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Quality and safety in the literature: February 2024
  1. Diana Kakos1,
  2. Nathan Houchens1,2,
  3. Ashwin Gupta1,2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Diana Kakos, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0624, USA; dkakos{at}

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Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • A randomised controlled trial showed that a communication coach improved cardiologists’ ability to respond to patients with empathy, elicit questions and facilitate enhanced conversational flow. Cardiologists reported that a communication coach helped their clinical practice. JAMA Intern Med; 1 June 2023

  • In a randomised controlled trial conducted across multiple hospital sites, a written communication tool provided to clinicians significantly improved documentation of goals-of-care discussions in the electronic medical record, with a more substantial impact on patients in racial or ethnic minority groups. JAMA; 21 May 2023

  • In a multicentre, randomised controlled trial, a web-based decision-making aid regarding renal replacement therapy facilitated improved decision quality and knowledge and better elucidated treatment preferences among older patients with advanced chronic kidney disease for 6 months after the intervention. Ann Intern Med; 20 December 2022


A positive physician–patient relationship is at the core of high-quality medical care. Effective communication drives this relationship, as it creates trust and fosters empathy for both patients and providers. Studies have shown that optimal communication improves patient outcomes, especially as it pertains to health literacy and aligning goals of care,1–3 adherence to treatment plans4 and patient satisfaction.5 6 Evidence also suggests benefits to physicians. For instance, a study by Penberthy et al showed improvement in emotional exhaustion and emotional flooding (an overwhelming emotional response or state of negative feelings that may lead to irrational behaviours) for physicians who enrolled in an interpersonal communication skills training …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NH and AG are employed by the United States Department of Veterans Affairs.

  • Provenance and peer review Commissioned; internally peer reviewed.