Medical communication

We are confronted with communication difficulties every day when dealing with our patients. Exchanging information, breaking bad news, caring for patients with no tangible complaints, dealing with demanding patients and relatives all pose communication challenges for us. Simple techniques can help us to carry out these tasks in a more professional and structured way.

Our communication training courses are aimed at the entire spectrum of medical staff, with a focus on doctors and nurses, as well as students as part of university teaching.

The doctor's visit is a basic element of patient-centered medicine. Communication with patients, the care team and relatives is particularly important here, as this is where important topics relating to the current medical situation are usually discussed and further therapies are determined. The ward round is therefore essential in terms of both organization and content and requires good communication skills in addition to medical knowledge. Complex medical, psychosocial and organizational tasks have to be solved with various healthcare professionals, relatives and patients within the normally short duration of the visit of around 10-20 minutes per patient.

The medical communication team offers ward rounds support for junior doctors with direct feedback and teaching in medical communication.

The longitudinal curriculum in medical communication provides medical students at the University of Basel with professional training in evidence-based doctor-patient communication in various clinically relevant medical situations from the first year of study until graduation.

It starts with general communication techniques, the difference between professional and private communication in the first year. In the second year, students learn how to communicate in a patient- and doctor-centered way. This includes a practical part with a new innovative web-based program where they can make an appointment with a trained simulation patient and take a medical history. The simulation patient can thus give the students direct feedback on the conversation conducted and they later receive additional professional feedback from Prof. Hunziker and her team (more details in the e-learning and blended learning section, see below).

In the third year, they will learn more about diagnostic techniques, such as specific history taking and case presentation in different clinical settings. In addition, bedside teaching takes place in small groups in real-life settings to practice these techniques.

In the fourth year of study (1st Master), courses and lectures are held on the topic of "delivering bad news". These techniques can then be practiced and applied by the students in the practical year. In the final year of study, students are prepared for the state examination in the form of role plays with simulated patients. Overall, the courses are very complex and time-consuming in terms of organization, as they are held in small groups with a large number of trainers and simulation patients involved, who also receive regular training from the Medical Communication team.

Patient presentation at the bedside or at the door? Chief physician rounds in the focus of a randomized, controlled multicenter study

Although ward rounds are one of the most important pillars of inpatient care, there have been few studies investigating the best approach to patient engagement. During patient rounds, physicians often use medical terminology that patients may not be familiar with. This can lead to uncertainty or misunderstandings. However, understanding and knowledge are important prerequisites for the successful implementation of therapies.

In an SNSF-supported multicenter study, we compared the influence of patient presentation (directly at the patient's bedside versus in front of the patient's room) on patient-relevant outcomes. We were able to show that both patient groups had comparable knowledge about their medical condition and care. On the other hand, patients for whom the patient presentation took place at the bedside reported more confusion due to medical terminology and uncertainty as a result of the medical discussion within the medical team. In addition, less sensitive topics were addressed in the group with the bedside presentation. Although the direct contact between patient and treatment team was longer in the bedside presentation group and was perceived by the patients to be longer, this form of ward round proved to be more time-efficient.

The study, which was conducted at Basel University Hospital, Aarau Cantonal Hospital and Baselland Cantonal Hospital, thus provided important insights into the preferences of both patients and the treatment team and where we should continue to focus our education and training in order to further optimize ward round communication in the respective form of implementation.

An article with the main results was happily published in a high-ranking specialist journal and received international attention.

Effect of Bedside Compared With Outside the Room Patient Case Presentation on Patients' Knowledge About Their Medical Care

Further studies as part of the BEST PRESENTATION / BEDSIDE-OUTSIDE-Trial

Perspective of doctors and nursing staff
An accompanying survey of over 800 participating employees showed that doctors preferred presenting patients in front of the room - in particular due to better scheduling, the opportunity to discuss sensitive topics and less stress for the team. Nurses, on the other hand, indicated a higher level of satisfaction with bedside presentations, as they are more patient-centered. The results underline the different perspectives of professional groups and the importance of targeted communication training.

Influence of patients' decision-making preferences
A further analysis examined the extent to which patients want to be involved in medical decisions (so-called decisional control preferences). This showed that regardless of their role in decision-making, all patients had a similar level of knowledge about their illness. However, patients with an active decision-making preference reported less trust in the treatment team and lower satisfaction with their hospital stay. These results suggest that visit communication should be more tailored to individual needs.

Dealing with sensitive issues
A large proportion of hospitalized patients were confronted with sensitive issues such as medical uncertainty, concomitant mental illnesses, tumor diagnoses or social problems. On average, these patients reported a lower level of satisfaction with their care - especially if conflicts or misunderstandings arose during the visit. The study shows how important targeted communication techniques are in order to improve the care of patients with stressful issues

A cardiac arrest puts people in a life-threatening situation, which places a heavy burden on both patients and their families and has an impact on psychological morbidity. In initial studies, we were able to show that around 40% of relatives of resuscitation patients exhibit symptoms of post-traumatic stress disorder. Even one year after resuscitation, 17% of relatives met the definition of clinically relevant depression.

In the Communicate study at the University Hospital Basel, we systematically survey anxiety and depression symptoms, symptoms of post-traumatic stress disorder, alexithymia and neurological and physical impairments in patients after resuscitation and their relatives 3 months, 1 and 2 years after resuscitation. We record a number of potential risk factors and investigate their influence on these long-term consequences with the aim of prevention, early detection and treatment.

In addition, we are investigating how and whether a communication strategy can reduce the morbidity of relatives of critically ill patients, particularly with regard to post-traumatic stress disorder.

Prognosis and outcome after cardiac arrest

An early, reliable prognosis after cardiac arrest can facilitate decision-making with regard to further medical treatment. In our study, we are investigating new innovative biomarkers with the aim of improving existing risk scores for prognosis assessment and enabling better prediction.

The results of our study should make it possible to improve both the medical treatment of patients after cardiac arrest and their psychosocial care.

In a systematic review with meta-analysis published in the journal JAMA Network Open, we investigated the influence of various communication interventions on resuscitation status decisions. The analysis of randomized trials shows that such interventions - especially video information as a decision-making aid - significantly improve patients' knowledge of resuscitation measures. At the same time, the use of videos meant that resuscitation was dispensed with more frequently in the event of cardiac arrest (RR 0.56 compared to RR 1.03 for other interventions, p < .001)

https://pubmed.ncbi.nlm.nih.gov/31173119/

It should be noted that the interventions were heterogeneous and consisted predominantly of visual, video-based information formats - direct, face-to-face discussions rarely took place in the included studies. This raises the question of how video formats can be meaningfully combined with real, interactive conversations to enable individual, informed decisions without unsettling patients.

As a next step, we therefore conducted a multicentre, randomized study. In this study, we compared a communication strategy based on the principles of shared decision making and using a structured communication checklist with the usual care approach to resuscitation status. The aim was to test the effect of such a strategy, promote the quality of discussions, support informed individual decisions and avoid anxiety.

A national, representative survey of the Swiss general population

Cardiac arrest is still one of the most common causes of death today. If cardiac arrest occurs outside the hospital, the chances of survival are around ten percent. If the cardiac arrest occurs in hospital, around one in five people survive.

Our representative survey of the Swiss population showed that people drastically overestimate how successful resuscitation is after a cardiac arrest. For example, 80 percent of respondents preferred to be resuscitated, regardless of the circumstances. The most important predictor for this decision was the assessment of the chance of survival. The average chance of survival without neurological restrictions was estimated at 40 to 60 percent.

Consequently, the desire for resuscitation is based on a misjudgment in many cases. It is therefore important to explain what resuscitation means in the event of cardiac arrest so that patients can make an informed decision that makes sense for them.

(Publication link: https://pubmed.ncbi.nlm.nih.gov/37056958/)

These misconceptions are also widespread in the healthcare sector. In a national survey of 1,803 intensive care, anesthesia and emergency medicine professionals, it became clear that doctors and nurses also tend to overestimate the probability of survival after a cardiac arrest (mean estimate 12-15%). These personal perceptions also influence decisions in clinical case vignettes: 85% of respondents preferred a do-not-resuscitate (DNR) status for a 70-year-old patient and 53% would refrain from resuscitation themselves.

(Publication link: https: //pubmed.ncbi.nlm.nih.gov/38375442/)

News on this topic can be found at the bottom under "News".

On admission to hospital, the measures to be taken in the event of sudden cardiac arrest are routinely discussed and documented with each patient, usually at the beginning of their stay. The patient's wishes and preferences are decisive here, taking into account their medical condition. These discussions are challenging and require good communication in order to reflect the patient's wishes and not make them feel insecure. At the same time, it is known that patients often overestimate the chances of success of resuscitation - an aspect that can significantly influence decision-making. However, there has been no clear evidence to date.

In a cluster-randomized multicenter study at six Swiss teaching hospitals, we investigated how a communication strategy based on shared decision making - with a checklist and prognostic decision aids - affects the quality of the conversation, decision-making and patient knowledge.

We included 206 residents and 2,663 internal medicine patients. Compared to usual care, the communication strategy showed clear advantages: Patients felt more confident in their decision, were more involved in decision-making and had better knowledge of prognosis and treatment options. In addition, there was more reluctance to request resuscitation, especially if the prognosis was unfavorable.

.

These results illustrate the importance of structured communication in complex medical situations. It enables more informed decision-making, takes individual values into account and contributes to more targeted, patient-centered care. The manuscript of this study was published in NEJM Evidence (see here:

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400422)

Supplementary studies:

- on resuscitation status in advanced disease:

Further parallel and follow-up studies examined key aspects of decision-making during resuscitation discussions in greater depth. These studies complement the main CLEAR study and show how structured communication and evidence-based prognostic tools contribute hand in hand to patient-centered, realistic decision-making.

A parallel study to the CLEAR study ("GUIDE Trial") [JAMA Network Open 2025] looked at patients in whom resuscitation was considered medically futile (so-called medical futility with regard to resuscitation measures). It showed that a structured, checklist-based discussion significantly reduced the preference for admission to the intensive care unit and that doctors perceived the discussions as less stressful - without placing a greater psychological burden on the patients.

Link to the publication: https://pubmed.ncbi.nlm.nih.gov/40996760/

- Long-term results of the CLEAR study:

In a follow-up study of the CLEAR study [JAMA Network Open 2025], it was also shown that the Good Outcome Following Attempted Resuscitation (GO-FAR) score and the Clinical Frailty Scale (CFS) are highly informative for estimating long-term mortality. The combination of both instruments enables a more precise prognosis assessment and thus supports clinical decisions and anticipatory guidance.

Link to the publication: https://pubmed.ncbi.nlm.nih.gov/41026487/

Newspaper article on this paper:

https://www.bazonline.ch/herzstillstand-jede-zweite-person-will-keine-wiederbelebung-354079221081

https://www.bernerzeitung.ch/herzstillstand-jede-zweite-person-will-keine-wiederbelebung-354079221081

https://www.derbund.ch/herzstillstand-jede-zweite-person-will-keine-wiederbelebung-354079221081

https://www.tagesanzeiger.ch/herzstillstand-jede-zweite-person-will-keine-wiederbelebung-354079221081

https://www.linkedin.com/posts/nejm-evidence_medicalresearch-clinicaltrials-activity-7324443884208463872-Nz0M?utm_source=share&utm_medium=member_ios&rcm=ACoAAEUj_8QBBVPSdULskP25VBBcm8qHVREXbZ8

The results of the randomized study (see above: "Multicenter study on the resuscitation conversation") are now to be transferred to everyday clinical practice in various Swiss hospitals. To this end, the Medical Communication department has developed the Code Clear app and is continuously optimizing it.

Flyer Code Clear (German)

Flyer Code Clear (English)

Flyer Code Clear (French)

The app offers an interactive checklist that enables patients to be fully informed and actively involved in the decision for or against resuscitation measures. Central elements are an individually calculated survival prognosis after a cardiac arrest and visual decision-making aids that facilitate communication and support informed decision-making.

The agreed resuscitation status is documented as a PDF, stored in the hospital information system and can - if desired - be given to patients or sent to the family doctor treating them.

The University Hospital Basel has already adapted its processes accordingly. All doctors are currently being trained in the use of the Code Clear app and are conducting resuscitation consultations in accordance with the Code Clear standard. Training and e-learning courses are accompanying the introduction. Further centers are being planned, and a nationwide roll-out with an accompanying implementation study is planned.

The app is already available in the App Store and on Google Play. A user code is currently required for access. A demo access code can be found under thislink; an automatic user ID is currently being implemented. Interested persons or centers who would like to implement the app in their institution are welcome to contact us at or codecleardoc@usb.ch or sabina.hunziker@usb.ch.

https://www.icks.ch/de/meta/news/newsdetail/news/app-empfehlung-strukturierte-besprechung-des-reanimationsstatus-mit-der-code-clear-app

https://www.icks.ch/fr/meta/mitteilungen/newsdetail/news/recommandation-dapplication-discussion-structuree-du-statut-de-reanimation-avec-lapplication-code-clear

Systematic review and meta-analysis of the effect of communication interventions on resuscitation decisions

Communication interventions, in particular resuscitation videos as decision aids, were associated with an increased likelihood of patients refusing resuscitation in the event of cardiac arrest. There was also evidence of a link between communication interventions and increased knowledge about resuscitation.

A realistic understanding of their own prognosis can help patients with advanced cancer to make informed decisions about their treatment, avoid unnecessarily stressful therapies and better prepare for the future. However, previous studies show that many patients do not realistically assess their prognosis. Most studies relate to people in very late stages of the disease with a life expectancy of only a few weeks to months. Evidence on prognostic understanding in patients in earlier stages of the disease is still scarce.

The aim of our multicenter study (University Hospital Basel, St. Claraspital Basel, Cantonal Hospital Liestal and Cantonal Hospital Olten) is therefore to better understand what patients with advanced cancer and their relatives know about their prognosis, how they deal with it and what information needs exist. Using structured surveys, we want to gain insights into how good prognostic understanding actually is - and which factors influence it.

In addition, we are investigating whether a realistic understanding is related to psychological well-being, quality of life and trust in the treatment team. Further objectives areto recordthe desire for prognostic information as well as wishes and care deficits .

CARE INSIGHTS is financially supported by the Swiss Cancer League.

In patient simulator research, we are working with the Medical Intensive Care Unit team to investigate the influence of important communication elements such as leadership statements. This has shown that targeted instruction via management communication can significantly improve resuscitation performance. Fortunately, the results of these studies have been incorporated into the resuscitation guidelines of the American Heart Association since 2010. It is now recommended to teach communicative skills regarding teamwork and leadership behavior in resuscitation courses. A large multicenter, randomized study is currently underway with an American center to investigate the influence of leadership allocation and group size in the resuscitation situation.

The project to establish a guide for communication at the University Hospital Basel, or Northwest, a "communication pocket guide", is being planned.