Describing the Impact of Physician End-of-Life Communication Training on Simulated Stress Using a Novel Stress Marker

Authors

Amy H. Wolfe, Department of Critical Care Medicine, Children's National Hospital, Washington, DC, USA.
Pamela S. Hinds, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Adre J. du Plessis, Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
Heather Gordish-Dressman, Center for Translational Research, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Lamia Soghier, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

3-25-2025

Journal

The American journal of hospice & palliative care

DOI

10.1177/10499091251330279

Keywords

communication; critical care; education; graduate; high fidelity simulation training; medical; palliative; psychological; stress; supportive care

Abstract

IntroductionEmpathetic end-of-life (EOL) communication is important for high quality pediatric patient and family outcomes. Trainees may have limited exposure and training in caring for patients at EOL which may impact communication-related stress. This study had 2 aims: (1) describe pediatric resident physician EOL exposure and training (2) measure objective and subjective stress during simulated critical communication encounters and the impact of prior communication training/exposures on stress responses.MethodsWe performed a prospective, pilot observational cohort study measuring physician exposure to caring for patients/families at EOL and simulated communication stress. Simulated stress was measured subjectively using the state-trait anxiety inventory (STAI) and objectively using heart rate variability (HRV) during a communication training intervention.Results85.7% (18/21) of residents reported seldom/never caring for patients at EOL and universally felt ill-prepared to provide care. Subjective and objective stress increased when directly communicating with the simulated parent/patient actor compared to baseline in all HRV domains. Residents with limited exposure to patients/families at EOL had a smaller stress response than those who cared for a substantial number.ConclusionsPediatric residents report limited opportunities to communicate with patients/families at EOL, which may impact stress responses when communicating life-altering news to families. Simulated communication encounters can be designed to evoke subjective and objective stress which can be measured using novel technology and may help address limited EOL opportunities.

APA Citation

Wolfe, Amy H.; Hinds, Pamela S.; du Plessis, Adre J.; Gordish-Dressman, Heather; and Soghier, Lamia, "Describing the Impact of Physician End-of-Life Communication Training on Simulated Stress Using a Novel Stress Marker" (2025). GW Authored Works. Paper 6760.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6760

Department

Pediatrics