{"id":1526,"date":"2020-12-15T09:14:55","date_gmt":"2020-12-15T01:14:55","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=1526"},"modified":"2021-05-04T08:32:27","modified_gmt":"2021-05-04T00:32:27","slug":"a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit\/","title":{"rendered":"A systematic scoping review of teaching and evaluating communications in the intensive care unit"},"content":{"rendered":"<p>Submitted: 4 May 2020<br \/>\r\nAccepted: 3 August 2020<br \/>\r\nPublished online: 5 January, TAPS 2021, 6(1), 3-29<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/RA2351\">https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/RA2351<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Elisha Wan Ying Chia<sup>1,2<\/sup>, Huixin Huang<sup>1,2<\/sup>, Sherill Goh<sup>1,2<\/sup>, Marlyn Tracy Peries<sup>1,2<\/sup>, Charlotte Cheuk Yiu Lee<sup>2,3<\/sup>, Lorraine Hui En Tan<sup>1,2<\/sup>, Michelle Shi Qing Khoo<sup>1,2<\/sup>, Kuang Teck Tay<sup>1,2<\/sup>, Yun Ting Ong<sup>1,2<\/sup>, Wei Qiang Lim<sup>1,2<\/sup>, Xiu Hui Tan<sup>1,2<\/sup>, Yao Hao Teo<sup>1,2<\/sup>, Cheryl Shumin Kow<sup>1,2<\/sup>, Annelissa Mien Chew Chin<sup>4<\/sup>, Min Chiam<sup>5<\/sup>, Jamie Xuelian Zhou<sup>2,6,7<\/sup> &amp; Lalit Kumar Radha Krishna<sup>1,2,5,7-10<\/sup><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><span lang=\"EN-GB\">Yong Loo Lin School of Medicine, National University of Singapore, Singapore; <sup>2<\/sup>Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore; <sup>3<\/sup>Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore; <sup>4<\/sup>Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore; <sup>5<\/sup>Division of Cancer Education, National Cancer Centre Singapore, Singapore; <sup>6<\/sup>Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, Singapore; <sup>7<\/sup>Duke-NUS Graduate Medical School, Singapore; <sup>8<\/sup>Centre for Biomedical Ethics, National University of Singapore, Singapore; <sup>9<\/sup>Palliative Care Institute Liverpool, Academic Palliative &amp; End of Life Care Centre, University of Liverpool; <sup>10<\/sup>PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore<\/span><\/i><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> Whilst the importance of effective communications in facilitating good clinical decision-making and ensuring effective patient and family-centred outcomes in Intensive Care Units (ICU)s has been underscored amidst the global COVID-19 pandemic, training and assessment of communication skills for healthcare professionals (HCPs) in ICUs remain unstructured<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">To enhance the transparency and reproducibility, Krishna\u2019s Systematic Evidenced Based Approach (SEBA) guided Systematic Scoping Review (SSR), is employed to scrutinise what is known about teaching and evaluating communication training programmes for HCPs in the ICU setting. SEBA sees use of a structured search strategy involving eight bibliographic databases, the employ of a team of researchers to tabulate and summarise the included articles and two other teams to carry out content and thematic analysis the included articles and comparison of these independent findings and construction of a framework for the discussion that is overseen by the independent expert team.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Results:<\/span><\/b><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">9532 abstracts were identified, 239 articles were reviewed, and 63 articles were included and analysed. Four similar themes and categories were identified. These were strategies employed to teach communication, factors affecting communication training, strategies employed to evaluate communication and outcomes of communication training.\u00a0\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Conclusion:<\/span><\/b><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">This SEBA guided SSR suggests that ICU communications training must involve a structured, multimodal approach to training. This must be accompanied by robust methods of assessment and personalised timely feedback and support for the trainees. Such an approach will equip HCPs with greater confidence and prepare them for a variety of settings, including that of the evolving COVID-19 pandemic.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Communication, Intensive Care Unit, Assessment, Skills Training, Evaluation, COVID-19, Medical Education<\/span><\/i><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">The global COVID-19 pandemic has underscored the importance of effective communications in the Intensive Care Unit (ICU).<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">ICU communications training should adopt a longitudinal, structured and multimodal approach.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Robust stepwise evaluation of learner outcomes via Kirkpatrick\u2019s Hierarchy is needed.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Supportive host organisation and conducive learning environment and are key to successful curricula.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<ol><\/ol>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The COVID-19 pandemic has placed immense strain on intensive care units (ICU)s with healthcare teams and resources stretched to meet the sudden increased healthcare demands of critically ill patients. To further complicate the situation, ICU teams are called to not only communicate closely with colleagues in a bid to support them but also counsel families confronting acute distress and uneasy waits separated from their loved ones due to restrictions to visiting in an effort to limit the spread of this pandemic (Ministry of Health, 2020; World Health, 2020). From breaking bad news (Blackhall, Erickson, Brashers, Owen, &amp; Thomas, 2014; J. Yuen &amp; Carrington Reid, 2011), to conveying the need for sedation and intubation (Carrillo Izquierdo,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Diaz Agea,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Jimenez Rodriguez , Leal Costa, &amp;<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Sanchez Exposito, 2018) and providing progress reports on critically ill patients (Curtis et al., 2005; Curtis, White, Curtis, &amp; White, 2008; Yang et al., 2020), communication skills amongst ICU healthcare professionals (HCPs) are pivotal in reassuring anxious, emotional and stressed patients and families (Ahrens, Yancey, &amp; Kollef, 2003; Foa et al., 2016; Kirchhoff et al., 2002). Good communication in the ICU has also been shown to improve patient-physician relationships (K. G. Anderson &amp; Milic, 2017), patient and family-centred outcomes, quality of care, and patient and family satisfaction (Bloomer, Endacott, Ranse, &amp; Coombs, 2017; Cao et al., 2018; Currey, Oldland, Considine, Glanville, &amp; Story, 2015). Effective communications between HCPs in ICU also enhances clinical decision-making (Kleinpell, 2014), reduces medication and treatment errors (Clark, Squire, Heyme, Mickle, &amp; Petrie, 2009; Happ et al., 2014; Sandahl et al., 2013), decreases physician burnout (Rachwal et al., 2018), and improves staff retention and satisfaction (Hope et al., 2015). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">With evidence suggesting that poor communication skills (Downar, Knickle, Granton, &amp; Hawryluck, 2012; Foa et al., 2016) and training (Smith, O&#8217;Sullivan, Lo, &amp; Chen, 2013) are likely to increase patients\u2019 (Dithole, Sibanda, Moleki, &amp; Thupayagale \u2010 Tshweneagae, 2016) and families\u2019 (Curtis et al., 2008) stress, adversely affect care and recovery (Dithole et al., 2016), and increase healthcare costs (Kalocsai et al., 2018), some authors have suggested that effective communication skills are at least as important (Adams, Mannix, &amp; Harrington, 2017; Cicekci et al., 2017; Van Mol, Boeter, Verharen, &amp; Nijkamp, 2014) to good patient care as clinical acumen (Curtis et al., 2001a). Yet despite evidence of the importance of communication skills in ICU, communication skills training remains inconsistent, variable and not evidence-based in most ICU settings (Adams et al., 2017; Berlacher, Arnold, Reitschuler-Cross, Teuteberg, &amp; Teuteberg, 2017; Bloomer et al., 2017; D. A. Boyle et al., 2017; Miller et al., 2018; Sanchez Exposito et al., 2018). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">With this in mind, a systematic scoping review (SSR) is proposed to map current approaches to communications skills training in ICUs (Munn et al., 2018) and potentially guide design of a communications training programme. An SSR allows for systematic extraction and synthesis of actionable and applicable information whilst summarising available literature across a wide range of pedagogies and practice settings employed to understand what is known about teaching and evaluating communication training programmes for HCPs in the ICU setting (Munn et al., 2018).<\/span><\/p>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">\u00a0II. <\/span><span lang=\"EN-GB\"><\/span><span lang=\"EN-GB\">METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">To overcome concerns about the transparency and reproducibility of SSR, a novel approach called Krishna\u2019s Systematic Evidenced Based Approach (henceforth SEBA) is proposed (Kow et al., 2020; Krishna et al., 2020; Ngiam et al., 2020). This SEBA guided SSR (henceforth SSRs in SEBA) adopts a constructivist perspective to map this complex topic from multiple angles (Popay et al., 2006) whilst a relativist lens helps account for variability in communication skills training (Crotty, 1998; Ford, Downey, Engelberg, Back, &amp; Curtis, 2012; Pring, 2000; Schick-Makaroff, MacDonald, Plummer, Burgess, &amp; Neander, 2016). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">To provide a balanced review, the research team was supported by the medical librarians from the National University of Singapore\u2019s (NUS) Yong Loo Lin School of Medicine (YLLSoM), the National Cancer Centre Singapore (NCCS) and local educational experts and clinicians at the NCCS, the Palliative Care Institute Liverpool, YLLSoM and Duke-NUS Medical School (henceforth the expert team). The research and expert teams adopted an interpretivist approach as they proceeded through the five stages of SEBA (Figure 1).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"762\" height=\"567\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-1-1.png\" alt=\"\" class=\"alignnone size-full wp-image-1527\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-1-1.png 762w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-1-1-300x223.png 300w\" sizes=\"auto, (max-width: 762px) 100vw, 762px\" \/><\/p>\r\n<p style=\"text-align: center\"><span style=\"font-size: 10pt\">Figure 1. The SEBA Process<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\"><\/span><\/i><em><span lang=\"EN-GB\">A. <\/span><\/em><i><span lang=\"EN-GB\">Stage 1: Systematic Approach<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">1) Determining the title and research question: <\/span><\/i><span lang=\"EN-GB\">The research and expert teams agreed upon the goals, population, context and concept to be evaluated in this SSR. The two teams then agreed that the primary research question should be \u201cWhat is known about teaching and evaluating communication training programs for HCPs in the ICU setting?&#8221; The secondary research questions were \u201cHow are communication skills taught and assessed in the ICU setting?\u201d and \u201cHow effective have such interventions been as described in the published literature?\u201d<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">2) Inclusion criteria: <\/span><\/i><span lang=\"EN-GB\">A Population, Intervention, Comparison, Outcome, Study Design (PICOS) format was adopted to guide the research process (Peters, Godfrey, Khalil, et al., 2015a; Peters, Godfrey, McInerney, et al., 2015b) (Table 1).<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"104%\">\r\n<tbody>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">PICOS<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Inclusion Criteria<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Exclusion Criteria<b><\/b><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Population<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Undergraduate and postgraduate healthcare providers (e.g. doctors, medical students, nurses, social workers) within ICU setting<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">ICU settings including medical, surgical, cardiology and neurology ICU<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Communication between healthcare providers and patients in the ICU, or between healthcare providers in the ICU and patients\u2019 families <\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Communication between or within healthcare providers\u2019 teams in the ICU<\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Articles focusing solely on neonatal\/ paediatric ICU setting<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Articles focusing solely on speech therapy\/ physical therapy\/ occupational therapy <\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Non-ICU settings (e.g. general wards, emergency department)<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Non-medical professions (e.g. Science, Veterinary, Dentistry)<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Communication carried out over technological platforms\u00a0 <\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Intervention<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Need for\/ importance of interventions to teach communication in ICU setting<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Facilitators and barriers to teaching communication in ICU setting<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Recommendations, interventions, methods (e.g. tools, simulations, videos), curriculum content and assessments used for teaching communication in ICU setting<\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Comparison<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Comparisons of various interventions, methods, curricula and evaluation methods used to teach or assess communication in ICU setting and its impact upon patients, healthcare providers, healthcare, and society<\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><i><span lang=\"EN-US\">\u00a0<\/span><\/i><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Outcome<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Impact of interventions on patients, healthcare providers, healthcare, and society <\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Evaluation methods to assess interventions, methods, or curriculum used to teach communication<\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"16%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Study design<b><\/b><\/span><\/p>\r\n<\/td>\r\n<td width=\"44%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Articles in English or translated to English<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">All study designs including:<\/span><\/p>\r\n<p><span lang=\"EN-US\">o\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Mixed methods research, meta-analyses, systematic reviews, randomised controlled trials, cohort studies, case-control studies, cross-sectional studies, and descriptive papers <\/span><\/p>\r\n<p><span lang=\"EN-US\">o\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Case reports and series, ideas, editorials, and perspectives<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Publication dates: 1<sup>st<\/sup> January 2000 \u2013 31<sup>st<\/sup> December 2019<\/span><\/p>\r\n<p><span lang=\"EN-US\">\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Databases: PubMed, ERIC, JSTOR, Embase, CinaHL, Scopus, PsycINFO, Google Scholar <\/span><\/p>\r\n<\/td>\r\n<td width=\"39%\" valign=\"top\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 1. PICOS<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Nine members of the research team carried out independent searches for articles published between 1st January 2000 &#8211; 31st December 2019 in eight bibliographic databases (PubMed, ERIC, JSTOR, Embase, CINAHL, Scopus, Psycinfo and Google Scholar). The searches were carried out between 27th January 2020 and 14th February 2020. The PubMed search strategy can be found in Supplementary Material A. An independent hand search was done to identify key articles.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">3) Extracting and charting: <\/span><\/i><span lang=\"EN-GB\">Nine members of the research team independently reviewed the titles and abstracts identified and created individual lists of titles to be included which were discussed online. Consensus was achieved on the final list of articles to be included using (Sambunjak, Straus, &amp; Marusic, 2010)\u2019s \u201cnegotiated consensual validation\u201d approach through collaborative discussion and negotiation on points of disagreement on online meetings.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">B. Stage 2. Split Approach<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Working in three independent groups, the reviewers analysed the included articles using the \u2018split approach\u2019 (Ng et al., 2020). In one group, four researchers independently reviewed and summarised all the included articles in keeping with according recommendations set out by Wong, Greenhalgh, Westhorp, Buckingham, and Pawson (2013)\u2019s \u201cRAMESES publication standards: meta-narrative reviews\u201d and Popay et al. (2006)\u2019s \u201cGuidance on the conduct of narrative synthesis in systematic reviews\u201d. The four research team members then discussed their individual findings at online meetings and employed \u2018negotiated consensual validation\u2019 to achieve consensus on the tabulated summaries (Sambunjak et al., 2010). The tabulated summaries served to highlight key points from the included articles. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The four members of the research team also employed the Medical Education Research Study Quality Instrument (MERSQI) (Reed et al., 2008) and the Consolidated Criteria for Reporting Qualitative Studies (COREQ) (Tong, Sainsbury, &amp; Craig, 2007) also evaluated the quality of qualitative and quantitative studies included in this review.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Concurrently, the second group of five researchers analysed all the included articles using (Braun &amp; Clarke, 2006)\u2019s approach to thematic analysis then discussed their individual findings at online meetings and employed \u2018negotiated consensual validation\u2019 to achieve consensus on the final themes (Sambunjak et al., 2010). The third group of four researchers employed Hsieh and Shannon (2005)\u2019s approach to directed content analysis to independently analyse all the included articles, discussed their independent findings online and employed \u2018negotiated consensual validation\u2019 to achieve consensus on the final themes (Sambunjak et al., 2010). This split approach consisting of the tabulated summaries and concurrent thematic analysis and content analysis enhances the reliability of the analyses. The tabulated summaries also help ensure that important themes are not lost. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">1) Thematic analysis: <\/span><\/i><span lang=\"EN-GB\">Phase 1 of Braun and Clarke (2006)\u2019s approach saw the team \u2018actively\u2019 reading the included articles to find meaning and patterns in the data. In phase 2, \u2018codes\u2019 were constructed from the \u2018surface\u2019 meaning (Braun &amp; Clarke, 2006; Sawatsky, Parekh, Muula, Mbata, &amp; Bui, 2016; Voloch, Judd, &amp; Sakamoto, 2007) and collated into a code book to code and analyse the rest of the articles using an iterative step-by-step process. As new codes emerged, these were associated with previous codes and concepts (Price &amp; Schofield, 2015). In phase 3, the categories were organised into themes that best depict the data. In phase 4, the themes were refined to best represent the whole data set and discussed. In phase 5, the research team discussed the results of their independent analysis online and at reviewer meetings. \u201cNegotiated consensual validation\u201d was used to determine a final list of themes (Sambunjak et al., 2010). <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">2) Directed content analysis: <\/span><\/i><u><span lang=\"EN-GB\"><\/span><\/u><span lang=\"EN-GB\">Hsieh and Shannon (2005)\u2019s approach to directed content analysis (Hsieh &amp; Shannon, 2005) was employed in three stages. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Using deductive category application (Elo &amp; Kyng\u00e4s, 2008; Wagner-Menghin, de Bruin, &amp; van Merri\u00ebnboer, 2016), the first stage (Mayring, 2004; Wagner-Menghin et al., 2016) saw codes drawn from the article \u201cEnhancing collaborative communication of nurse and physician leadership into two intensive care units\u201d (D. K. Boyle &amp; Kochinda, 2004). Drawing upon Mayring (2004)\u2019s account, each code was defined in the code book that contained \u201cexplicit examples, definitions and rules\u201d drawn from the data. The code book served to guide the subsequent coding process. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Stage 2 saw the four reviewers using the \u2018code book\u2019 to independently extract and code the relevant data from the included articles. Any relevant data not captured by these codes were assigned a new code that was also described in the code book. In keeping with deductive category application (Wagner-Menghin et al., 2016), coding categories and their definitions were revised. The final codes were compared and discussed with the final author to enhance the reliability of the process (Wagner-Menghin et al., 2016). The final author checked the primary data sources to ensure that the codes made sense and were consistently employed. The reviewers and the final author used \u201cnegotiated consensual validation\u201d to resolve any differences in the coding (Sambunjak et al., 2010). The final categories were selected (Neal, Neal, Lawlor, Mills, &amp; McAlindon, 2018) based on whether they appeared in more than 70% of the articles reviewed (Curtis et al., 2001b; Humble, 2009). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The narrative produced was guided by the Best Evidence Medical Education (BEME) Collaboration guide (Haig &amp; Dozier, 2003) and the STORIES (Structured approach to the Reporting In healthcare education of Evidence Synthesis) statement (Gordon &amp; Gibbs, 2014).<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">9532 abstracts were identified from ten databases, 239 articles reviewed, and 63 articles were included as shown in Figure 2 (Moher, Liberati, Tetzlaff, &amp; Altman, 2009).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"742\" height=\"747\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-2.png\" alt=\"\" class=\"alignnone size-full wp-image-1528\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-2.png 742w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-2-298x300.png 298w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-2-150x150.png 150w\" sizes=\"auto, (max-width: 742px) 100vw, 742px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Figure 2. PRISMA Flowchart<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">3) Comparisons between summaries of the included <\/span><\/i><u><span lang=\"EN-GB\"><\/span><\/u><i><span lang=\"EN-GB\">articles, thematic analysis and directed content analysis: <\/span><\/i><span lang=\"EN-GB\">In keeping with SEBA approach the findings of each arm of the split approach was discussed amongst the research and expert teams. The themes identified using Braun and Clarke (2006)\u2019s approach to thematic analysis were how to teach and evaluate communication training in ICU and the factors affecting training. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The categories identified using Hsieh and Shannon (2005)\u2019s approach to directed content analysis were 1) strategies employed to teach communication, 2) factors affecting communication training, 3) strategies employed to evaluate communication, and 4) outcomes of communication training. These categories reflected the major issues identified in the tabulated summaries.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">These findings were reviewed with the expert team who agreed that given that the themes identified could be encapsulated by the categories identified, the categories and the themes will be presented together. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">a) Strategies employed to teach communication in ICU: <\/span><\/i><span lang=\"EN-GB\">61 articles described various interventions used to teach communication in the ICU. 19 involved ICU physicians, 18 involved ICU nurses, 4 saw participation of ICU physicians and nurses, 13 included the multidisciplinary team in the ICU, 1 was aimed at medical interns, 2 at medical students, 2 at nursing students, and 2 at both medical and nursing students. Given the overlap between teaching strategies, topics taught, and assessment methods employed in ICU communication training for nurses, doctors, nursing and medical students and HCPs in the literature, we discuss and generalise the results across HCPs.\u00a0\u00a0\u00a0\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">In curriculum design, seven studies (D. K. Boyle &amp; Kochinda, 2004; Hope et al., 2015; Krimshtein et al., 2011; Lorin, Rho, Wisnivesky, &amp; Nierman, 2006; McCallister, Gustin, Wells-Di Gregorio, Way, &amp; Mastronarde, 2015; Miller et al., 2018; Sullivan, Rock, Gadmer, Norwich, &amp; Schwartzstein, 2016) designed a curriculum based on extensive reviews of literature on teaching communication. Brunette and Thibodeau-Jarry (2017) used Kern\u2019s 6-step approach to curriculum development to design a structured curriculum targeted at meeting the needs identified whilst Sullivan et al. (2016) and Lorin et al. (2006) used the authors\u2019 own experiences in tandem with existing literature to guide curriculum design. W. G. Anderson et al. (2017) designed a communication training workshop based on behaviour theories whilst McCallister et al. (2015) based their curriculum on principles of shared decision-making and patient-centred communication. Northam, Hercelinskyj, Grealish, and Mak (2015) conducted a pilot study before implementing their intervention.<\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: justify\"><span lang=\"EN-GB\">Topics included in the curriculum were categorised into \u201ccore topics\u201d, or topics essential to the curriculum, and \u201cadvanced\u201d which may be useful to incorporate into the curriculum. Core topics were deemed as topics that were most frequently cited in the literature or are crucial across a variety of interactions in the ICU setting such as history taking, relationship skills as well as on common scenarios in the ICU such as breaking bad news and communicating difficult decisions. \u201cAdvanced\u2019 topics, though important, are not mentioned as frequently and appeared to be more site specific and sociocultural and ethical issues. These topics are outlined in Table 2 (full table with references found in Supplementary Material B). The methods employed are outlined in Table 3 (full table with references found in Supplementary Material C).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-US\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b><span lang=\"EN-US\">Curriculum<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"8\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Core curriculum content <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Communication skills<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">With families (n=25)<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">With patients (n=5)<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">With HCPs (n=12)<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">General principles<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Breaking bad news<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Understanding\/defining goals of care, building therapeutic relationships with families, setting goals and expectations, shared decision making<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Eliciting understanding and providing information about a patient\u2019s clinical status <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Relationship skills<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Recognising and dealing with strong emotions<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Empathy<\/span><\/p>\r\n<p><span lang=\"EN-US\">Relationship skills include the \u201ckey principles\u201d of esteem, empathy, involvement, sharing, and support <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Problem solving\/conflict management\/facing challenges<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Frameworks for good communication<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Ask-Tell-Ask <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">\u201cTell Me More\u201d<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">\u201cSBAR\u201d \u2013 Situation, Background, Assessment, Recommendation: to share information obtained in discussions with patients or family members with other HCPs<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">\u201c3Ws\u201d \u2013<\/span><span lang=\"EN-US\"> What I see, What I\u2019m concerned about, and What I want<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Four-Step Assertive Communication Tool &#8211; get attention, state the concern (eg, \u201cI\u2019m concerned about\u2026\u201d or \u201cI\u2019m uncomfortable with\u2026\u201d), offer a solution, and get resolution by ending with a question (eg, \u201cDo you agree?\u201d)<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">\u201c4 C\u2019s\u201d palliative communication model: <\/span><\/p>\r\n<p><span lang=\"EN-US\">a.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Convening \u2013 ensuring necessary communication occurs between the patient, family, and interprofessional team;<\/span><\/p>\r\n<p><span lang=\"EN-US\">b.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Checking \u2013 for understanding;<\/span><\/p>\r\n<p><span lang=\"EN-US\">c.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Caring \u2013 conveying empathy and responding to emotion; and<\/span><\/p>\r\n<p><span lang=\"EN-US\">d.\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Continuing \u2013 following up with patients and families after discussions to provide support and clarify information.<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">\u2018\u2018Communication Strategy of the Week\u2019\u2019 using teaching posters <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">PACIENTE Interview (Introduce yourself, Listen carefully, Tell you the diagnosis, Advises treatment, Exposes the prognosis, Appoints the bad news introductory phrases, Takes time to comfort empathic, Explains a plan of action involving the family) <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Stages of communication (open, clarify, develop, agree, close) <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Processes of communication (procedural suggestions, check for understanding) <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Explain illness in clear, simple terms <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Using a reference manual and pocket reference cards<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">How HCPs should introduce himself to patients\/family members\/other HCPs <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">ICU decision making <\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Survival after CPR<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">DNR discussions<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Prognostication<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Legal and ethical issues surrounding life-sustaining treatment decisions<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Withdrawing therapies <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"7\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Advanced Topics <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Ethics<\/span><\/p>\r\n<p><span lang=\"EN-US\">&#8211;\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-US\">Eg. Offering organ donation <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Cultural\/spirituality\/religious issues<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Leadership<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Roles and responsibilities in communication with patients and families<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Discussing patient safety incidents<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Integration of 5 common behaviour theories: health belief model, theory of planned behaviour, social cognitive theory, an ecological perspective, and transtheoretical model<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-US\">Law<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 2. Topics taught<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Methods Employed<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Number of Studies<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Didactic Teaching, which may be employed in conjunction with other methods in a structured programme<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">20<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Simulated scenarios with family members\/ standardised patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">17<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Role-play<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">12<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Use of simulation technology such as with mannequins <\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">6<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Group discussions, group reflections and team-based learning <\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">7<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Case presentations, case discussions and patient care conferences<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">4<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Online videos<\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Online Powerpoint slides <\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"392\" valign=\"top\">\r\n<p><span lang=\"EN-US\">Did not specify <\/span><\/p>\r\n<\/td>\r\n<td width=\"80\" valign=\"top\">\r\n<p><span lang=\"EN-US\">9<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 3. Pedagogy<\/span><\/p>\r\n<p align=\"justify\" style=\"text-align: justify\"><i><span lang=\"EN-GB\">b) Factors affecting communication training: <\/span><\/i><span lang=\"EN-GB\">Identifying facilitators and barriers are critical to the success of communication programmes. Facilitators and barriers to training may be found in Table 4 (full table with references may be found in Supplementary Material D).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\">\r\n<tbody>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><b><span lang=\"EN-US\">Facilitators<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><b><span lang=\"EN-GB\">Barriers<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Longitudinal, structured process with horizontal and vertical integration<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Lack of time<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Safe learning environment<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Resource constraints<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Clear programme objectives and programme content<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Poor design and a lack of longitudinal support<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Funding for training <\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Insecurity and awkwardness during simulations<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Simulated patients<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Disrupted training<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Protected time for training<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Programmes that were not pitched at the right level<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Faculty experts helping to plan and review curricula and implement interventions<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Training that is not learner centered<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">St<\/span><span lang=\"EN-GB\">akeholders\u2019 engagement<\/span><span lang=\"EN-US\"> to facilitate interprofessional collaboration, as well as debriefing and program feedback<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Training that lacked feedback or debrief sessions<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Reflective practice<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Lack of a longitudinal aspect to training<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Timely and appropriate feedback<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">A lack of a supportive environment in which HCPs can apply the skills learnt<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Multidisciplinary learning<\/span><\/p>\r\n<\/td>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-GB\">Discordance between physicians\u2019 and nurses\u2019 communication with families<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Role modeling<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"50%\" valign=\"top\">\r\n<p align=\"left\"><span lang=\"EN-US\">Peer support<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 4. Facilitators and barriers to training<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">c) Strategies employed to evaluate communication training: <\/span><\/i><span lang=\"EN-GB\">Thirty-nine articles discussed evaluation methods of communication training. The assessment methods are described as follows in Table 5 (full table with references may be found in Supplementary Material E).<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td width=\"472\" colspan=\"2\" valign=\"top\">\r\n<p><b><span lang=\"EN-GB\">Method<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"472\" colspan=\"2\" valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Self-assessment<\/span><\/i><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Quantitative and qualitative surveys were administered to learners to assess their knowledge, experience in the programme, and perceived preparedness, comfort and confidence in communicating<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">1.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Some programmes only used post-intervention assessments<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">1.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Others used a combination of pre- and post-intervention assessments of learners<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">1.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Some programmes adapted existing tools to conduct post-intervention surveys to evaluate learners\u2019 experiences and skills learnt<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"472\" colspan=\"2\" valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Feedback from Others<\/span><\/i><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">patients, family members, peers and simulated patients was obtained through a combination of surveys and interviews that assessed their level of satisfaction with learners\u2019 communication skills<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"472\" colspan=\"2\" valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Observation<\/span><\/i><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">Direct observation of HCPs\u2019 communication skills to ascertain the frequency, quality, success and ease of communication post-intervention. This was done through the use of modified communication tools and feedback forms<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"472\" colspan=\"2\" valign=\"top\">\r\n<p><i><span lang=\"EN-GB\">Debriefing Sessions<\/span><\/i><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"31\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">4<\/span><\/p>\r\n<\/td>\r\n<td width=\"441\" valign=\"top\">\r\n<p><span lang=\"EN-GB\">One study used debriefing sessions to understand shared experiences of learners.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Table 5. Assessment Methods<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">d) Outcomes of communication training: <\/span><\/i><span lang=\"EN-GB\">The outcomes of communication training may be mapped to 5 levels of the Adapted Kirkpatrick\u2019s Hierarchy (Jamieson, Palermo, Hay, &amp; Gibson, 2019; Littlewood et al., 2005; Roland, 2015) allowing outcome measures used were also identified. Majority of the programmes achieved Level 2a and Level 2b outcomes as shown in Table 6 (full table with references may be found in Supplementary Material F). 40 articles described successes and three articles described variable outcomes of teaching communications.<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><b>Adapted Kirkpatrick\u2019s Hierarchy<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><b>Items evaluated <\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"4\" valign=\"top\">\r\n<p><b>Level 1 (participation)<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Experience in the programme<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Assessment of programme\u2019s effectiveness<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Trainee satisfaction<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Programme completion<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"5\" valign=\"top\">\r\n<p><b>Level 2a (attitudes and perception)<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Attitudes towards\/ experience with communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Self-rated confidence\/ preparedness in communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Colleagues\u2019 satisfaction with communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Trainees\u2019 views on training programme (e.g. satisfaction, perceived effectiveness)<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Self-perceived job stress\/ job satisfaction<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"6\" valign=\"top\">\r\n<p><b>Level 2b (knowledge and skills)<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Self-rated skill level using Likert scales<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Form asking trainees to list\/ indicates skills they learnt during the programme<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Self-rated knowledge level using Likert scales<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Self-evaluation of communication skills using validated tools<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Evaluation of trainees\u2019 knowledge by faculty\/ experts<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Evaluation of trainees\u2019 communication skills by faculty\/ experts<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"6\" valign=\"top\">\r\n<p><b>Level 3 (behavioural change)<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Feedback from peers and facilitators on interactions with actors<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Records of ICU rounds<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Notes from colleagues documenting supportive environment and involvement in communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Frequency of usage of communication skills taught<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Workplace observations<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Evaluation of trainees\u2019 communication skills in clinical setting by patients and colleagues<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><b>Level 4a (increased interprofessional collaboration)<\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Workplace observations<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" valign=\"top\">\r\n<p><b>Level 4b (patient benefits) <\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p>Self-perceived quality of care<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Patient and family satisfaction with communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p>Family satisfaction with communication<\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\"><span style=\"font-size: 10pt\">Table 6. Outcome Measures mapped onto Adapted Kirkpatrick\u2019s Hierarchy<\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Three studies compared outcomes with non-intervention arms and reported improved patient satisfaction and self-rated and third party reported improvements in communication (Awdish et al., 2017; Happ et al., 2014; McCallister et al., 2015).<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">C. Stage 3: Jigsaw Perspective<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The jigsaw perspective builds upon Moss and Haertel\u2019s (2016) concept of methodological pluralism and sees data from different methodological approaches as pieces of a jigsaw providing a partial picture of the area of interest. The Jigsaw perspective brings data from complementary pieces of the training process in order to paint a cohesive picture of ICU communication training. As a result, related aspects of the training structure and the working culture were studied together so as to better understand the influences each of the aforementioned have on the other. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\"><em>\u00a0D.<\/em><\/span><i><span lang=\"EN-GB\">Stage 4. An Iterative Process<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Whilst there was consensus on the themes\/categories identified, the expert team and stakeholders raised concerns that data from grey literature which is neither quality assessed nor necessarily evidenced based could bias the discussion. To address this concern, the research team thematically analysed the data from grey literature and non-research-based pieces such as letters, opinion and perspective pieces, commentaries and editorials drawn from the bibliographic databases separately and compared these themes against themes drawn from peer reviewed evidenced based data. This analysis revealed the same themes with an additional tool (PACIENTE tool) identified in the grey literature to enhance communication with patients\u2019 families (Pabon et al., 2014).<\/span><\/p>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: left\"><i style=\"text-align: justify\"><span lang=\"EN-GB\">E. Stage 5. Synthesis of Systematic Scoping Review in SEBA<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This SSR in SEBA reaffirms the importance of communications training in ICU and suggests that a combination of training techniques is required (Akgun &amp; Siegel, 2012; Chiarchiaro et al., 2015; Happ et al., 2010; Happ et al., 2015; Hope et al., 2015; Lorin et al., 2006; Miller et al., 2018; Roze des Ordons, Doig, Couillard, &amp; Lord, 2017; Sandahl, et al., 2013; D. J. Shaw, Davidson, Smilde, Sondoozi, &amp; Agan, 2014).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A framework for the design of a competency-based approach to ICU communications training (W. G. Anderson et al., 2017; Berkenstadt et al., 2013; D. Boyle et al., 2016; Brown, Durve, Singh, Park, &amp; Clark, 2017; Chiarchiaro et al., 2015; Fins &amp; Solomon, 2001; Happ et al., 2010; Hope et al., 2015; Karlsen, Gabrielsen, Falch, &amp; Stubberud, 2017; Pabon et al., 2014; Roze des Ordons et al., 2017; Tamerius, 2013; J. Yuen &amp; Carrington Reid, 2011) may be found in Figure 3 below.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" width=\"1233\" height=\"471\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-3.png\" alt=\"\" class=\"alignnone size-full wp-image-1529\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-3.png 1233w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-3-300x115.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-3-1024x391.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-3-768x293.png 768w\" sizes=\"auto, (max-width: 1233px) 100vw, 1233px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\" style=\"font-size: 10pt\">Figure 3. Framework for Competency-based Approach to ICU Communication Skills Training<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">These findings resonate with Kirkpatrick\u2019s Hierarchy (Jamieson et al., 2019; Littlewood et al., 2005; Roland, 2015) where each level builds upon the next and the learner moves from \u201cperipheral participation\u201d to active \u201cdoing and internalising\u201d in real clinical practice.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Such a competency-based programme necessitates a structured approach to holistic and longitudinal assessments of the learner\u2019s progress. Such a structured approach must be horizontally and vertically integrated into other forms of clinical training as cogent communication is a fundamental skillset across all practice and specialties (Akgun &amp; Siegel, 2012; Roze des Ordons et al., 2017). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Whilst Kirkpatrick\u2019s Hierarchy offers a viable framework for assessing trainees\u2019 progress (Boothby, Gropelli, &amp; Succheralli, 2018; Roze des Ordons et al., 2017), ICU training programmes may also keep in mind the various outcomes measures listed previously in Table 3 when designing assessment tools. These tools should conscientiously account for perspectives offered by trainers, standardised patients and family members involved in the evaluation process and should consider benefits and repercussions of their communication abilities to patients, families and the ICU multidisciplinary team(Aslakson, Randall Curtis, &amp; Nelson, 2014; Awdish et al., 2017; Blackhall et al., 2014; D. A. Boyle et al., 2017; DeMartino, Kelm, Srivali, &amp; Ramar, 2016; Happ et al., 2014; Happ et al., 2015; Hope et al., 2015; Miller et al., 2018; Sanchez Exposito et al., 2018; Sullivan et al., 2016; Turkelson, Aebersold, Redman, &amp; Tschannen, 2017). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">With flexibility within training programmes highlighted as essential (Ernecoff et al., 2016), this flexibility should also extend to cover remediation and provision of additional support in areas jointly identified and agreed upon by trainees and trainers to be paramount for targeted improvement. As it is worrying that no studies have focused on the effects of remediation on ICU communication skills training thus far, this should be a critical area for future research considering its importance (Steinert, 2013).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Likewise, it is pivotal that trainers should undergo rigorous training (Berlacher et al., 2017; Roze des Ordons et al., 2017) and are granted protected time for this undertaking (Boothby et al., 2018; Happ et al., 2010; Roze des Ordons et al., 2017). In order to ensure that quality and up-to-date skills and knowledge are transferred down the line, it is posited that trainers should also be holistically and longitudinally assessed alongside their charges (Roze des Ordons et al., 2017). Whilst trainers should ideally nurture a safe, collaborative, learning environment for all (Hales &amp; Hawryluck, 2008; Milic et al., 2015; Roze des Ordons et al., 2017; Sandahl, et al., 2013), it is clear that this can only be achieved through sustained administrative and financial support, according learners and trainers sufficient time and resources to foster cordial relationships open to mutual and honest feedback (Akgun &amp; Siegel, 2012; Miller et al., 2018).<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\">\u00a0<strong>V. <\/strong><\/span><strong><span lang=\"EN-GB\"><\/span><span lang=\"EN-GB\">LIMITATIONS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The SSR in SEBA approach is robust, reproducible and transparent addressing many of the concerns about inconsistencies in SSR methodology and structure arising from diverse epistemological lenses and lack of cogency in weaving together context-sensitive medical education programmes. Through a reiterative step-by-step process, the hallmark \u2018Split Approach\u2019 which saw concurrent and independent analyses and tabulated summaries by separate teams of researchers allowed for a holistic picture of prevailing ICU communications training programmes without loss of any conflicting data. Consultations with experts every step of the way also significantly curtailed researcher bias and enhanced the accountability and coherency of the data. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Yet it must be acknowledged that this SSR focused on articles published in English or with English translations. Hence, much of the data comes from North American and European countries, potentially skewing perspectives and raising questions as to the applicability of these findings in the setting of other cultures. Moreover, whilst databases used were selected by the expert team and the team utilised independent selection processes, critical papers may still have been unintentionally omitted. Whilst use of thematic analysis to review the impact of the grey literature greatly improves transparency of the review, inclusion of grey literature-based themes may nonetheless bias results and provide these opinion-based views with a \u2018veneer of respectability\u2019 despite a lack of evidence to support it.<\/span><\/p>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">\u00a0VI. <\/span><span lang=\"EN-GB\"><\/span><span lang=\"EN-GB\">CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">In the absence of a standardised evidence-based communication training programme for HCPs in ICUs, many HCPs are left in the hope that clinical experience alone will be sufficient to ensure their proficiency in communication. This SSR provides guidance on how to effectively develop and structure a communications training programme for HCPs in ICUs and suggests that communications training in ICU must involve a structured multimodal approach to training carried out in a supportive learning environment. This must be accompanied by robust methods of assessment and personalised and timely feedback and support of the trainees. Such an approach will equip HCPs with greater confidence and preparedness in a variety of situations, including that of the evolving COVID-19 pandemic. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">To effectively institute change in communication training within ICUs, further studies should look into the desired characteristics of trainers and trainees, the context and settings as well as the case scenarios used. The design of an effective tool to evaluate learners\u2019 communication skills longitudinally, holistically, and in different settings should be amongst the primary concerns for future research.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr EWYC recently graduated from Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms HH is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms SG is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms MTP is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms CCYL is a nursing student at Alice Lee Centre for Nursing Studies, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms LHET is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr MSQK recently graduated from Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr KTT recently graduated from Yong Loo Lin School of Medicine, National University of Singapore. He was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms YTO is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Mr WQL is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms XHT is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Mr YHT is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms CSK is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms AMCC is a senior librarian from Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ms MC is a researcher at the Division of Cancer Education, NCCS. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Dr JXZ is a Consultant at the Division of Supportive and Palliative Care, NCCS. She was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Professor LKRK is a Senior Consultant at the Division of Supportive and Palliative Care, NCCS. He was involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This is a systematic scoping review study which does not require ethical approval.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This work was carried out as part of the Palliative Medicine Initiative run by the Department of Supportive and Palliative Care at the National Cancer Centre Singapore. The authors would like to dedicate this paper to the late Dr S Radha Krishna whose advice and ideas were integral to the success of this study.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">There is no funding for the paper. <\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><span lang=\"EN-GB\"><strong>Declaration of Interest<\/strong><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The authors declare that they have no competing interests.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Adams, A. M. N., Mannix, T., &amp; Harrington, A. (2017). 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Development of an innovative workshop to teach communication skills in goals-of-care discussions in the ICU. <i>Jounral of General Internal Medicine, 26<\/i>, S605. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1007\/s11606-011-1730-9\">https:\/\/doi.org\/10.1007\/s11606-011-1730-9<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Yuen, J. K., Mehta, S. S., Roberts, J. E., Cooke, J. T., &amp; Reid, M. C. (2013). A brief educational intervention to teach residents shared decision making in the intensive care unit. <i>Journal of Palliative Medicine, 16<\/i>(5), 531-536. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1089\/jpm.2012.0356\">https:\/\/doi.org\/10.1089\/jpm.2012.0356<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left\">*Ong Yun Ting<br \/>\r\n1E Kent Ridge Road, <br \/>\r\nNUHS Tower Block, Level 11, <br \/>\r\nSingapore 119228<br \/>\r\nTel: +65 6227 3737<br \/>\r\nEmail: e0326040@u.nus.edu<\/p>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":2,"template":"","issues_category":[16],"archive_category":[],"issue_type":[25],"volume_category":[59],"class_list":["post-1526","issues","type-issues","status-publish","hentry","issues_category-review-article","issue_type-past-issue","volume_category-volume-6-number-1-january-2021"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>A systematic scoping review of teaching and evaluating communications in the intensive care unit - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A systematic scoping review of teaching and evaluating communications in the intensive care unit - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 4 May 2020 Accepted: 3 August 2020 Published online: 5 January, TAPS 2021, 6(1), 3-29 https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/RA2351 Elisha Wan Ying Chia1,2, Huixin Huang1,2, Sherill Goh1,2, Marlyn Tracy Peries1,2, Charlotte Cheuk Yiu Lee2,3, Lorraine Hui En Tan1,2, Michelle Shi Qing Khoo1,2, Kuang Teck Tay1,2, Yun Ting Ong1,2, Wei Qiang Lim1,2, Xiu Hui Tan1,2, Yao Hao Teo1,2, [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2021-05-04T00:32:27+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2020\/11\/RA2351_Figure-1-1.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"49 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-systematic-scoping-review-of-teaching-and-evaluating-communications-in-the-intensive-care-unit\/\",\"name\":\"A systematic scoping review of teaching and evaluating communications in the intensive care unit - 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