Communicating Serious News: The House Model

Needs Statement

Communication is one of the most critical skills in medicine and not widely taught. Communication is an exchange of information and meaning. Communicating Serious News: The House Model was developed in the setting of caring for patients with serious progressive illness, where we have some of the most emotional and difficult conversations. This module was developed to help learners develop skills for those conversations.
The national survey conducted by Whitsett et al. (2022) highlights significant gaps in palliative care (PC) training among transplant hepatology fellows. Despite the recognized benefits of PC for patients with cirrhosis, the survey reveals variability in physician experiences and perspectives on best practices. Key findings indicate that while most fellows feel moderately to very comfortable with communication skills such as breaking bad news and leading family meetings, a substantial proportion report discomfort in managing psychological distress, including anxiety, depression, and spiritual distress. Additionally, nearly one-quarter of fellows have never discussed or documented advance care plans during their fellowship.
The survey underscores the need for enhanced training in specific domains, particularly in the assessment and management of physical symptoms and psychological distress. Fellows expressed a desire for further instruction in these areas to improve their competencies and ultimately enhance patient care. Addressing these educational gaps is crucial for developing well-rounded transplant hepatologists capable of providing comprehensive palliative care.
Incorporating insights from the "Advanced Multimodal Communication Curriculum for Pediatric Residents" by Marsh et al., it is evident that innovative curricular approaches and targeted educational interventions are essential to bridge these gaps. Emphasizing experiential learning, simulation-based training, and interdisciplinary collaboration can significantly enhance the effectiveness of education.
This curriculum will focus on the house model process, with different stages of the house building process representing different aspects of conversation with the patient. These include relationship, patient story, medical story, balanced medical recommendation, and collaborative decision making. The House Model was developed in the setting of serious illness. It has been shown to be helpful in any patient, family, or colleague interaction and has been shown to be time efficient and improve clinician professional satisfaction. In this module the learner will be given some tools for communication, pearls to use along the way, and the structure of the House Model.

Educational Objectives

At the conclusion of the activity, participants should be able to:

• Define serious news.
• Describe the changes that occur in the brain during discussions of serious news and practice responding to emotion.
• Differentiate between curing and healing.
• Construct a five-step visual model for delivering serious news and discussing goals of care and practice asking before telling.

Target Audience

Activity Evaluation

Evaluation by questionnaire will address program content, presentation, and possible bias.

Educational Methods

• Interactive Module

Accreditation/Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Baylor College of Medicine and CommonSpirit Health. Baylor College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Term of Approval

May 1, 2025 through April 30, 2027. Original release date: May 1, 2025.

Disclosure Policy

Baylor College of Medicine (BCM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. BCM is committed to sponsoring CE activities that are scientifically based, accurate, current, and objectively presented.

In accordance with the ACCME Standards for Commercial Support, BCM has implemented a mechanism requiring everyone in a position to control the content of an educational activity (i.e., directors, planning committee members, faculty) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships at the time of the activity or within 24 months prior.

In addition, BCM has requested activity faculty/presenters to disclose to participants any unlabeled use or investigational use of pharmaceutical/device products; to use scientific or generic names (not trade names) in referring to products; and, if necessary to use a trade name, to use the names of similar products or those within a class. Faculty/presenters have also been requested to adhere to the ACCME's validation of clinical content statements.

BCM does not view the existence of financial relationships with commercial interests as implying bias or decreasing the value of a presentation. It is up to participants to determine whether the relationships influence the activity faculty with regard to exposition or conclusions. If at any time during this activity you feel that there has been commercial/promotional bias, notify the Activity Director or Activity Coordinator. Please answer the questions about balance and objectivity in the activity evaluation candidly.

All of the relevant financial relationships listed for these individuals have been mitigated.