The Effect of Simulated Communication Training on Self-efficacy and Frequency of Discussions in Oncology Nurses Conducting Advance Directive Discussions with Patients on Clinical Trials

Advance Directives (ADs) help patients identify goals and values for future medical care if they are no longer able to communicate for themselves. If ADs are not completed, critical healthcare and end of life decisions may be made without sufficient knowledge of the patient’s preferences. Nurses are in a unique position to help patients navigate the process of completing ADs but are not consistently prepared or confident in assisting patients with these documents. Simulation has the potential to improve nurses’ communication skills in eliciting ADs. The purpose of this Quality Improvement (QI) project was to measure the effect of nurses’ participation in communication skills training (CST) on self-efficacy of nurses conducting AD discussions and the frequency of documented ADs. All day shift nurses, from a medium-sized, federally funded research hospital, were approached to participate in a CST. All twenty-eight nurses completed the Self-Efficacy-12 questionnaire pre- and post-CST to evaluate changes in self-efficacy measures. A pre- and post-audit of the Electronic Health Record (EHR) of advance directive documentation was performed pre- and post-CST intervention for 31 consecutive days. Nurses most significantly identified improved self-efficacy on question #3, their ability to urge the patients to expand on their problems/worries, (Z = -4.24 p < .001), with a median rating 7.0 pre-training (IQR = 4) and 9.0 post-CST (IQR = 2). Prior to CST, the AD document was present in the chart 76.6% on admission, and post CST, the AD document was present 100% on admission (p = .011).