A pragmatic model for cultural adaptation of serious illness communication skills training

Key Message : Our team developed an effective model for integrating cultural adaption into routine communication skills training in Rwanda. This pragmatic approach has potential for widespread use in other contexts.

Abstract:

Purpose: Serious illness communication skills training (CST) is needed in many African contexts, including Rwanda.(1) Since clinical communication is strongly influenced by culture, training interventions developed in the U.S. may not be directly transferable elsewhere.(2) Existing methods for systematic cultural adaptation of interventions are time- and resource-intensive, limiting scalability.(3) We aimed to develop a pragmatic method for integrating cultural adaptation into routine CST in Rwanda.

Methods: CST tools from the U.S. program VitalTalk for delivering serious news (G.U.I.D.E.) and expressing empathy (N.U.R.S.E.) were translated to Kinyarwanda. Four facilitators led a training with oncology and palliative care providers using lecture, demonstrations, scripted roleplay, and small group discussions. Data collection was embedded within training activities to inform cultural adaptation, including interactive parts of lecture, brainstorming during small groups, large group debriefs, and an optional post-training focus group. These were audio recorded and analyzed using rapid techniques.(4) Trainees evaluated training effectiveness using Likert scales and open-ended questions.


Results: Twenty-four interdisciplinary providers participated in the training. Three facilitators and 5 trainees participated in the focus group. Core elements of the VitalTalk tools were perceived as culturally relevant, though participants offered more appropriate Kinyarwanda phrases for conveying difficult information and expressing empathy than the direct translations from English. They suggested incorporating cultural elements (i.e., family involvement, religious faith) and adapting for high patient volumes by including time management and dividing communication among interdisciplinary providers. Training activities received mean scores of 4.7 to 4.9 on a 5-point scale of perceived effectiveness (5=most effective). Many suggested having a multi-day training to include more skills practice.

Conclusion: Embedding feedback and brainstorming into routine CST informs iterative adaptations of an existing CST intervention for a different context. This is an effective and pragmatic approach to address the widespread unmet need for context-appropriate CST in low resource settings.

References: 1. DeBoer RJ, Wabl CA, Mushi BP, et al. A scoping review of clinical communication in cancer care in Africa. The Oncologist. 2025;30(4):oyaf039. doi:10.1093/oncolo/oyaf039
2. Uwamahoro P, Girukubonye I, Bigirimana JB, et al. Setting the stage for communication skills training in Rwandan cancer care: a qualitative study of local priorities and key contextual factors. BMC Palliat Care. 2025;24(1):1-13. doi:10.1186/s12904-025-01879-z
3. DeBoer RJ, Uwamahoro P, Ndoli DA, et al. Adaptation of a serious illness communication training intervention for the Rwandan context. Journal of Pain and Symptom Management. (In press).
4. Vindrola-Padros C, Johnson GA. Rapid Techniques in Qualitative Research: A Critical Review of the Literature. Qual Health Res. 2020;30(10):1596-1604. doi:10.1177/1049732320921835