Skip to main content

The effectiveness of communication-skills training interventions in end-of-life noncancer care in acute hospital-based services: A systematic review

  • Laura Lord (a1), David Clark-Carter (a1) and Amy Grove (a2)

A systematic review was conducted in order to explore the effectiveness of communication-skills training interventions in end-of-life care with noncancer acute-based healthcare staff.


Articles were included if they (1) focused on communication-skills training in end-of-life/palliative care for noncancer acute-based staff and (2) reported an outcome related to behavior change with regard to communication. Sixteen online databases were searched, which resulted in 4,038 potential articles. Screening of titles left 393 articles that met the inclusion criteria. Abstracts (n = 346) and full-text articles (n = 47) were reviewed, leaving 10 papers that met the criteria for our review. All articles explored the effect of communication-skills training on aspects of staff behavior; one study measured the effect on self-efficacy, another explored the impact on knowledge and competence, and another measured comfort levels in discussing the end of life with patients/families. Seven studies measured a number of outcomes, including confidence, attitude, preparedness, stress, and communication skills.


Few studies have focused on end-of-life communication-skills training in noncancer acute-based services. Those that do have report positive effects on staff behavior with regard to communication about the end of life with patients and families. The studies varied in terms of the population studied and the health services involved, and they scored only moderately or weakly on quality. It is a challenge to draw a definite conclusion about the effectiveness of training interventions in end-of-life communication because of this. However, the findings from our review demonstrate the potential effectiveness of a range of training interventions with healthcare professionals on confidence, attitude, self-efficacy, and communication skills.

Significance of results:

Further research is needed to fully explore the effectiveness of existing training interventions in this population, and evidence using objective measures is particularly needed. Ideally, randomized controlled trials or studies using control groups and longer follow-ups are needed to test the effectiveness of interventions.

Corresponding author
Address correspondence and reprint requests to Laura Lord, Research and Innovation, The Beeches, Penn Hospital, Penn, Wolverhampton, WV4 5HN, United Kingdom. E-mail:
Hide All
Arnold, R.M., Back, A.L., Emlet, L.L., et al. (2010). A communication course for intensive care unit fellows. Medical Encounter, 24, 189.
Ashworth, C.D., Williamson, P. & Montano, D. (1984). A scale to measure physicians' beliefs about psychosocial aspects of patient care. Social Science & Medicine, 19, 12351238.
Back, A.L., Arnold, R.M., Tulsky, J.A., et al. (2003). Teaching communication skills to medical oncology fellows. Journal of Clinical Oncology, 21, 24332436.
Barnes, S., Gott, M., Chady, B., et al. (2012). Enhancing patient–professional communication about end-of-life issues in life-limiting conditions: A critical review of the literature. Journal of Pain and Symptom Management, 44, 866879.
Betcher, D.K. (2010). Elephant in the room project: Improving caring efficacy through effective and compassionate communication with palliative care patients. Medsurg Nursing, 19, 101105.
Blank, L. (1995). Defining and evaluating physician competence in end-of-life patient care. The Western Journal of Medicine, 163, 297301.
Block, S.D. & Billings, J.A. (2001). The program in palliative care education and practice. Cambridge: Harvard Medical School Department of Continuing Education. Available from
Bristowe, K., Shepherd, K., Bryan, L., et al. (2014). The development and piloting of the REnal-specific Advanced Communication Training (REACT) programme to improve advance care planning for renal patients. Palliative Medicine, 28, 360366.
Buckley, J.D., Addrizzo-Harris, D.J., Clay, A.S., et al. (2009). Multisociety task force recommendations of competencies in pulmonary and critical care medicine. American Journal of Respiratory and Critical Care Medicine, 180, 290295.
Butow, P., Cockburn, J., Girgis, A., et al. (2008). Increasing oncologists' skills in eliciting and responding to emotional cues: Evaluation of a communication skills training program. Psycho-Oncology, 17, 209218.
Clayton, J.M., Butow, P.N., Waters, A., et al. (2012). Evaluation of a novel individualized communication-skills training intervention to improve doctors' confidence and skills in end-of-life communication. Palliative Medicine, 27, 236243.
Coates, C.J. (1996). Development of the caring efficacy scale: Self-report and supervisor versions. Unpublished manuscript. Denver: University of Colorado Health Sciences Center.
Curtis, J.R., Engelberg, R.A., Wenrich, M.D., et al. (2002). Studying communication about end-of-life care during the ICU family conference: Development of a framework. Journal of Critical Care, 17, 147160.
Department of Health (2008). End-of-life care strategy: Promoting high quality care for all adults at the end of life. London: Department of Health. Available from
Ellershaw, J. & Ward, C. (2003). Care of the dying patient: The last hours or days of life. BMJ, 326, 3034.
Fallowfield, L., Saul, J. & Gilligan, B. (2001). Teaching senior nurses how to teach communication skills in oncology. Cancer Nursing, 24, 185191.
Goldberg, R., Guadangnoli, E. & LaFarge, S. (1987). A survey of house staff attitudes towards terminal care education. Journal of Cancer Education, 2, 159163.
Herzler, M., Franze, T., Dietze, F., et al. (2000). Dealing with the issue “care for the dying” in medical education: Results of a survey of 592 European physicians. Medical Education, 34, 146147.
Hewison, A., Lord, L. & Bailey, C. (2014). “It's been quite a challenge”: Redesigning end-of-life care in acute hospitals. Palliative & Supportive Care, 28, 110.
Jenkins, V. & Fallowfield, L. (2002). Can communication skills training alter physicians' beliefs and behaviour in clinics? Journal of Clinical Oncology, 20, 765769.
Kelley, A.S., Back, A.L., Arnold, R.M., et al. (2012). Geritalk: Communication skills training for geriatric and palliative medicine fellows. Journal of the American Geriatrics Society, 60, 332337.
Kerai, S.M. & Wheeler, M. (2013). The forgotten education needs of the house staff: Training internal medicine residents to address end-of-life issues. Omega, 67, 147153.
Krimshtein, N.S., Luhrs, C.A., Puntillo, K.A., et al. (2011). Training nurses for interdisciplinary communication with families in the intensive care unit: An intervention. Journal of Palliative Medicine, 14, 13251332.
Lautrette, A., Ciroldi, M., Ksibi, H., et al. (2006). End-of-life family conferences: Rooted in the evidence. Critical Care Medicine, 34, S364S372.
Lautrette, A., Darmon, M., Megarbane, B., et al. (2007). A communication strategy and brochure for relatives of patients dying in the ICU. The New England Journal of Medicine, 256, 469478.
Lenzi, R., Baile, W.F., Berek, J., et al. (2005). Design, conduct and evaluation of a communication course for oncology fellows. Journal of Cancer Education, 20, 143149.
Mason, S. & Ellershaw, J. (2004). Assessing undergraduate palliative care education: Validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. Medical Education, 38, 11031110.
McDonagh, J.R., Elliott, T.B., Engelberg, R.A., et al. (2004). Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction. Critical Care Medicine, 32, 14841488.
Moher, D., Liberati, A., Tetxlaff, J., et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264269.
Mulder, S.F., Bleijenberg, G., Verhagen, S.C., et al. (2009). Improved competence after a palliative care course for internal medicine residents. Palliative Medicine, 23, 360368.
National Health Service (2012). NHS choices. Available from
National Institutes of Health (2004). State-of-the-science conference statement on improving end-of-life care. Available from
Ramirez, A.J., Graham, J., Richards, M.A., et al. (1996). Mental health of hospital consultants: The effects of stress and satisfaction at work. Lancet, 347, 724728.
Schell, J.O., Green, J.A., Tulsky, J.A., et al. (2013). Communication skills training for dialysis decision-making and end-of-life care in nephrology. Clinical Journal of the American Society of Nephrology, 8, 675680.
Schwarzer, R. & Jerusalem, M. (1995). Generalized self-efficacy scale. In Measures in health psychology: A user's portfolio. casual and control beliefs. Weinman, J. et al. (eds.), pp. 3537. Windsor: National Foundation for Education Research, Nelson Publishing Company.
Smith, L., O'Sullivan, P., Lo, B., et al. (2013). An educational intervention to improve resident comfort with communication at the end of life. Journal of Palliative Medicine, 16, 5459.
Thomas, B.H., Ciliska, D., Dobbins, M., et al. (2004). A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing, 1, 176184.
Ury, W.A., Reznich, C.B. & Weber, C.M. (2000). A needs assessment for a palliative care curriculum. Journal of Pain and Symptom Management, 20, 408416.
White, D.B., Braddock, C.H., Bereknyei, S., et al. (2007). Toward shared decision making at the end of life in intensive care units: Opportunities for improvement. Archives of Internal Medicine, 167, 461467.
Zapka, J.G., Hennessy, W., Carter, R.E., et al. (2006). End-of-life communication and hospital nurses: An educational pilot. The Journal of Cardiovascular Nursing, 21, 223231.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 35
Total number of PDF views: 283 *
Loading metrics...

Abstract views

Total abstract views: 962 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st March 2018. This data will be updated every 24 hours.