(39 - Saturday) At the Heart of the Matter – Building Peer Directed Patient Centered Communication Skills for Cardiac Advanced Practice Providers

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Abstract:

Introduction:
The Cardiac Center (CC) at the Children’s Hospital of Philadelphia (CHOP) has 50 advanced practice providers (APPs) in specialized inpatient, outpatient and surgical roles. Historically, APPs at CHOP have not had access to formal training on delivering difficult news and responding to emotion. VitalTalk (VT) is a national recognized, validated methodology for teaching clinicians empathic and patient and family centered communication skills. VT training is integrated into fellowship and resident training at our institution, and is primarily taught by trained physician facilitators. A limited number of CC APPs received informal VT training and subsequently led family meetings, served as continuity providers for complex patients and developed therapeutic relationships with families for challenging cases in our cardiac intensive care unit (CICU). Given the distinct and important roles of CC APPs who deliver difficult news in highly emotional situations on a regular basis we identified a need to provide APP led formal communication training to the CC APPs.

Objective:
To develop APP led specialized skills-based communication training for CC APPs utilizing Vital Talk teaching methodology.

Methods:
Additional cardiac providers including an APP were trained as facilitators through VT’s national faculty development program. Additional APPs with CHOP’s palliative care team were trained as well. We reworked existing cardiac cases to tailor them to the APP role and updated clinical aspects of the case to be relevant and realistic. The initial session with two cardiac cases was held fully virtual for five APPs from our CICU and was facilitated by one CICU APP and one palliative care team APP. A pre and post assessment was distributed to the participants via email.

Results:
On the pre assessment, 80 percent of the APPs were in their first two years of practice and reported feeling “somewhat” comfortable with delivering difficult news and responding to emotion. All APPs reported on their post assessment that the training was “very valuable” and that they delivery difficult news “very frequently”. Post assessment results revealed the majority of APPs reporting feeling “very comfortable” with delivering difficult news and responding to emotion.

Conclusions:
Communication training specifically designed for CC APPs is valuable and provides essential skills that are frequently used. Effective and empathetic communication with patients and families helps to build partnerships and trusting relationships. Equipping APPs with concrete skills on delivering difficult news and responding to emotion can empower them to lead family meetings and serve as continuity providers, and increase their comfort level in these situations. APPs face challenges in communication unique to their role, and by using peers as facilitators we hope to increase the value for the participants and effectiveness of the training. Limitations to expanding this training include time of the facilitators, time of the participants, funding for additional training of facilitators, and buy in from leadership on the importance of this skill development. The initial group was all CICU APPs and we plan to expand to additional groups of CC APPs in the future.