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Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial

  • Rose McCabe (a1), Paula John (a2), Jemima Dooley (a1), Patrick Healey (a3), Annie Cushing (a4), David Kingdon (a5), Stephen Bremner (a6) and Stefan Priebe (a6)...
Abstract
Background

A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis.

Aims

To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422).

Method

In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship.

Results

Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03–0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01–0.41, P = 0.043, a medium effect).

Conclusions

Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.

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Copyright
Corresponding author
Professor Rose McCabe, Room 1.05, College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK. Email: r.mccabe@exeter.ac.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial

  • Rose McCabe (a1), Paula John (a2), Jemima Dooley (a1), Patrick Healey (a3), Annie Cushing (a4), David Kingdon (a5), Stephen Bremner (a6) and Stefan Priebe (a6)...
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eLetters

Communication skills training for psychiatrists

Philippa Ditton-Phare, PhD student, University of Newcastle
Brian Kelly, Professor / Dean of Medicine, University of Newcastle
Carmel L. Loughland, Associate Professor, University of Newcastle
31 January 2017

Dear Editor,

It is encouraging to see studies emerge regarding communication skills training for psychiatrists. Whilst these authors claim that this is the first study to test an intervention for psychiatrists to enhance communication with patients with psychosis, we would like to draw readers’ attention to other work that has been published in this area. In Australia, since 2013 an advanced communication skills training program for postgraduate psychiatry trainees (ComPsych) has been part of psychiatry trainees’ formal postgraduate education (1), which focuses on improving doctor-patient communication about schizophrenia diagnosis, prognosis and treatment. Two pilot studies have been published about this program, evaluating trainees’ attitudes and self-efficacy regarding the program and their confidence in their own communication skills (2), and an objective evaluation of their skills utilising standardised patient assessments (3). It is our hope to continue this important work and we are encouraged to also see the work done by the authors of this paper.

Yours sincerely

Philippa Ditton-Phare

University of Newcastle

1.Ditton-Phare P, Halpin S, Sandhu H, Kelly B, Vamos M, Outram S, et al. Communication skills in psychiatry training. Australas Psychiatry. 2015; 23(4): 429-31.

2.Loughland C, Kelly B, Ditton-Phare P, Sandhu H, Vamos M, Outram S, et al. Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 2015; 39(2): 160-4.

3.Ditton-Phare P, Sandhu H, Kelly B, Kissane D, Loughland C. Pilot Evaluation of a Communication Skills Training Program for Psychiatry Residents Using Standardized Patient Assessment. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 2016.

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