A feasibility study of online training in empathic and optimistic communication in primary care: adapting to the COVID pandemic
Empathic and optimistic healthcare interactions have the potential to improve patient quality of life and satisfaction with care. We previously rigorously developed brief online training for primary care practitioners (PCPs) in empathic and optimistic communication. This study aimed to establish the feasibility of trial procedures, recruitment, outcome and process measures to evaluate practitioner training versus usual care.
A cluster-randomised controlled feasibility trial was designed in which ten GP practices were to be randomised to online training or usual care. Plans included testing the feasibility of: PCPs completing the online training; different ways for PCPs and researchers to recruit patients in practices; PCPs filming consultations as part of the training and as part of a trial; patients completing a variety of outcome and process measures. Approvals had been obtained and the feasibility trial was due to start in early 2020. The COVID-19 pandemic and the consequent situation in primary care required rapid adaptation of the trial protocol. With very limited access to GP practices, new ethics approval was sought and obtained to recruit recent primary care consulters via social media and complete our process and outcome measures online. Some PCPs were still able to complete the online training. PCPs and patients participated in qualitative interviews about their experiences over the telephone.
11 PCPs took part. On average, they spent just under one hour completing the online training (mean = 57 minutes; standard deviation = 25 minutes) and completed it in between one and ten sessions (median = 3) during working hours. PCP-completed process measures had acceptable internal consistency (min. alpha = 0.69) and scores indicated that PCPs were confident they could enact the empathy and optimism behaviours in the training, intended to implement their goals and expected the changes they made would positively impact patient outcomes. 437 patients consented to complete our online questionnaires, of whom 301 completed our post-consultation process and outcome measures and 219 completed follow-up measures after 2 weeks. Preliminary analysis suggests that: PCPs are able to complete our online training; further intervention optimisation is needed to ensure the training is relevant for different forms of remote consultations; it is possible to use social media and other remote methods to recruit patients who have recently had a primary care consultation; our chosen outcome and process measures are broadly acceptable to patients. Quantitative and qualitative data analysis are ongoing: results will be finalised ready for presentation at the conference.
Rapid adaptation, flexibility and good teamwork enabled research to continue, providing valuable feasibility data despite COVID-19 restrictions. Practitioner feedback on the intervention was generally very positive and, pending final tweaks to ensure relevance to remote consultations, the training is now ready for evaluation in a full trial.