Multi-layered evaluation of a pilot, experiential-based communication skills training for nursing home staff

Background: The acknowledged relationship between the quality of communication (QoC) at the end of life and the quality and intensity of care has increased investments in professionals’ communication skills training, even if limited to acute contexts. Aim/Research question or hypothesis: To evaluate the impact of a communication skills training intervention for nursing home (NH) personnel on staff, family, and residents. Methods: Pre-post study in a 53-bed NH. A 6-hour residential programme was conducted using traditional and experiential learning methods. Data on staff, family, and residents were collected before (T0), 4 weeks (T1) and 6 months (T2) after the intervention. For staff, self-reported confidence in talking about death (NRS 0-10). For family: a) self-reported QoC (NRS 0-10); b) emotional burden (Zarit Burden Inventory, score 0-80); and c) satisfaction with care (5-point Likert question). For residents: a) documented Advance Care Planning (ACP); and b) use of hospital services in the last month. Results: Overall, 78% (46/59) of the staff attended the training. Only 28/53 (53%) residents had a reference family carer; 12/28 families participated at T0, 10/12 at T1, and 4/12 at T2. Staff reported improved confidence in talking about death at T1 (effect size 0.46, p=0.02). Instead, family carers perceived worsened QoC post-intervention, both with physicians (p=0.004 at T1 and p=0.003 at T2) and nurses (p=0.054 at T1 and p=0.0034 at T2), decreased satisfaction with care (p=0.045 at T1 and p=0.003 at T2) and higher emotional burden (median 22.5 [IQR 7.8-30.3] vs. 15.5 [IQR 11.8- 30.3]) at T1. In the post-intervention period, two residents had ACP at T2; no changes in emergency department transfers occurred, and no palliative consultations or hospice transfers were documented. Discussion: A short, experiential-based communication skills training program improves staff confidence. However, the effect on family- and residents-related outcomes is unclear. Although small sample renders conclusions tentative, study findings guide towards interventions targeting multiple stakeholders.