Skip to content

Training clinicians in serious illness communication using a structured guide: Evaluation of a training program in three health systems

Journal of Palliative Medicine February 20, 2020

Read the full article

Research Areas


BACKGROUND Failure to initiate discussions about patients’ values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. 

OBJECTIVE: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians’ self-reported competencies in serious illness communication. 

DESIGN: Multimethod evaluation of an educational program. 

SETTING/CONTEXT: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. 

MEASURE: As collected by a post-training questionnaire, primary evaluation measure is clinicians’ self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. 

RESULTS: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. 

CONCLUSION: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.