Table 3.

Overview of outcome measurements and intervention effects in N=24 publications

Publication	(1) Communication-related outcome measurements; (2) effects of the intervention
Cannone et al 201966	(1) External rating of 6 domains of communication skills in OSCE-scenarios by faculty members and SP via a self-developed instrument based on SPIKES protocol, self-reported perceived readiness and comfort level; (2) Sign. improvement in global communication skills and positive changes in some subcategories rated by faculty members (‘emotion and empathy’, ‘delivering phase of breaking bad news’ (BBN), isolated items of other domains), increased comfort level in all areas.
Andrade et al 201063	(1) Self-reported self-efficacy via the self-efficacy Affective Competency Score;86 (2) Sign. improvement of self-efficacy.
Liénard et al 201060	(1) Quantitative analyses of physicians’ utterances regarding assessment, support and information type in transcripts of audiotaped SP encounters via a communication content analysis software, external rating of 3 phases of the BBN-process; (2) Signficantly more open questions, open directive questions and empathy as well as a sign. decrease in the amount of given information in IG; BBN process: IG allocated more time to the predelivery phase and less time to the delivery phase and delivered bad news more precisely.
Gorniewicz et al 201758	(1) External rating of 5 domains of BBN skills in videotaped SP-OSCE-sessions via a BBN rating form checklist by SP, external rating of 5 general communication skills via the Common Ground Assessment Summary form83 by SP; (2) Sign. intervention effect on 3 BBN domains: ‘BBN’, ‘communication related to emotions’ and ‘after BBN, determines patient readiness to proceed and communication preferences’, significant intervention effect on four general communication skills (‘active listening’, ‘addressing feelings with patients’, ‘closing the interview’ and ‘global interview performance’).
Butow et al 200854	(1) External rating of 10 key doctor behaviours and the number of predetermined patient concerns plus the degree to which they were adequately addressed in videotaped SP encounters via a self-developed instrument; (2) Trend of IG to show more creating environment and fewer blocking behaviours than the CG (n.s.).
Baile et al 199953	(1) Self-reported confidence in communication regarding BBN and difficult patient situations via self-developed items; (2) Workshop 1 (BBN): significant improvement of confidence in 18 of 21 items; workshop 2 (managing difficult patient situations): sign. improvement of confidence in 11 of 45 items.
Fujimori et al 200351	(1) Self-reported confidence in communication with patients regarding BBN via items developed by Baile et al;53 (2) Sign. improvement of confidence in 20 of 21 items at post and follow-up.
Fujimori et al 201456	(1) External rating of 4 communication domains in videotaped SP encounters via a self-developed rating system based on the SHARE protocol on BBN,85 self-reported confidence in communication via items related to SHARE and the confidence questionnaire by Baile et al,53 self-reported patients’ satisfaction with consultation and trust in oncologist via self-developed items; (2) Sign. intervention effect on ‘setting up supportive environment for interview’, ‘considering how to deliver bad news’ and ‘providing reassurance/addressing patient’s emotions with empathic responses’, sign. effect on confidence; no change in satisfaction.
Yamada et al 201870	(1) Self-reported intrapersonal empathy via the Jefferson Scale of Physician Empathy (JSPE)87 and the Interpersonal Reactivity Index (IRI);88 (2) Sign. improvement of JSPE total empathy-score and all subscale scores (‘perspective taking’, ‘compassionate care’, ‘standing in the patient’s shoes’) at post and follow-up, sign. improvement in 2 of 3 IRI subscales (‘perspective taking’ and ‘personal distress’) from pre to follow-up.
Lenzi et al 201168	(1) Self-reported data on self-efficacy, use of BBN and communication skills, knowledge on communication skills as well as attitudes via not specified questionnaires; (2) Sign. improvement in 14 of 15 items on used BBN-skills, most of the communication skills items, knowledge questions, attitudes and self-efficacy.
Goelz et al 201157	(1) External rating of 3 domains of communication behaviour in videotaped SP encounters via a rating system developed for this purpose (COM-ON-Checklist (communication in oncology-transition); (2) Sign. intervention effect on all domains: transition to palliative care, global communication skills and involvement of sign. others.
Bylund et al 201065	(1) External rating of 6 communication domains in videotaped real patient encounters via the self-developed Comskil Coding System; (2) Sign. improvement in two communication domains (‘establishing the consultation framework’, ‘checking skills’) and in five individual items; mediated by amount of modules participated in.
Brown et al 201052	(1) Self-reported confidence about discussing prognosis via two self-developed items; (2) Sign. improvement in both items.
Annadurai et al 202150	(1) External rating of 7 core communication skills via an assessment tool based on SPIKES71 and NURSE72 statements plus some additional skills in pre and post audio recordings of real clinical encounters; (2) Sign. intervention effect on eliciting patient values, no increase in overall and other communication skills.
Bickell et al 202049	(1) Perception and quality of Goals-of-Care (GoC) discussions rated by patients via two self-developed items, external rating of 7 core communication skills via an assessment tool based on SPIKES71 and NURSE72 statements (detailed description by Annadurai et al50) and some additional skills in pre and post audio recordings of real clinical encounters; (2) Sign. intervention effect on eliciting patient values, prevalence/quality of GoC communication n.s., overall and other communication skills n.s.
Hulsman et al 200267	(1) External rating of 7 domains of communication behaviour in videotaped real patient encounters via the self-developed Communication Rating System, self-reported patients’ satisfaction via the Medical Interview Satisfaction Scale;89 (2) Sign. intervention effect on observed general communication behaviour only in the group identified as ‘implementers’ (no change in non-implementers); no change in patients’ satisfaction.
Yakhforoshha et al 201869	(1) External rating of 7 domains of BBN performance during SP encounters in real outpatient setting via the modified BBN-checklist90 (Iranian version of the SPIKES-protocol;71 (2) Sign. level changes in three domains of BBN checklist: strategy, knowledge and invitation; longitudinal effects n.s.
Back et al 200764	(1) External rating of quality of BBN (based on SPIKES model,71 quality of discussing transition to palliative care (based on self-developed 6-step-approach) and empathy (five skills based on NURSE model72 in 2 pre-SP and two post-SP encounters; (2) Sign. improvement in 4 SPIKES-steps regarding BBN, 4 steps regarding the transition to palliative care and 4-5 empathic skills
Epstein et al 201755	(1) External rating of 4 communication domains in audio recorded real physician visits via a self-developed instrument (a combination of scales from different existing instruments), self-reported patient-physician relationship, healthcare climate and perceived efficacy in patient-physician interactions by patients and physicians via standardised questionnaires; (2) Sign. intervention effect on three domains: ‘engaging patients in discussions’, ‘responding to emotions’ and ‘discussions of prognosis and treatment choices’, self-reported outcomes n. s.
Delvaux et al 200548	(1) External rating of form, function and emotional level of each utterance in transcripts of simulated and real audiotaped three-person-interviews (with patient and relative) via the adapted Cancer Research Campaign Workshop Evaluation Manual with a new scale to identify the addressee of utterances, self-reported retrospective perception of the interview by patient, relative and physician via the Perception of the Interview Questionnaire (unpublished dissertation); (2) Sign. intervention effect on 2 of 16 communication skills (‘openness toward patient’s and relative’s concerns and needs’ and ‘open assessment skills’; changes toward relatives more modest in actual than in simulated interviews), difference in the number of utterance-addressees n. s., sign. intervention effect on patients’ (but not in relatives’) perception of the physician’s performance.
Razavi et al 200347	(1) External rating of form, function and emotional level of each utterance in transcripts of simulated and real audiotaped patient encounters via the adapted Cancer Research Campaign Workshop Evaluation Manual, retrospective perception of the interview via the Perception of the Interview Questionnaire (unpublished dissertation); (2) Basic training effect mainly observable in simulated interviews; consolidation workshops: sign. intervention effect on 3 of 22 communication skills in simulated interviews (‘open and open directive questions’, ‘utterances alerting patients to reality’, decrease in ‘premature reassurance’) and in 4 of 22 skills in actual interviews (‘acknowledgments’, ‘empathic statements’, ‘educated guesses’, ‘negotiations’); patients view: physicians’ of IG showed significantly better understanding of disease.
Tulsky et al 201162	(1) External rating of number of empathic statements in audiotaped real clinic visits via NURSE statement72 and responses to empathic opportunities via a model by Suchman et al,91 postmeasurement of patients’ trust and perceptions of their oncologist; (2) IG shows significantly more empathic statements and better responding to empathic opportunities; greater trust of patients whose oncologists were in IG.
Malhotra et al 201961	(1) External rating of the number of negative emotion expressions via the model of empathic communication by Suchmann et al91 and number of empathic responses via self-developed items in pre and post transcripts of real patient encounters, proportion of consultations discussing prognosis and goals of care; (2) Sign. more empathic responses and more discussions about prognosis in IG.
Henselmans et al 201959	(1) External rating of shared desicion making (SDM) in videotaped SP encounters via the Observing Patient Involvement Sclae 12,84 external rating of SDM per stage via a self-developed instrument, external rating of 2 communication skills via self-developed items, self-reported oncologists’ satisfaction with communication via oncologist-version of the 5-item Patient Satisfaction Questionnaire; (2) Sign. intervention effect on amount of SDM, improvement in all SDM stages and improvement in both communication skills (‘responsiveness to emotions’ and ‘information provision skills’), no effect on satisfaction with the consultation.

CG, control group; IG, intervention group; n.s., not significant; OSCE, objective structured clinical exams; sign., significant; SP, simulated patients.