When people become seriously ill, healthcare decisions are influenced not only by their medical condition, but also by their personal situation, values, wishes, and daily life circumstances. A medically appropriate treatment may not always fit what is important or realistic for an individual. Contextualised care aims to integrate relevant aspects of a patient's life into care and decision-making. This study investigates whether an interactive communication training program can help healthcare professionals provide more contextualised care for people with serious illness. The training aims to improve professionals' skills in recognising, exploring, and integrating relevant patient context into clinical decision-making and teamwork. Healthcare professionals from hospital teams in the Netherlands will participate, including physicians, nurses, nurse specialists, and physician assistants caring for patients with serious illness. The training consists of two three-hour sessions. Participants will practice communication skills using realistic clinical situations and learn how patient context can be incorporated into care planning and communication within the healthcare team. The effects of the training will be evaluated in several ways. Healthcare professionals will complete questionnaires before and after training to assess competence, communication, and job satisfaction. Responses to simulated patient situations will be analysed to examine how participants recognise and respond to patients' concerns. Medical records will also be reviewed to examine whether non-somatic aspects of care are more often documented, anticipated, and communicated after the training. Hospital-based healthcare use and associated costs will also be assessed. The study aims to provide insight into whether training hospital teams in contextualised communication can support more personalised, appropriate, and person-centred care for people living with serious illness.
Serious illness affects not only a person's physical health but also many other aspects of life, including daily functioning, relationships, social roles, personal identity, values, and future perspectives. As medical possibilities increase, healthcare professionals are increasingly confronted with complex decisions about treatments and care plans. In these situations, the most appropriate care is not necessarily the intervention that is optimal from a purely biomedical perspective, but the care that best fits the individual patient's medical condition together with their personal circumstances, goals, preferences, and possibilities. Although multidimensional and person-centred care are widely recognised as important components of high-quality healthcare, clinical decision-making is often still predominantly focused on biomedical information. Relevant aspects of patients' lives may remain unidentified or insufficiently incorporated into care planning. This can result in care that does not adequately match patients' needs, priorities, or everyday realities. This study focuses on contextualised care, an approach that aims to systematically integrate relevant patient context into healthcare communication, clinical reasoning, shared decision-making, and care planning. Within this approach, patient context refers to personal circumstances and characteristics that may influence the appropriateness, feasibility, or consequences of healthcare decisions. Relevant contextual factors may include, for example, patients' abilities and limitations, responsibilities, social circumstances, living situation, values, goals, coping strategies, preferences, and aspects of life that influence what patients consider meaningful or realistic. The contextual care model is based on the principle that healthcare professionals should not only ask what treatment is medically possible, but also explore whether that treatment fits the person receiving it. Contextual information becomes clinically relevant when overlooking it may negatively influence healthcare decisions or outcomes. Integrating this information can support more personalised care, improve alignment between treatment plans and patients' lives, and contribute to appropriate healthcare utilisation. Previous research has demonstrated that healthcare professionals can improve their contextual communication skills through training. However, existing interventions have mainly focused on individual healthcare professionals or specialist palliative care teams. In many healthcare systems, including the Netherlands, much care for people with serious illness is delivered by generalist hospital teams rather than specialist palliative care services. Therefore, it is important to understand whether contextualised care can be integrated into routine practice through training multidisciplinary hospital teams. The aim of this study is to evaluate the effects of an interactive communication training program designed to improve healthcare professionals' competencies in providing contextualised care for patients with serious illness. The study evaluates whether training can support healthcare professionals in recognising relevant patient context, exploring this context in conversations, integrating contextual information into care planning, and communicating relevant information within multidisciplinary teams. The training intervention is based on the contextual care model and extends the original four-step contextual communication process with an additional step focused on contextual handover. The five steps of the training approach are: 1. Recognising: identifying verbal and non-verbal cues indicating that a patient's personal context may be relevant. 2. Exploring: asking appropriate questions to understand the possible contextual factors influencing the patient's situation. 3. Identifying: determining which aspects of the patient's context are relevant for healthcare decisions and planning. 4. Integrating: incorporating relevant contextual information into care planning and decision-making. 5. Handing over: communicating relevant contextual information within the healthcare team to support continuity and coordination of care. The intervention is designed as an interactive team-based training program. It combines theoretical education with practical exercises, including simulated clinical situations and reflection. Attention is given both to individual communication skills and to team processes that support the integration of patient context into routine clinical practice. The study uses a mixed-methods evaluation design to examine the impact of the intervention at multiple levels. The evaluation includes healthcare professionals' perceptions of their own competence, their ability to apply contextualised communication skills in simulated situations, changes in documentation and integration of relevant patient context in clinical practice, and healthcare utilisation and associated costs. Qualitative data are collected to explore how healthcare professionals experience contextualised care, including factors that support or hinder implementation in daily practice. The study is conducted among multidisciplinary hospital teams in the Netherlands that provide care for patients with serious illness. By focusing on teams rather than individual professionals, the study reflects the collaborative nature of hospital care, where recognition and communication of relevant patient context require shared responsibility across healthcare professionals. The results of this study will contribute to understanding whether contextualised care can be embedded in routine hospital practice through a scalable educational intervention. Ultimately, the study aims to support healthcare teams in providing care that is not only medically appropriate but also aligned with the lives, values, and priorities of people living with serious illness.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
81
The Contextualized Care Communication Training is an interactive educational intervention designed to strengthen healthcare professionals' ability to integrate relevant patient context into care for people with serious illness. The training is based on the contextual care model and extends the original 4C-process with a fifth step focused on contextual handover within healthcare teams. The training focuses on five steps: (1) recognizing contextual cues that indicate potentially relevant patient circumstances, (2) exploring these cues through patient-centred communication, (3) identifying contextual factors that are relevant for care decisions, (4) integrating relevant contextual information into care planning, and (5) handing over contextual information within the multidisciplinary team to support continuity of care. The intervention consists of two interactive 3-hour training sessions delivered to existing hospital teams. The first session focuses on individual communication skills,
Radboudumc
Nijmegen, Netherlands
Change in self-assessed competence in contextualised care (measured using the Spiritual Care Competence Scale)
Healthcare professionals' self-assessed competence will be assessed using selected domains of the Spiritual Care Competence Scale (SCCS), including communication, assessment, and referral competencies. The SCCS assesses healthcare professionals' perceived competence in addressing patients' multidimensional needs through communication, assessment, and appropriate support or referral. Higher scores indicate higher perceived competence. Changes from baseline to 4 and 16 weeks after the training will be assessed.
Time frame: Baseline (4 weeks before training) to 4 and 16 weeks after training
Change in patient- and family-centred communication competence
Change in healthcare professionals' self-assessed competence in patient- and family-centred communication will be assessed using the 12-item Patient- and Family-Centered Communication subscale of the End-of-Life Professional Caregiver Survey (EPCS). Higher scores indicate higher perceived competence.
Time frame: Baseline (4 weeks before training) to 4 and 16 weeks after training
Change in self-efficacy in end-of-life communication
Change in healthcare professionals' self-efficacy in end-of-life care communication will be assessed using the Self-Efficacy in End-of-Life Care (S-EOLC) questionnaire. Higher scores indicate higher perceived self-efficacy.
Time frame: Baseline (4 weeks before training) to 4 and 16 weeks after training
Change in applied competence in contextualised communication
Applied competence will be assessed using participants' written responses to simulated clinical consultation videos before and after the training. Responses will be analysed to evaluate how healthcare professionals recognise, interpret, and explore patients' concerns and relevant context.
Time frame: Baseline (4 weeks before training) to 4 and 16 weeks after training
Change in documentation and integration of patient context in clinical practice
Implementation of contextualised care in routine clinical practice will be assessed through retrospective review of electronic medical records of deceased patients cared for by participating teams. The review will assess documentation and anticipation of relevant non-somatic and contextual dimensions, including psychological, social, and spiritual aspects, as well as handover of contextual information.
Time frame: One year before and one year after the training intervention
Change in healthcare professionals' job satisfaction
Healthcare professionals' job satisfaction will be assessed using a single-item self-report measure. Higher scores indicate higher job satisfaction.
Time frame: Baseline (4 weeks before training) to 4 and 16 weeks after training
Hospital-based healthcare costs per patient in the final three months of life
Hospital-based healthcare utilisation will be assessed retrospectively from electronic medical records and converted into costs using standardized unit costs. Resource use includes hospital and intensive care days, emergency department visits, and treatments including chemotherapy, radiotherapy, immunotherapy, and surgery. Costs of these healthcare utilisation components will be summed at the patient level, together with allocated intervention costs in the post-intervention period, to calculate total hospital-based healthcare costs per patient (Unit of Measure: Euros (€) per patient).
Time frame: Final 3 months of life
Hospital-based healthcare costs per patient in the final month of life
Hospital-based healthcare utilisation will be assessed retrospectively from electronic medical records and converted into costs using standardized unit costs. Resource use includes hospital and intensive care days, emergency department visits, and treatments including chemotherapy, radiotherapy, immunotherapy, and surgery. Costs of these healthcare utilisation components will be summed at the patient level, together with allocated intervention costs in the post-intervention period, to calculate total hospital-based healthcare costs per patient (Unit of Measure: Euros (€) per patient).
Time frame: Final month of life
Perceived barriers and facilitators for contextualising care
Factors influencing contextualised care will be assessed using qualitative free-text responses in which healthcare professionals report perceived barriers and facilitators to contextualising care. Responses will be analysed using directed content analysis and categorised according to predefined factors identified in previous research. This outcome does not use a numerical scale or total score.
Time frame: Baseline (4 weeks before training) and 4 and 16 weeks after training
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