Providers Improving Care Conversations, Especially With Children

Seated in a quiet room, two people begin a difficult conversation. “I’d like to talk with you today about what is ahead with your illness and what is most important to you, so that I can make sure we provide you with care that matches your values. Is this okay?” says Kacey Boyle, RN, speaking in a calm, direct tone.  

At an intimate gathering of University of Vermont Health Network physicians and nurses, Boyle demonstrates patient communication techniques developed by TalkVermont, a group of UVM Medical Center physicians dedicated to improving conversations between clinicians, seriously ill patients and their families.  

“When clinicians communicate in this way, patients and families feel seen and heard,” says Stephen Berns, MD, director of TalkVermont. “A lot of the tools we teach are patient and family-centered to help identify information gaps, fill them in, and then recognize and respond to emotion. We need to find out what’s most important to people and match their care to that.” 

TalkVermont recently identified another patient population that would benefit from this innovation: children.  

Communicating as a Team

“Pediatrics is the birthplace of family-centered care, and you can only achieve that if you’re communicating effectively as a team. Our care conversations are especially important because often the parent or caregiver is the decision maker for the child – and that is a tremendous responsibility,” says Kaitlin Ostrander, MD, pediatrics. 

And so TalkVermontPEDS was born. The newly created team is led by Dr. Berns, Iris Toedt-Pingel, MD, and Dr. Ostrander. The three were honored as 2019 Frymoyer Scholars which recognizes physicians investing in outstanding medical education and promoting teaching that emphasizes the art of patient care. 

TalkVermontPEDS will expand on TalkVermont’s existing mission that “every seriously ill patient in Vermont will be surrounded by providers who can skillfully and compassionately engage in conversation about what matters most to them” to include pediatric patients and their families, such that care plans are family-centered and value-based. Their goal is to improve outcomes for these families and increase provider satisfaction, resilience and well-being. 

Supporting Families in Shared Decisions

“It can feel overwhelming for patient families to choose treatment options. Instead, families can tell us what’s important to them and we develop a plan that aligns with those goals and values. And the only way we can achieve that is through improved critical conversations and shared decision making,” says Dr. Berns. 

These conversations about quality of life are essential when discussing palliative care for chronic illness, congenital conditions, life-limiting illness and end-of-life care. Families of these children need to navigate difficult decisions. Conversations about pediatric goals of care have unique complexities that require empathic providers skilled in complex communication. The goal for this innovative program is to establish a series of workshops for pediatric care teams to ensure that seriously ill children and their families will be met by providers who can skillfully engage in approachable, human conversation. 

“These communication workshops create a very bonding experience, and build stronger more cohesive care teams for our patients and their families,” says Dr. Toedt-Pingel. “When care teams communicate effectively, patients retain info better, they have higher trust, better quality of life and an improved care experience.”