Teaching Communication and Goals of Care in Geriatrics

The role of communication skills in contributing to improved patient outcomes and satisfaction with care is widely recognized. However, until relatively recently, medical trainees and practicing providers received little, if any, formal communication education with the historical assumption that they would learn how to optimize communication during patient interactions. Fortunately, recent literature supports that effective communication skills are teachable and clinicians can continually improve in their effectiveness as a communicator over their career. Education regarding general communication skills, as well as specific approaches to current and advanced goals of care communication, are critical in ensuring high-quality, patient-centered care for older adults. Importantly, communication skills in geriatrics should account for the lower health literacy of the geriatric cohort and more frequent communication challenges which are present secondary to cognitive and functional impairment. Shared decision-making models, often utilized during current care communication, can be taught using available resources such as the Geriatric Shared Decision-Making module developed by the Communication Skills Training and Research (“Comskil”) Laboratory at Memorial Sloan Kettering Cancer Center (Shen et al., Patient Educ Couns. 103:2328–2334, 2020). Patient Priories Care, a specific shared decision-making framework that includes elicitation of patient health priorities and subsequent alignment of healthcare decision-making, has successfully been taught to interprofessional learners using virtual, case-based education (Tinetti et al., Clin Geriatr Med 32:261–275, 2016). Many educational tools to teach and learn Patient Priorities Care are also available at https://patientprioritiescare.org/ (Patient Priorities Care, 2019). Specific communication models and focused communication skills training programs, including the SPIKES model, Geritalk, the Serious Illness Care Program, and the Veterans Health Administration Life-Sustaining Treatment Initiative, have educational resources available and have been successfully taught to a variety of learners (Baile et al., Oncologist 5:302–311, 2000; Kelley et al., J Am Geriatr Soc 60(2):332–337, 2012; Bernacki et al., BMJ Open 5(10):e009032, 2015; Foglia et al., Jt Comm J Qual Patient Saf. 45:47–56, 2019).