The effect of training and education at the emergency department 127 6 significance. As can be seen in table 2, both care decision communication and total quality of communication improved significantly after the interventions, as opposed to general communication. Table 2. Quality of communication scores before and after implementation of the interventions. Before interventions n= 149 After interventions n= 184 Statistical comparison (p-value) Care decision communication, median (IQR) 0.0 (0.0-7.0) 6.0 (0.0-8.0) <0.001 General communication, median (IQR) 8.0 (7.5-9.0) 8.0 (8.0-9.0) 0.126 Total Quality of Communication, median (IQR) 8.0 (7.0-8.0) 8.0 (7.0-9.0) 0.003 Univariate analysis. Mann Whitney U was used to test for statistical significance. IQR = Interquartile range. Next, we aimed to adjust for potential confounders with a multiple linear regression model. First, we inspected the Pearson correlations amongst all variables (supplementary appendix 1). All correlations were well below 0.8, so we continued with the model. In supplementary appendix 2, the complete results from our multiple linear regression model to adjust for potential confounders can be found. Both before and after addition of potential confounders to the model, there was a significant difference for the interventions. After adjustment for confounders, the quality of care decision communication was 1.753 (95% CI [0.906, 2.599]) higher in the after-group compared to the before-group (p<0.001). Next, we explored the effect of time. Table 3 shows the results from linear regression in the before- and after-group. Both before and after the interventions, there was no significant effect of time on quality of care decision communication, which makes it likely that the increase in quality of care decision communication after the interventions (1.753 higher after the interventions, see above) is due to the interventions and not simply an effect of increase over time. After the interventions, significantly more patients recalled a care decision conversation at the emergency department (63.7% after vs 45.9% before, p=0.001). Both before and after the interventions, most conversations were initiated by the physician (86.6 before vs 86.9% after).
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