***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The efficacy of a communication skills training programme was shown through a r and omised trial . Oncologists ( N=160 ) from 34 cancer centres were allocated to written feedback plus course ; course alone ; written feedback alone or control .  Each clinician had 6 – 10 interviews  with patients videotaped at baseline and 3 months postintervention . Analysis of videotapes revealed improvements in the communication skills of clinicians r and omised to training ( n=80 ) compared with others ( n=80 ) . A 12-month follow-up assessment is reported here . Robust Poisson conditional analyses of counts of changes in communication behaviours revealed no demonstrable attrition in those who had shown improvement previously , including fewer leading questions , appropriate use of focused and open-ended questions and responses to patient cues . Additional skills , not apparent at 3 months , were now evident ; the estimated effect sizes corresponded to 81 % fewer interruptions ( P=0.001 ) and increased summarising of information to 38 % ( P=0.038 ) . However , expressions of empathy ( 54 % , P=0.001 ) declined . The overall results show that 12 – 15 months postintervention , clinicians had integrated key communication skills into clinical practice and were applying others . This is the first RCT to show an enduring effect of communication skills training with transfer into the clinic Abstract Purpose : To evaluate and compare the effects of two types of continuing medical education ( CME ) programs on the communication skills of practicing primary care physicians . Participants : Fifty-three community-based general internists and family practitioners practicing in the Portl and , Oregon , metropolitan area and 473 of their patients . Method : For the short program ( a 4 1/2-hour workshop ) , 31 physicians were r and omized to either the intervention or the control group . In the long program ( a 2 1/2-day course ) , 20 physicians participated with no r and omization . A research assistant visited all physicians ’ offices both one month before and one month after the CME program and audiotaped five sequential visits each time . Data were based on analysis of the content and the affect of the interviews , using the Roter Interactional Analysis Scheme . Results : Based on both t-test analysis and analysis of covariance , no effect on communication was evident from the short program . The physicians enrolled in the long program asked more open-ended questions , more frequently asked patients ’ opinions , and gave more biomedical information than did the physicians in the short program . Patients of the physicians who attended the long program tended to disclose more biomedical and psychosocial information to their physicians . In addition , there was a decrease in negative affect for both patient and physician , and patients tended to demonstrate fewer signs of outward distress during the visit . Conclusion : This study demonstrates some potentially important changes in physicians ’ and patients ’ communication after a 2 1/2-day CME program . The changes demonstrated in both content and affect may have important influences on both biologic outcome and physician and patient satisfaction Objective We investigated whether patient-centered communication skills can be taught to residents in Internal Medicine by using a time-limited behaviorally oriented intervention . Method Residents working at the Department of Internal Medicine were r and omly assigned to an intervention group ( IG ; N = 19 ) or a control group ( CG ; N = 23 ) . In addition to 6 hours of st and ard medical education per week , the IG received specific communication training of 22.5 hours duration within a 6-month period . Initially and 10 months later , participants performed interviews with simulated patients . Interviews were rated by blinded raters who used the Maastricht History and Advice Checklist-Revised . Results Compared with the CG , the IG improved substantially in many specific communication skills . Both groups improved in the " amount of medical information identified " and in the ability to " communicate about feasibility of treatment . " Conclusion Patient-centered communication skills such as those presented in this intervention study can be taught . The ability to gain medical information and the readiness to communicate about aspects of medical treatment seem to improve with more professional experience ; however , they also profit from the intervention We conducted a prospect i ve study of 130 unselected adults admitted to hospital with advanced malignancy . The study assessed how patients perceived information  conveyed to them by physicians  and the level of communication between patients and health care staff  on questions relating to patients ’ underst and ing , pain control , and sense of well-being . Nearly 10 % of patients were unaware of a diagnosis of cancer . Of those who knew their diagnosis , one quarter stated that the diagnosis was not disclosed in a clear or caring manner . One third of patients had an incomplete underst and ing of their prognosis , and patients generally overestimated their underst and ing when compared to hospital medical officers ( HMOs ) and nurses . The severity of pain was underestimated by the HMOs in 63 % to 89 % of patients . Thus HMOs require specific training in communication skills and the management of chronic cancer-related pain in patients with incurable cancer .  Professional interpreters should be employed for all patients who are not fluent in English The emotional content of health care professionals – cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy . One hundred and fifteen oncology nurses participating in a communication skills training workshop  were assessed at three different periods . Nurses r and omly allocated to a control group arm ( waiting list ) were assessed a first time and then 3 and 6 months later . Nurses allocated to the training group were assessed before training workshop , just after and 3 months later . Each nurse completed a 20-min clinical and simulated interview . Each interview was analysed by three content analysis systems : two computer-supported content analysis of emotional words , the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level , the Cancer Research Campaign Workshop Evaluation Manual . The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained ( P=0.056 ) : training group subjects use 4.3 ( std : 3.7 ) emotional words per 1000 used before training workshop , and 7.0 ( std : 5.8 ) right after training workshop and 5.9 ( std : 4.3 ) 3 months later compared to control group subjects which use 4.5 ( std : 4.8 ) emotional words at the first assessment point , 4.3 ( std : 4.1 ) at the second and 4.4 ( std : 3.3 ) at the third . The same trend is noticeable for emotional words used by health care professionals in simulated interviews ( P=0.000 ) . The emotional words registry used by health care professionals however remains stable over time in clinical interviews ( P=0.141 ) and is enlarged in simulated interviews ( P=0.041 ) . This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training ( P=0.005 ) . This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression BACKGROUND Doctors ' communication with patients is commonly hampered by lack of training in this core skill . This study aim ed to assess the efficacy of an intensive 3-day training course on communication skills in a r and omised controlled trial with a two-by-two factorial design and several outcomes . METHODS 160 oncologists from 34 UK cancer centres were r and omly allocated to four groups : written feedback followed by course ; course alone ; written feedback alone ; and control . At each of two assessment periods , consultations with six to ten consecutive , consenting patients per doctor were videotaped . 2407 patients participated . Outcome measures included objective and subjective ratings made by research ers , doctors , and patients . The primary outcomes were objective improvements after the intervention in key communication skills . Course content included structured feedback , videotape review of consultations , role-play with simulated patients , interactive group demonstrations , and discussion led by a trained facilitator . FINDINGS In Poisson regression analysis of counts of communication behaviours , course attendance significantly improved key outcomes . The estimated effect sizes corresponded to higher rates of use of focused questions ( difference between course attenders [ n=80 ] and non-attenders [ n=80 ] 34 % , p=0.003 ) , focused and open questions ( 27 % , p=0.005 ) , expressions of empathy ( 69 % , p=0.003 ) , and appropriate responses to patients ' cues ( 38 % , p=0.026 ) , and a 24 % lower rate of use of leading questions ( p=0.11 ) . There was little evidence for the effectiveness of written feedback . INTERPRETATION The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience . This trial shows that training courses significantly improve key communication skills . More re sources should be allocated to address doctors ' training needs in this vital area OBJECTIVE To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes . DATA SOURCES The MEDLINE data base was search ed for articles published from 1983 to 1993 using " physician-patient relations " as the primary medical subject heading . Several bibliographies and conference proceedings were also review ed . STUDY SELECTION R and omized controlled trials ( RCTs ) and analytic studies of physician-patient communication in which patient health was an outcome variable . DATA EXTRACTION The following information was recorded about each study : sample size , patient characteristics , clinical setting , elements of communication assessed , patient outcomes measured , and direction and significance of any association found between aspects of communication and patient outcomes . DATA SYNTHESIS Of the 21 studies that met the final criteria for review , 16 reported positive results , 4 reported negative ( i.e. , nonsignificant ) results , and 1 was inconclusive . The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes . The outcomes affected were , in descending order of frequency , emotional health , symptom resolution , function , physiologic measures ( i.e. , blood pressure and blood sugar level ) and pain control . CONCLUSIONS Most of the studies review ed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes . The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs . Future research should focus on evaluating such educational programs PURPOSE We sought to determine the effects of a communication process that was design ed to encourage the use of advanced supportive technology when it is of benefit , but to limit its burdens when it is ineffective . We compared usual care with a proactive , multidisciplinary method of communicating that prospect ively identified for patients and families the criteria that would determine whether a care plan was effective at meeting the goals of the patient . This process allowed caregivers to be informed of patient preferences about continued advanced supportive technology when its continuation would result in a compromised functional outcome or death . MATERIAL S AND METHODS We performed a before- and -after study in 530 adult medical patients who were consecutively admitted to a university tertiary care hospital for intensive care .  Multidisciplinary meetings were held within 72 hours of critical care admission . Patients , families , and the critical care team discussed the care plan and the patients ' goals and expectations for the outcome of critical care . Clinical " milestones " indicative of recovery were identified with time frames for their occurrence . Follow-up meetings were held to discuss palliative care options when continued advanced supportive technology was not achieving the patient 's goals . We measured length of stay , mortality , and provider team and family consensus in 134 patients before the intensive communication intervention and in 396 patients after the intervention . RESULTS Intensive communication significantly reduced the median length of stay from 4 days ( interquartile range , 2 to 11 days ) to 3 days ( 2 to 6 days , P = 0.01 by survival analysis ) . This reduction remained significant after adjustment for acute physiology and chronic health evaluation ( APACHE ) 3 score [ risk ratio ( RR ) = 0.81 ; 95 % confidence interval ( CI ) , 0.66 to 0.99 ; P = 0.04 ) . Subgroup analysis revealed that this reduction occurred in our target group , patients with acuity scores in the highest quartile who died ( RR = 0.60 ; 95 % CI , 0.38 to 0.92 ; P = 0.02 ) . The intervention , which allowed dying patients earlier access to palliative care , was not associated with increased mortality . CONCLUSIONS Intensive communication was associated with a reduction in critical care use by patients who died . Our multidisciplinary process targeted advanced supportive technology to patients who survived and allowed the earlier withdrawal of advanced supportive technology when it was ineffective The research literature on patient perceptions of general practice consultations shows that , while patients are generally satisfied with the treatment they receive from doctors , they report less satisfaction with the amount and clarity of information they receive and doctors ' expression of caring and respect . In the surgery , inadequate information transmission during the interaction also has the effect of increasing the level of anxiety reported by patients after their consultations . A communication skills programme was developed , incorporating variables from both the emotional and cognitive domains of the consultation . A group of GPs undertook training in this programme . It was hypothesized that patients of the trained doctors would report greater satisfaction and less anxiety , compared with patients of untrained general practitioners . Subsequent r and omized interviews with patients of the trained doctors showed that these patients were significantly more satisfied with their consultations . Patients of the trained doctors also reported less state anxiety immediately following their consultations , as measured using the State-Trait Anxiety Inventory . Attempts by doctors to communicate more effectively in consultations therefore increased patients ' positive feelings and reduced anxiety The importance of good doctor-patient communication is widely recognised . The aims of this study were to evaluate the immediate effects of the participation of patients with cancer on the attitudes and skills of undergraduate medical students receiving an interview skills training programme  , and to assess the effects of the participation of patients with cancer on the attitudes and interview performance of students 2 years later . It was hypothesised 
    Output:
    
Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods .
Conclusions The best results are to be expected from a training programme that is carried out over a longer period of time .
Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective .
Small groups encouraged more intensive participation .