Developing and evaluating a course programme to enhance existential communication with cancer patients in general practice

Abstract

Objective: Our objective was to describe the development and evaluation of a course programme in existential communication targeting general practitioners (GPs).

Design: The UK Medical Research Council’s (MRC) framework for complex intervention research was used as a guide for course development and evaluation and was furthermore used to structure this paper. The development phase included: identification of existing evidence, description of the theoretical framework of the course, designing the intervention and deciding for types of evaluation. In the evaluation phase we measured self-efficacy before and after course participation. To explore further processes of change we conducted individual, semi-structured telephone interviews with participants.

Subjects and setting: Twenty practising GPs and residentials in training to become GPs from one Danish region (mean age 49).

Results: The development phase resulted in a one-day vocational training/continuing medical education (VT/CME) course including the main elements of knowledge building, self-reflection and communication training. Twenty GPs participated in the testing of the course, nineteen GPs answered questionnaires measuring self-efficacy, and fifteen GPs were interviewed. The mean scores of self-efficacy increased significantly. The qualitative results pointed to positive post course changes such as an increase in the participants’ existential self-awareness, an increase in awareness of patients in need of existential communication, and an increase in the participants’ confidence in the ability to carry out existential communication.

Conclusions: A one-day VT/CME course targeting GPs and including the main elements of knowledge building, self-reflection and communication training showed to make participants more confident about their ability to communicate with patients about existential issues and concerns.

Key points

• Patients with cancer often desire to discuss existential concerns as part of clinical care but general practitioners (GPs) lack confidence when discussing existential issues in daily practice.

• In order to lessen barriers and enhance existential communication in general practice, we developed a one-day course programme.

• Attending the course resulted in an increase in the participants’ confidence in the ability to carry out existential communication.

• This study adds knowledge to how confidence in existential communication can be increased among GPs.

Keywords:

• Communication
• cancer
• existential
• spiritual
• religious
• general practitioners
• vocational training
• continuing medical education

Acknowledgements

The authors wish to thank all the GPs participating in this study for their time and interest.

Disclosure statement

There are no conflicts of interest in connection with this paper. The authors alone are responsible for the content and writing of this paper.

Ethical approval

The study was approved by the Danish Data Protection Agency (J. no.: 2015-41-3859) and all participants gave their written informed consent.

Additional information

Funding

The study has received funding from the Danish Cancer Society, The Committee of Psychosocial Cancer Research [grant numbers: R114-A7131-14-S3], from The Novo Nordisk Foundation [grant number: 13986], from The Committee of Quality and Continuing Education Region of Southern Denmark [EU Appl. 02/15] and from The Foundation for General Practice [grant number: 15/2092].

Notes on contributors

Elisabeth Assing Hvidt

Elisabeth Assing Hvidt is a sociologist of religion and received her PhD in Humanistic Health Research from the University of Southern Denmark in 2013. Her research interests include existential and spiritual illness dimensions, doctor–patient communication and relationships in general practice.

Jette Ammentorp

Jette Ammentorp's main research interest is in patient communication, patient experiences and empowerment of patients with a special focus on methods to improve the communication between health professionals and patients.

Jens Søndergaard

Jens Søndergaard is the head of the Research Unit of General Practice at University of Southern Denmark, he is a clinical pharmacologist and general practitioner and professor in general practice.

Connie Timmermann

Connie Timmermann has acquired her PhD in Nursing from University of Aarhus, Denmark, and is currently employed as a postdoc of patient-centered cancer care at IRS/University of Southern Denmark & Vejle Hospital. A common thread throughout her research is the focus on and discussion of existential resources and concerns of patients and their relatives.

Dorte Gilså Hansen

Dorte Gilså Hansen received her PhD from the University of Southern Denmark in 2004 and is currently Associate Professor and head of center of the National Research Center for Cancer Rehabilitation. Her research areas include physical, psychosocial and existential problems due to life-threatening diseases, rehabilitation and individual needs assessment.

Niels Christian Hvidt

Niels Christian Hvidt, born in 1969, is a Danish theologian and Professor in Spiritual Care at University of Southern Denmark, trained in Copenhagen and Rome. Hvidt's research areas include spirituality and health, spiritual careandpatient perspectives.