{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T19:44:39Z","timestamp":1785872679742,"version":"3.56.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K19352"],"award-info":[{"award-number":["25K19352"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure (HF) palliative care communication is essential but difficult to train at scale because conventional role-play programmes require facilitators and standardized patients. Large language models (LLMs) have emerged as potential tools for scalable communication training. This pilot study aimed to evaluate the feasibility of a web-based LLM-driven communication training application and to explore its early educational signal on physicians\u2019 self-efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This single-arm pilot study included physicians who completed one session using a Japanese-language web-based LLM application designed to simulate patients with advanced HF and provide automated framework-based feedback. The primary outcome was change in self-efficacy scores assessed by pre- and post-session questionnaires. Ten sessions were analysed. Physicians engaged in a mean of 7.6 \u00b1 2.0 dialogue turns. Mean response time per model output and feedback generation were approximately 3 and 17\u2005s, respectively. Significant improvements were observed in knowledge of palliative care communication (mean difference +1.7, adjusted P &amp;lt; 0.01) and confidence in HF palliative care communication (+1.2, adjusted P = 0.03). Other domains showed non-significant changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This pilot study demonstrated the feasibility of a web-based LLM-simulated patient system and suggested an early educational signal in physicians\u2019 self-efficacy for HF palliative care communication. Our scalable LLM-driven communication training may complement traditional educational approaches with further evaluation in larger controlled studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>Trial registration number: UMIN000059988<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztag119","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:30:08Z","timestamp":1784633408000},"source":"Crossref","is-referenced-by-count":0,"title":["Large language model\u2013based simulated patient training for heart failure palliative care communication: a pilot study"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-8373","authenticated-orcid":false,"given":"Risa","family":"Kishikawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, The University of Tokyo Hospital , 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, The University of Tokyo Hospital , 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 ,","place":["Japan"]},{"name":"Cardiovascular Biobank Research Center, International University of Health and Welfare , 4-1-26 Akasaka, Minato-ku, Tokyo 107-8402 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2908-6875","authenticated-orcid":false,"given":"Satoshi","family":"Kodera","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, The University of Tokyo Hospital , 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"2026080415012158600_ztag119-B1","doi-asserted-by":"crossref","first-page":"e411","DOI":"10.1016\/S2214-109X(20)30004-8","article-title":"Post-discharge prognosis of patients admitted to hospital for heart failure by world region, and national level of income and income disparity (REPORT-HF): a cohort study","volume":"8","author":"Tromp","year":"2020","journal-title":"Lancet Glob Health"},{"key":"2026080415012158600_ztag119-B2","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.jchf.2024.01.010","article-title":"Palliative care across the spectrum of heart failure","volume":"12","author":"Gelfman","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026080415012158600_ztag119-B3","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.puhe.2021.02.033","article-title":"Palliative care education and its effectiveness: a systematic review","volume":"194","author":"Li","year":"2021","journal-title":"Public Health"},{"key":"2026080415012158600_ztag119-B4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0263523","article-title":"Evaluation of the effectiveness of the physician education program on primary palliative care in heart failure","volume":"17","author":"Shibata","year":"2022","journal-title":"PLoS One"},{"key":"2026080415012158600_ztag119-B5","first-page":"164","article-title":"Approaching difficult communication tasks in oncology","volume":"55","author":"Back","year":"2005","journal-title":"CA Cancer J Clin"},{"key":"2026080415012158600_ztag119-B6","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1017\/S147895151300031X","article-title":"Development and preliminary evaluation of communication skills training program for oncologists based on patient preferences for communicating bad news","volume":"12","author":"Fujimori","year":"2014","journal-title":"Palliat Support Care"},{"key":"2026080415012158600_ztag119-B7","first-page":"123","article-title":"Advance care planning and communication skills improve after an interprofessional team simulation with standardized patients","volume":"3","author":"Millstein","year":"2022","journal-title":"Palliat Med Rep"},{"key":"2026080415012158600_ztag119-B8","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1089\/jpm.2016.0509","article-title":"The impact of communication skills training on cardiology fellows\u2019 and attending physicians\u2019 perceived comfort with difficult conversations","volume":"20","author":"Berlacher","year":"2017","journal-title":"J Palliat Med"},{"key":"2026080415012158600_ztag119-B9","doi-asserted-by":"crossref","first-page":"e1511","DOI":"10.3109\/0142159X.2013.818632","article-title":"Simulation in healthcare education: a best evidence practical guide. 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