All Providers Better Communication Skills Program' (ABCs)

Evidence shows that clinicians rarely engage patients in discussions about their serious illness and that there is a lack of training options to help health care providers develop these communication skills. By developing these skills, these conversations will be made easier, allowing patients to access a palliative approach to care earlier in their illness journey, providing them with the support and resources they need to manage their symptoms, alleviate their suffering, and improve their physical and mental health. This study will examine the ABCs education intervention that features a blended format of online modules and interactive virtual workshops, relevant to clinicians at all levels of training and practice, to build provider competency and comfort in serious illness communication.

The investigators developed the 'All providers: Better Communication Skills program' (ABCs), a virtual, person-centred education curriculum for interprofessional health care providers. This curriculum is a product of the collaboration among a large interdisciplinary team of palliative and end-of-life care clinicians, researchers, and educators, based on years of teaching advance care planning and goals of care discussions workshops with Hospice Palliative Care Ontario. The ABCs program adopts a blended format (i.e., participants engage in both asynchronous online modules \[five\] and synchronous interactive workshops \[three\]) that has relevance to learners and clinicians at all levels of training and practice. The investigators piloted this education program with medical learners and interdisciplinary health care providers with prior palliative care experience and still found that completion on the ABCs improved these participants self-reported confidence in initiating this communication and external rater assessments of their competency.

The ABCs program focuses on four essential elements of being a skillful communicator: principles of effective communication, conversation structure, communication skills, and reflective practice. The program consists of virtual modules that provide any clinician with practical tools, tips, and strategies to implement when communicating with seriously ill patients and their families. The ABCs program is intended to increase HCPs (particularly primary care providers) and medical learners' competency and comfort in having these, often difficult, conversations, while also encouraging them to initiate these discussions earlier in their patient's disease trajectory - moving a palliative approach to care further upstream. Terminology is clarified and consistent, the complexities of conversations are simplified and the fundamental approach and structure can be applied to different contexts.

The objective of this study is to complete a rigorous trial evaluating the impact of a communication skills curriculum for health care providers that addresses difficult conversations with seriously ill patients. The investigators aim to develop sustainable educational resources that can be administered virtually. Specially, the investigators will assess the impact of the ABCs education program on participant skill acquisition in communication and objective behavior change in simulated patient encounters. Secondly, the investigators will assess the impact of the education program on participant competency in communication from their own perspective and that of standardized patients with whom the participant has simulated encounters. The investigators will also measure participant satisfaction and perceived usefulness of the ABCs education program.

Potential participants across Canada will be informed about ABCs through advertising by the investigators partner stakeholders and organizations. The study design is a prospective stepped wedge group - randomized controlled trial (SWGRT) of interprofessional health care providers (HCPs) who enroll in the ABCs program. In this trial design, half of the participants begin the study in the control condition as randomly assigned, and cross-over to the intervention condition at a pre-determined time points, so that both the intervention and control groups eventually receive the intervention. The primary comparison will be between the trial arms upon completion of a program by the initial intervention group. This study will also measure the change among all participants from pre to post intervention.

• Self-Efficacy Questionnaire (SE-12) [Time frame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).]
• End-of-life Professional Caregiver Survey (EPCS) [Time frame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).]
• Blended Learning Usability Evaluation - Questionnaire (BLUE-Q) [Time frame: Post ABCs education, at 4 months for Intervention Group, at 8 months for Control Group]
• Qualitative Interviews [Time frame: Post ABCs education, at 4 months for Intervention Group, at 8 months for Control Group]
• Questionnaire on Quality of Physician-Patient Interaction (QQPPI) [Time frame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).]
• Feeling Heard and Understood scale [Time frame: All groups: 1) From enrollment to start of Intervention Group ABCs education, 2) Post ABCs education for Intervention Group, at 4 months, 3) Post ABCs education for Control Group, at 8 months. Sample: 6 months post ABCs (14 months).]