Communication course on discussing the HF prognosis and end-of-life care

One of the research projects within the Cesar network is called TALK-HF (Developing and evaluating a Training program Aimed at reducing the Lack of Knowledge and communication concerning palliative care issues in Heart Failure patients.) This exciting project is led by professor Tiny Jaarsma. Other members in the project team is Anna Strömberg, Jan Mårtensson, Maria Friedrichsen, Anna Sandgren and Lisa Hjelmfors (PhD student).

The overall purpose of the study is to improve the quality of care for HF patients and their families, focusing on communication issues between them and health care professionals in order to improve their quality of life and also prevent unnecessary suffering and resource utilization. 

In order to try to improve communication a practical communication course was developed for health care professionals working in the area of cardiology. The course was partly web based, partly campus-based, with one practical communication skills training day. Other components of the course included lectures, individual tasks and group discussions. During the course the participants got knowledge about the importance of discussing the HF prognosis and end-of-life care with the patient and the family.  They got the chance to practice to discuss prognosis and end-of-life care with simulated patients and family members.

They also got a communication tool, a practical booklet (a Question Prompt List) that they could hand out to patients and families in their clinical practice. The QPL is a structured list of questions that serves as a prompt for patients to consider questions about prognosis and end-of-life care to ask the professional. By enabling patients and families to ask questions that concerns them about their future and living with a chronic illness such as HF, communication may be improved.

8 February 2017 was an interesting and exciting day in the course when it was time for the practical communication training day and 15 participants (3 physicians and 13 nurses) from different regions in Sweden met at Linkoping University. The morning started with group discussions were participants reflected and shared clinical experiences of discussing prognosis with patients and family. The researchers facilitated the discussions and posed critical questions to support the learning situation. After lunch it was time for simulation training were each participant got the chance to practice to have a conversation about prognosis and end-of-life care with a person who simulated to be a patient with HF. Simulation can be defined as a situation or an event which is made to resemble clinical practice to enhance student learning. In this simulated conversation, the patient posed questions from the QPL to the participants (who acted in their real professional roles as a nurse or a physician). The patient asked about how life could be living with HF, what would happen to the ICD in the end-of-life and what support there is for family members when the patient gets more ill etc. Those participants who wanted also got the chance to simulate being a family member to the patient and participate in the conversation. This gave an extra dimension to the training where they could get a better understanding of” the other side” of the conversation. The participants took turn and simulated or acted as observers during the training. During the simulation training, the researchers were present in the room, but did not participate in the conversations or interact with the participants. Directly after the simulation training, a post-simulation debriefing was held were the researchers guided the discussions and the participants were given the possibility to debrief and reflect on their own experiences of the simulation. All participants were engaged in the training and provided feed-back to each other on how the simulation went. The day ended with a joint group reflection of the training day. The participants were satisfied with the day and thought it was great to meet other colleagues to discuss and learn from each other as well as practicing to have conversations with simulated patients and family members. The research team is now evaluating the course and plan for a RCT study to test the effectiveness of the course to improve professional communication about prognosis and end-of-life care in cardiology.


The web-based course (in Swedish)


The front page of the QPL (in Swedish)


Examples of questions in the QPL (in Swedish)

/Lisa Hjelmfors