Posted August 28, 2007

Training eases end-of-life conversations with families

Medical student in SIM center
Photo by Ryan Brandenberg/Temple University
Temple resident Daniel Kim, M.D., (right) talks with an actor patient during a simulation about organ donation.

One of the most important, yet most difficult conversations for a doctor comes when approaching a family about organ donation when a patient is diagnosed as brain-dead. Yet sensitive, thoughtful communications between doctors and the families of these patients could potentially improve organ donation rates. Prior research has correlated a family’s understanding of brain death and donation consent rates.

In an ongoing study, Amy Goldberg, M.D., is testing the value of communications training for residents to improve their skills in talking with a family about the terminal prognosis of a family member. Goldberg, professor of surgery at Temple University’s School of Medicine, is director of trauma and critical care at the Hospital.


So far, Goldberg and her colleagues have found that just two extra hours of communications training in end-of-life issues is valuable. Residents were tested at Temple’s Institute for Clinical Simulation and Patient Safety.

Others have already expressed interest in the Temple program. Representatives from the New England Organ Bank recently visited the institute to observe and now plan to use this training method in Boston.

One group of residents participated in a simulated conversation explaining the brain death of a loved one to families, while another group received no specialized training. Eight weeks later, both groups participated in formal videotaped family communication simulations regarding brain death. Their performances were reviewed and rated by professionals considered to be experts in this area. Residents who had received previous training scored 20 percent better than those residents who had not received any training.

In the next phase of the study, all residents viewed their performances along with comments by the experts and repeated the simulated scenarios. An analysis of the results is in progress.

“We plan to expand to all residents at Temple and hope to eventually engage the other Philadelphia teaching hospitals in a collaborative educational effort,” said Goldberg, who believes that incorporating this communication simulation into formal training programs has the potential to create a positive impact on organ donation. She plans further studies to test this hypothesis.

“Interpersonal & Communication Skills” is now among the six competencies stressed as a critical skill by the American College of Graduate Medical Education for residents. Due to the extreme sensitivity surrounding the end of a patient’s life, experts recommend the following techniques for doctors when interacting with family members:

• Provide small amounts of ‘up-to-date’ information

• Minimize the number of staff members who talk to families about brain death

• Choose words carefully. Use simple language as opposed to clinical language

• Repeat and multiple explanations might be necessary

Joining Goldberg on the research team are Richard Milner, BS, Carol A. Fisher, BA, John Gaughan, PhD, John Travaline, MD, Mercedes Jacobson, MD, Mark J. Seamon, MD, Soo Kim, MD, and Daniel T. Dempsey, MD, of Temple; and Margaret Harrison, BA, Stacey Doll, MPA, Gweneth George, BS, and Howard Nathan, BS, CPTC, of the Gift of Life Donor Program.