (9%)	11 (10%)
25+	67 (56%)	63 (57%)
Valid N	120 (100%)	111 (100%)
Number of difficult conversations led
None	7 (6%)	7 (7%)
1–10	32 (29%)	31 (30%)
11–24	10 (9%)	10 (10%)
25+	62 (56%)	55 (53%)
Valid N	111 (100%)	103 (100%)

Notes: ^aThis category includes psychologists and social workers.

^bThis category includes chaplains, physiotherapists, educators, biologists, and risk managers.

Table 2.  Perceived impact of the program

Questions	Yes % (n)	No % (n)	Missing % (n)
Has the workshop improved your sense of preparation to engage in difficult discussions with patients and their families?	89 (115)	9 (12)	2 (2)
Has the workshop improved your communication skills to engage in difficult discussions with patients and their families?	87 (112)	11 (14)	2 (3)
Has the workshop improved your ability to develop and maintain relationships with patients and their families?	86 (111)	12 (16)	1 (2)
Has the workshop improved your sense of confidence when engaging in difficult discussions with patients and their families?	87 (112)	12 (16)	1 (2)
Has the workshop reduced your sense of anxiety when engaging in difficult discussions with patients and their families?	60 (77)	36 (46)	5 (6)
Would you recommend the program to others in your position?	96 (124)	1 (1)	3 (4)

Table 3.  Impact of the program on participants’ sense of preparation, communication skills, ability to develop and maintain relationships, confidence, and anxiety

Dimensions	Baseline Mean (SD)	Post-workshop Mean (SD)	Paired sample T-Test	95% Confidence interval
Preparation (n = 129)	2.84 (0.956)	3.33 (0.753)	t = −6.681 p < 0.001	−0.633	−0.344
Communication (n = 129)	3.10 (0.856)	3.41 (0.777)	t = −5.547 p < 0.001	−0.421	−0.199
Relationship (n = 129)	3.50 (0.651)	3.52 (0.708)	t = −0.262 p = 0.794	−0.133	0.102
Confidence (n = 129)	2.95 (0.883)	3.45 (0.696)	t = −7.606 p ≤ 0.001	−0.625	−0.367
Anxiety (n = 126)	2.83 (0.922)	2.67 (0.847)	t = 1.891 p = 0.061	−0.007	0.309

Table 4.  Impact of the program on participants’ sense of preparation, communication skills, ability to develop and maintain relationships, confidence, and anxiety by discipline

Dimensions	Discipline	Pre-workshop Mean (SD)	Post-workshop Mean (SD)	Paired sample T-Test	95% Confidence interval
Preparation
	Physicians (n = 42)	3.19 (0.943)	3.67 (0.612)	t = −4.367 p < 0.001	−0.696	−0.256
	Nurses (n = 54)	2.76 (0.845)	3.26 (0.705)	t = −3.881 p < 0.001	−0.758	−0.242
	Psychosocial professionals (n = 19)	2.89 (0.994)	3.47 (0.772)	t = −3.644 p = 0.002	−0.913	−0.245
	Others (n = 14)	2.07 (0.917)	2.43 (0.514)	t = −1.439 p = 0.174	−o.893	0.179
Communication
	Physicians (n = 42)	3.48 (0.773)	3.74 (0.627)	t = −2.707 p = 0.010	−0.457	−0.067
	Nurses (n = 54)	2.94 (0.811)	3.33 (0.752)	t = −4.016 p < 0.001	−0.583	−0.195
	Psychosocial professionals (n = 19)	3.26 (0.806)	3.47 (0.697)	t = 1.714 p = 0.104	−0.469	0.047
	Others (n = 14)	2.36 (0.745)	2.64 (0.842)	t = −2.280 p = 0.040	−0.556	0.015
Relationship
	Physicians (n = 42)	3.76 (0.617)	3.88 (0.550)	t = −1.403 p = 0.168	−0.290	0.052
	Nurses (n = 54)	3.39 (0.627)	3.39 (0.627)	t = 0.000 p = 1.000	−0.205	0.205
	Psychosocial professionals (n = 19)	3.53 (0.612)	3.58 (0.769)	t = −0.438 p = 0.667	−0.305	0.200
	Others (n = 14)	3.14 (0.663)	2.86 (0.770)	t = 1.295 p = 0.218	−0.191	0.762
Confidence
	Physicians (n = 42)	3.36 (0.850)	3.71 (0.636)	t = −3.048 p = 0.004	−0.594	−0.121
	Nurses (n = 54)	2.85 (0.763)	3.44 (0.604)	t = −6.336 p < 0.001	−0.780	−0.405
	Psychosocial professionals (n = 19)	2.74 (0.933)	3.37 (0.684)	t = −3.076 p = 0.007	−1.063	−0.200
	Others (n = 14)	2.43 (0.938)	2.79 (0.802)	t = −2.110 p = 0.055	−0.723	0.009
Anxiety^a
	Physicians (n = 41)	2.68 (0.789)	2.51 (0.675)	t = 1.361 p = 0.181	−0.083	0.424
	Nurses (n = 52)	2.73 (0.888)	2.63 (0.841)	t = 0.697 p = 0.489	−0.181	0.373
	Psychosocial professionals (n = 19)	3.05 (0.911)	2.79 (0.976)	t = 1.229 p = 0.235	−0.187	0.713
	Others (n = 14)	2.29 (1.267)	3.14 (1.027)	t = 0.694 p = 0.500	−0.302	0.588

Note: ^aLower scores of this category in the post-questionnaire correspond to decreased anxiety.