Training in communication skills for healthcare providers in chronic care: a systematic review

Communication skills training (CST) is essential for healthcare providers in chronic care, enabling patient-centered, empathetic, and effective interactions. This systematic review sought to identify evidence on the effectiveness, content, and teaching methods of CST programs for providers in chronic care. It aimed to identify universal principles and adaptable strategies that help improve communication skills across diverse chronic conditions. Five databases (Medline/PubMed, Web of Science, Scopus, PsycINFO, and Cochrane Library) were searched from inception to August 2024. Randomized controlled trials (RCTs) and quasi-experimental studies evaluating the impact of CST programs on healthcare providers in chronic care were included. Study selection was carried out independently by two authors, with discrepancies resolved through discussion or consultation with a third reviewer when needed. The Mixed Method Appraisal Tool was used to assess the methodological quality of the included studies. Fifty-five studies (15 RCTs, 40 quasi-experimental) were included. Few interventions were developed with patient input (n = 4). Most interventions incorporated role-play with feedback (n = 46), didactics (n = 45), and group work (reflection and discussion) (n = 37), often used in combination. Common training foci included basic communication skills (n = 22), breaking bad news (n = 19), empathy (n = 17), and advance care planning (n = 14). Few interventions used booster training such as coaching, telephone, or email support (n = 8) or online/virtual modules (n = 8). Oncotalk and its adaptations were prevalent. CST programs demonstrated significant improvements in communication outcomes. Communication behaviors significantly improved in most studies (93%, 37/40), with similar improvements in communication self-efficacy and confidence (96%, 26/27), largely sustained at follow-ups. Positive shifts in attitudes and beliefs toward communication were also observed in most studies (80%, 8/10). CST programs consistently improve providers' communication skills, self-efficacy, and attitudes. Their adaptability across chronic care contexts underscores their potential for broad implementation. However, standardized approaches and innovative delivery methods are needed to enhance scalability and long-term impact.