(1114) Describing the Impact of Physician Communication Training on Stress Using a Novel Stress Marker

Introduction: Effective and empathetic communication is important for high quality pediatric patient/family outcomes. Unfortunately, important conversations are often ineffective and delayed, especially when stressful, critical clinical information must be conveyed. Important contributors to ineffective physician communication may include lack of exposure to caring for critically ill and dying patients, lack of communication training, and physician stress/burnout. The relationship among exposure to caring for patients/families at end-of-life (EOL), simulated communication stress, and trainee wellbeing are important yet undefined areas of study. This study had three aims: 1) define pediatric resident physician EOL care exposure/communication training, 2) measure objective and subjective stress during critical communication encounters and the impact of prior communication training and exposures on stress responses and 3) measure physician wellness pre/post a communication training intervention.

Methods: We performed a prospective, pilot observational cohort study measuring physician exposure to caring for patients/families at EOL, simulated communication stress and wellness. Simulated stress was measured subjectively using the state-trait anxiety inventory (STAI) and objectively using heart rate variability (HRV) during a communication training intervention. The Physician Wellness Inventory measured wellness at baseline and three months later.

Results: 85.7% (18/21) of residents reported seldom/never caring for patients at EOL and universally felt ill-prepared to provide care. Subjective (STAI 41 vs. 50; p=0.001) and objective stress (HRV; p=0.001) increased when directly communicating with the simulated parent/patient actor compared to baseline. Residents with limited exposure to patients/families at EOL had a smaller stress response than those who cared for a substantial number. The intervention did not impact resident wellness.

Conclusions: Pediatric 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.