Effectiveness of the AAA-Training Programme on GP resident-Patient Communication in Palliative care; a Controlled Clinical Trial (COMPACT in GP vocational training).

The aim of the proposed study is to improve palliative care (PC) in general practice, by improving general practitioner (GP)-patient communication in PC. GPs play a central role in providing PC in the Netherlands. Good GP-patient communication is essential for the delivery of high quality care. Communication in PC is difficult, involving a mix of physical, psychosocial, and spiritual issues. Because of barriers in communication, not all of the patient’s problems are clarified.
Consequently, GPs will not take subsequent actions, and the quality of life of the patient may be unnecessarily impaired. Our literature review and our preliminary studies yielded three key elements for GP-patient communication in PC: Availability, Active listening, and Anticipating (AAA). Existing PC training courses for GP residents are too much generalized, lacking tools for GPs to detect their personal gaps. We developed the AAA assessment tool, that enables GP residents to identify the gaps in their PC communication skills and to formulate learning goals. Tailored communication exercises are offered, and finally the tool is used for self-evaluation of learned AAA skills. The effectiveness of this tool will be evaluated in a controlled clinical trial. Study questions are:

1. what are the effects of implementing the AAA assessment tool on communication skills of GP residents?

2. Do GPs experience the newly acquired skills in their palliative practice as useful?

3. How can the AAA training be implemented in the vocational GP training?

A control group of 60 GP residents (= five groups of 12 GP residents) will attend the usual third year programme. An intervention group of 60 GP residents will attend a similar programme, in which the AAA tool is implemented.

Outcomes are
1. GP residents’ performance on PC communication skills, assessed by video-recorded consultations with simulated patients;

2. Perceived PC competence and applicability of learned skills, measured by GP-resident questionnaires;

3. Feasibility of the AAA training in the GP vocational training. If demonstrated to be effective, the AAA assessment tool will be implemented in the vocational GP training programme, also in other institutes.

Based on the literature and preliminary studies three key elements for GP-patient communication in PC were identified:

Availability, Active listening, and Anticipating (AAA). Existing GP residency training programmes on communication in PC are in need of a tool for identifying GP residents’ individual learning goals. The AAA assessment tool will enable GP residents to gain insight in the quality of their communication skills in PC; this will increase the effectiveness of the learning process by helping to focus on the aspects GP residents want to improve. All participating GP residents are in the last year of their vocational GP training, only the intervention groups will attend the training with the AAA assessment tool integrated in the programme.

- Months 1-6: Preparation of Controlled Clinical Trial and AAA assessment tool;

- Months 6-24: Pre-measurement, intervention/control, post-measurement in 10 groups of 12 GP residents;

- Months 18-36: Assessments of videotaped simulated patient consultations, analyses and report.

120 GP residents will be recruited.

No patients will be included in this study.