Adaptation of a serious illness communication training intervention for the Rwandan context.

Abstract

Context: Communication skills are essential in cancer care, and international guidelines recommend communication training for all cancer care providers. Both clinical communication and training methods are influenced by culture. As oncology and palliative care expand globally, procedures are needed to adapt evidence-based communication training for diverse contexts.

Objective: To adapt a serious illness communication training intervention in Rwanda.

Methods: Guided by the Cultural Adaptation Process model, we conducted focus groups to understand communication training needs and gather feedback on a U.S. tool, the Serious Illness Conversation Guide (SICG). Based on identified needs, we made initial adaptations to an SICG-based training, incorporating tools from another U.S. program (VitalTalk). We piloted this training with 14 clinical psychologists, using lecture, demonstration, scripted roleplay, and small group discussion. Effectiveness was assessed through 5-point scales and qualitative feedback.

Results: Seventeen interdisciplinary oncology providers participated in three focus groups. While some had received lectures on communication, all believed additional training is needed. They endorsed the approach of adapting an international program rather than creating a Rwandan training de novo. Based on their input, we adapted and piloted a training that focused on three skills: 1) Set up the conversation and assess understanding; 2) Share information via a succinct "headline;" 3) Respond to emotion. Training methods received mean scores of 4.0 to 4.33 (5=most effective). Further modifications were suggested to improve cultural concordance.

Conclusion: Despite vast cultural differences, communication training interventions developed in the U.S. can be effectively adapted in African contexts through co-creation with local providers.