[Difficult conversations in nephrology: assessment of a formative experience].

INTRODUCTION: Nephrologists often have to discuss difficult news with patients such as discussing treatment and prognosis, forgoing dialysis or end-of-life. Despite this, there are few educational interventions in this field. The aim of this study is to assess the efficacy of a workshop on difficult conversations in dialysis. METHOD: Within the Program to Enhance Relational and Communication Skills (PERCS) we developed a 4-hour workshop focused on communication in dialysis (PERCS-dialysis) at San Paolo Hospital,Milan. The workshop is geared around the enactment and debriefing of a case scenario. The scenario involves three conversations with a patient and a family member on dialysis and transplant. Before and after the workshop, participants are asked to complete a questionnaire on: sense of preparation, communication skills, relational skills, confidence and anxiety. The post-questionnaire also included some open-ended questions on the learning experience. RESULTS: 81 clinicians participated to 8 workshops. After the workshop, participants reported better preparation (p=.000) and confidence (p=.000). Perceived communication skills (p=.060), relational skills (p=.438) and anxiety (p=.441) improved but not significantly. All participants (100%) would recommend the workshop. In the open-ended questions participants reflected on the learning, appreciated the interactive methodology and offered suggestions. CONCLUSIONS: Consistently with the educational objectives, clinicians improved their preparedness and confidence in holding difficult conversations. Clinicians perception of their communication and relational abilities did not change. To affect these skills a longer and more intensive training is probably needed.