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Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis
Abstract and Figures
Purpose:
To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety.
Method:
MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before-after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and for improving physician confidence in delivering news and patient-reported depression/anxiety, respectively.
Results:
Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74, 95% CI = 0.47-1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60, 95% CI = 0.26-0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results.
Conclusions:
Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length.
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... A su vez, varios estudios han demostrado que los médicos durante su formación en las facultades de medicina no reciben las herramientas adecuadas para comunicar malas noticias y no desarrollan suficientes habilidades de comunicación efectiva 6,7 . Sumado a esto, la mayoría de los pacientes están insatisfechos con las habilidades de los médicos para transmitir malas noticias 8 . ...
... A partir de lo anterior surge esta revisión bibliográfica, con la necesidad de evidenciar cómo la capacidad que tenga el médico en entregar malas noticias puede fortalecer o destruir la relación médico-paciente 4 . Una entrega hábil de malas noticias puede brindar consuelo al paciente y a la familia, al mismo tiempo que puede ser beneficioso para el bienestar de los médicos 2,8 . Es por esto que el objetivo de esta revisión bibliográfica es establecer la importancia de que estudiantes de medicina reciban durante su formación académica una adecuada preparación para la entrega de malas noticias y para el desarrollo de habilidades de comunicación efectiva. ...
... A pesar de que existen protocolos para entregar malas noticias, como el anteriormente descrito, éstos no se implementan de manera rutinaria en la práctica clínica y son desconocidos por gran parte de los profesionales de la salud 8,12,13 . El conocimiento de este protocolo durante la formación de pregrado de los médicos podría ayudar a mejorar la entrega de malas noticias. ...
Introducción: El término “malas noticias” se define como cualquier información que se entregue a los pacientes y a sus familiares, que directa o indirectamente evidencie algún trastorno negativo o grave que pueda cambiar sus perspectivas sobre el futuro y su visión de la vida. Objetivo: Establecer la importancia de que estudiantes de medicina reciban durante su formación académica una adecuada preparación para la entrega de malas noticias. Metodología: Búsqueda bibliográfica en la base de datos Pubmed publicadas entre los años 2010 y 2020. Resultado: El uso de protocolos e intervenciones para mejorar la entrega de malas noticias se asoció con mejoras importantes y significativas en las habilidades comunicativas de los médicos. Además, éstas reducen el estrés y aumentan la confianza de los médicos al momento de entregar malas noticias. Discusión: A pesar de la importancia de esta habilidad en la práctica clínica, los médicos durante su formación en las facultades de medicina no reciben las herramientas necesarias para comunicar adecuadamente malas noticias. En consecuencia, esta habilidad de comunicación generalmente se aprende a través de prueba y error u observación de colegas superiores. Conclusión: Una entrega hábil de malas noticias puede brindar consuelo al paciente y a su familia, además de disminuir el estrés que esta situación le provoca al médico. Por consiguiente, es fundamental incluir intervenciones sobre cómo entregar malas noticias en la formación académica de los estudiantes de medicina.
... This model has been widely used in different disciplines (medicine: Marschollek et al., 2019; speech-language pathology: Gold & Gold, 2018;psychiatry: Seeman, 2010), and its value has been highlighted in several situations in psychology, such as providing the conclusions of a neuropsychological assessment (Longley et al., 2023) or communicating about dementia (The British Psychological Society, 2018). The SPIKES model has also been widely used as a framework for teaching students to break difficult news (Johnson & Panagioti, 2018) and has been associated with a substantial improvement in objective communication skills among health students (Johnson & Panagioti, 2018). This model includes six steps, one corresponding to each letter of the SPIKES acronym. ...
... This model has been widely used in different disciplines (medicine: Marschollek et al., 2019; speech-language pathology: Gold & Gold, 2018;psychiatry: Seeman, 2010), and its value has been highlighted in several situations in psychology, such as providing the conclusions of a neuropsychological assessment (Longley et al., 2023) or communicating about dementia (The British Psychological Society, 2018). The SPIKES model has also been widely used as a framework for teaching students to break difficult news (Johnson & Panagioti, 2018) and has been associated with a substantial improvement in objective communication skills among health students (Johnson & Panagioti, 2018). This model includes six steps, one corresponding to each letter of the SPIKES acronym. ...
... These results are discussed below. Overall, this study supports the positive impact on communication of simulation-based learning with an SP (Dale MacLaine et al., 2021;Johnson & Panagioti, 2018). Many previous studies had found this result, but they were in the field of medicine (Bauchat et al., 2016;Dale MacLaine et al., 2021;Johnson & Panagioti, 2018) and nursing education , not psychology. ...
In psychology, few studies have focused on the programs used to train the skills needed to communicate the psychological assessment feedback. This exploratory study assesses two types of analogue online training in this context. Sixty-nine graduate psychology students were randomly assigned to one of three conditions: simulation-based learning (SBL) with either a standardized patient (SP) or 360° immersive videos (360IV), or a waiting list. Both types of training targeted skills related to empathic communication, improvement of patient understanding, and participation in decision making. Pre-, post-, and follow-up assessments were based on recorded role-play with patient–actors. First, the skills trained were assessed by blind raters. Then, patient–actors assessed students’ empathy and their confidence in the students in their role as clinicians. Finally, students assessed their own empathy, self-efficacy, and stress. The study aimed to explore whether skills are improved in both experimental conditions (SBL-SP and SBL-360IV) as compared with the control condition. Results showed that SBL-SP resulted in improvements on all assessments. No significant changes were observed in the 360IV condition for blind rater assessments, whereas significant improvements were observed when the patient–actors assessed empathy. In conclusion, SBL-SP appears to be effective in improving clinical communication during psychological assessment feedback, while SBL-360IV appears promising but requires further finetuning.
... Education and training at undergraduate and postgraduate levels, complemented with ongoing professional development, are essential to equip health professionals to break bad news effectively. Related interventions are associated with significant improvements in observer-rated news delivery skills and moderate improvements in confidence (17). Indeed, those who have not received formal education and training in this area often feel ill-prepared for the task (18). ...
... A scoping review by Chow et al. reported that physicians who received training were more likely to experience personal accomplishment and less likely to feel emotional exhaustion and depersonalization (11). Similarly, a meta-analysis of 17 studies identified that training interventions were associated with large, significant improvements in observer-rated news delivery skills (17). ...
Introduction
Breaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization’s (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals’ experiences in delivering bad news within the WHO’s Eastern Mediterranean Region.
Methods
This scoping review was conducted according to the Joanna Brigg Institute’s scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to “breaking bad news” and “health professionals” was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO’s Eastern Mediterranean Region.
Results
Out of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants.
Conclusion
The scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO’s Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.
... No que se refere ao preparo profissional relacionado à comunicação de más notícias, a simulação emerge enquanto uma tecnologia promissora no sentido de aprimorar as habilidades comunicativas dos profissionais de saúde, incluindo o treinamento referente às más notícias, o ensino baseado na simulação é um método relativamente seguro de aprendizagem e os participantes tem a oportunidade de colocar em prática seus conhecimentos recém adquiridos, mantendo a segurança pessoal e dos pacientes, por isso, vários estudos demonstram os benefícios do uso da simulação na comunicação de más notícias (PAPADAKOS et al., 2021;DELUCHE et al., 2023;JOHNSON;PANAGIOTI, 2018). A utilização do protocolo SPIKES no EBS se apresenta como uma estratégia interessante, pois é algo facilmente replicável e útil, a utilização do protocolo em um ambiente seguro e similar ao real, favorece a aprendizagem e a reflexão acerca da temática (NAVAS; MARTÍNEZ; BERMÚDEZ, 2020). ...
... Previously reported interventions designed to address communication skills (including breaking bad news) infrequently use theory in their development and thus typically focus only on communication skills training techniques such as didactic teaching and simulation with feedback on performance [18]. These techniques have been demonstrated to improve proximal outcomes such as clinicians' self-rated confidence and observer-rated performance [34]; our study adds to this literature by using theory to understand the mechanisms through which these interventions could lead to such outcomes. However, the extent to which these interventions lead to sustained changes in clinical practice and impact on more distal outcomes such as patient and carer experience are rarely studied; it is typically assumed that improvements to clinicians' confidence and performance lead to enhanced outcomes [35,36]. ...
Background
Understanding recovery is important for patients with stroke and their families, including how much recovery is expected and how long it might take. These conversations can however be uncomfortable for stroke unit staff, particularly when they involve breaking bad news. This study aimed to begin development of a novel complex intervention to improve conversations about recovery on stroke units.
Methods
Informed by previously collected qualitative data, we used the Behaviour Change Wheel (BCW) approach to identify possible 1. barriers to communication about recovery on stroke units; 2. Intervention Functions; 3. Behaviour Change Techniques (BCTs) to incorporate in an intervention. We subsequently sought stroke professionals’ perspectives through an online survey. Respondents rated the importance of barriers for intervention inclusion and evaluated the usefulness and feasibility of the suggested BCTs.
Results
Our behavioural diagnosis identified a target behaviour of provision of information about recovery by stroke unit professionals to patients and carers. Twelve possible barriers to this behaviour were identified, with six potential Intervention Functions to address them, and 29 BCTs. Forty-eight multidisciplinary professionals responded to the survey. The six barriers rated as most important to address were: lack of confidence; perceptions of insufficient communication skills; lack of knowledge of the benefits; difficulties in deciding when and in what format to provide information; absence of private spaces for discussions; and lack of generic written information to support conversations. The developed intervention strategy comprised twelve clinically feasible and useful BCTs, encompassing the Intervention Functions of Training, Enablement, Persuasion, and Environmental restructuring.
Conclusions
The BCW approach was successfully used to begin development of an intervention to improve conversations about recovery on the stroke unit; our survey enabled incorporation of stakeholder perspectives. Further development work is required to design intervention materials and test whether the strategies are effective in improving staff and patient outcomes.
... Furthermore, in recent years, one of the more salient aspects that has been closely studied in this field is the communication between a patient and their physician. Different studies have confirmed the impact that a physician's communication may have on a patient's subsequent symptoms of depression and anxiety, and it may also influence their therapy options [12]. The evidence shows that patients who have been properly informed about their illness tend to adhere more to their treatment and show better long-term psychological adjustment [13]. ...
Simple Summary
Communication by health professionals impacts the mental health of cancer patients. This research sought to further explore this matter by studying the possible relationships between communication and a patient’s depression, anxiety, quality of life, coping strategies, and perception of their state of health. A total of 177 patients diagnosed with cancer answered a battery of questionnaires on these aspects. Our findings show that oncologists are better at delivering a cancer diagnosis than other healthcare professionals and that communication by them can impact patients’ mental and health variables. We believe that there is a need to implement better communication strategies among all healthcare professionals to facilitate the task of breaking bad news to patients. This will have a positive impact on patients’ emotional states and health while reducing stress and burnout among the healthcare professionals themselves.
Abstract
The field of healthcare is increasingly adopting a humanistic perspective in the physician–patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient’s anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient’s satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients.
A comunicação de más notícias em ambiente hospitalar é uma tarefa difícil em função da complexidade dos casos e ausência de capacitação adequados para realizar esta tarefa. Foram revisados os principais protocolos utilizados para comunicação de más notícias. Adicionalmente, foram avaliados os currículos das atividades acadêmicas com enfoque psicossocial ofertadas nas Faculdades de Medicina no estado do Rio Grande do Sul que permitam aos alunos terem o contato com o processo de comunicação de más notícias. Por fim, apresenta-se uma proposta resumida das recomendações técnicas, incluindo os pontos essenciais do processo de comunicação.
Background
Good communication between patients and practitioners is essential, especially during dental procedures, as these treatments are often associated with increased nervousness and anxiety. The aim of this study was to investigate, implement and evaluate a concept for communication skills training by using targeted training in combination with simulation patients in dental education.
Methods
Students (n = 34) were assigned to four small groups receiving targeted training consisting of two parts. A lecture about the theoretical basics of communication skills and two practical sessions with simulation patients. During this training, one of the students performed the conversation with the patient. Immediately after self-assessment was obtained, the simulation patient, the remaining students and the lecturer provided feedback. Additionally, anonymous surveys were administered to the students at the beginning of the semester, immediately after the training and at the end of the course.
Results
The students rated the learning of communication skills as important for later professional life at all times. After targeted training followed by subsequent use in simulated patients, there was a significant improvement in communication skills (p < 0.001). The number of open-ended questions asked to patients after attending the course significantly increased (p = 0.0245). The communication training was considered useful, especially in small groups.
Conclusion
The implementation of targeted training with subsequent use in simulated patients significantly contributed to the students’ improvement in communication skills. The concept offers a good opportunity to better prepare students for interaction with patients, both in their studies and in their upcoming professional lives.
Discussing serious news is a fundamental communication skill, and many clinicians have been taught to ask their patients how much detail they want to hear before sharing difficult information. Over the past decade, we have taught hundreds of medical students how to discuss serious news and reviewed hundreds of their recorded conversations. We’ve found that asking how much detail a patient wants to hear often results in confusion and is not an effective way to understand their communication preferences. Instead of asking how much detail your patient wants to hear, we propose an alternative way to tailor information to their needs when discussing serious news. By asking permission to share, presenting the news in a succinct, jargon-free headline, and providing emotional support and expert guidance at the right times, you can give the correct amount of detail while avoiding unnecessary confusion resulting in high-quality, patient centered communication every time you discuss serious news.
In medically assisted reproduction (MAR) success has mostly been measured in terms of achieving (healthy) livebirths. We argue this focus is too narrow and that success should be measured in terms of alleviating patient suffering caused by an unfulfilled child wish. The major implication is that clinics must better tailored care to effectively support patients who do not have child(ren) with treatment. First, we argue that clinics have a duty of care towards patients for whom MAR does not result in children because this is a common treatment outcome, because treatment is burdensome and creates new losses for patients, and because the field has the necessary expertise to provide support and it is part of patient-centred care. Then, we examine concerns about the adequacy of addressing the possibility that treatment may end without children, namely, that this may hinder patients’ hope and put them off doing treatment, and that it may be perceived as a sign of clinical incompetence, as well as concerns about the required skill set. We end with a set of research-informed recommendations to promote healthy adjustment to ending fertility treatment without children. These focus on the need to reconceptualize ‘success’ and ‘failure’ in MAR, to promote open discussion about the possibility of treatment not resulting in children and encourage patients to develop ‘plan(s) B’, to support patients who end treatment without children, and to create the organizational structures needed to support clinics and healthcare professionals in this endeavour.
Background:
This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective.
Objectives:
To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction.
Search methods:
For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies.
Selection criteria:
The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research.
Data collection and analysis:
Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs).
Main results:
We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias.
Authors' conclusions:
Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
Several rare diseases are regularly identified during the prenatal and perinatal periods, including dysmelia. How these are communicated to parents has a marked emotional impact, but minimal research has investigated this. The purpose of this study was to explore parent experiences and preferences when their baby was diagnosed with dysmelia.Twenty mothers and fathers were interviewed. Data was analyzed using thematic analysis. The overriding emotion parents experienced was shock, but the extent of this was influenced by several factors including their previous experience of disability. Four key needs of parents were identified, including the need for signposting to peer support organizations, for information, for sensitive communication, and for a plan regarding their child’s care. Parents wanted immediate information provision and signposting to peer support, and for discussions regarding possible causes of the dysmelia or termination (in the case of prenatal identification) to be delayed until they had processed the news.
Problem and background:
Dysmelia is usually detected prenatally or postnatally in maternity services. The provision of family-centred care for parents at the time of initial diagnosis is crucial to facilitate decision making, access to appropriate services, and the provision of parental care-giving, but no research has investigated parent experiences or preferences in this population.
Aims:
The current research aimed to address this by investigating satisfaction with service, occurrence of signposting and preferences in this group.
Methods:
Two online surveys were conducted. In the first survey (n=417), parents reported whether they were offered signposting information and their level of satisfaction with the service they received when initially diagnosed. In the second survey (n=130), a subgroup of participants who completed the first survey reported their preferences for signposting and health service access after diagnosis.
Findings:
On average, participants were less than satisfied with the service they received and only 27% were offered signposting information. Satisfaction was higher amongst parents who had been offered signposting information. 91% of parents said they would have wanted signposting information and 67% would have wanted access to a support group.
Conclusions:
There is a need to improve the family-centeredness of care when dysmelia is identified. Offering signposting information to relevant third-sector organisations may increase parent satisfaction and address parent preferences. These findings could have implications for parents of children with other rare diseases identified in maternity services.
Background
Medical curricula become more and more vertically integrated (VI) to prepare graduates better for clinical practice. VI curricula show early clinical education, integration of biomedical sciences and focus on increasing clinical responsibility levels for trainees. Results of earlier questionnaire-based studies indicate that the type of the curriculum can affect the perceived preparedness for work as perceived by students or supervisors. The aim of the present study is to determine difference in actual performance of graduates from VI and non-VI curricula.
Methods
We developed and implemented an authentic performance assessment based on different facets of competence for medical near-graduates in the role of beginning residents on a very busy day. Fifty nine candidates participated: 30 VI (Utrecht, The Netherlands) and 29 non-VI (Hamburg, Germany). Two physicians, one nurse and five standardized patients independently assessed each candidate on different facets of competence. Afterwards, the physicians indicated how much supervision they estimated each candidate would require on nine so called “Entrustable Professional Activities (EPAs)” unrelated to the observed scenarios.
Results
Graduates from a VI curriculum received significantly higher scores by the physicians for the facet of competence “active professional development”, with features like ‘reflection’ and ‘asking for feedback’. In addition, VI graduates scored better on the EPA “solving a management problem”, while the non-VI graduates got higher scores for the EPA “breaking bad news”.
Conclusions
This study gives an impression of the actual performance of medical graduates from VI and non-VI curricula. Even though not many differences were found, VI graduates got higher scores for features of professional development, which is important for postgraduate training and continuing education.
Objective:
This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures.
Methods:
This randomized control study (N=66) compared intervention and control groups of students (n=28) and residents' (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures.
Results:
Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=0.007, r=-0.47; breast cancer (BC), p=0.003, r=-0.53), attention to patient responses after BBN (CC, p<0.001, r=-0.74; BC, p=0.001, r=-0.65), and addressing feelings (BC, p=0.006, r=-0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r=-0.43), communication related to emotions (p=0.034, r=-0.30), determining patient's readiness to proceed after BBN and communication preferences (p=0.041, r=-0.28), active listening (p=0.011, r=-0.37), addressing feelings (p<0.001, r=-0.65), and global interview performance (p=0.001, r=-0.51).
Conclusion:
This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents.
Practice implications:
Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.
Pediatric residents report they are not sufficiently trained to communicate with families at a child's death. We performed a study to prove feasibility and assess whether simulation improves their communication and experience. Residents were assigned to intervention using simulation or control group. Communication was assessed by standardized patients and audiotapes of simulated encounters when they delivered bad news. Residents' perceptions of their communication were polled. The majority reported they never witnessed end-of-life discussions. All residents perceived themselves to be more capable at pronouncing the death of a child, and informing a family of a death after participating in either the interventional simulation or a bereavement retreat. Despite training within a pediatric intensive care unit, pediatric residents have little exposure to end-of-life discussions. Pediatric end-of-life simulation increases exposure of residents to end-of-life care and improves residents' perceptions of their communication.
The skill of delivering bad news is difficult to teach and evaluate. Residents may practice in simulated settings; however, this may not translate to confidence or competence during real experiences. We investigated the acceptability and feasibility of social workers as evaluators of residents' delivery of bad news during patient encounters, and assessed the attitudes of both groups regarding this process. From August 2013 to June 2014, emergency medicine residents completed self-assessments after delivering bad news. Social workers completed evaluations after observing these conversations. The Assessment tools were designed by modifying the global Breaking Bad News Assessment Scale. Residents and social workers completed post-study surveys. 37 evaluations were received, 20 completed by social workers and 17 resident self-evaluations. Social workers reported discussing plans with residents prior to conversations 90 % of the time (18/20, 95 % CI 64.5, 97.8). Social workers who had previously observed the resident delivering bad news reported that the resident was more skilled on subsequent encounters 90 % of the time (95 % CI 42.2, 99). Both social workers and residents felt that prior training or experience was important. First-year residents valued advice from social workers less than advice from attending physicians, whereas more experienced residents perceived advice from social workers to be equivalent with that of attending physicians (40 versus 2.9 %, p = 0.002). Social worker assessment of residents' abilities to deliver bad news is feasible and acceptable to both groups. This formalized self-assessment and evaluation process highlights the importance of social workers' involvement in delivery of bad news, and the teaching of this skill. This method may also be used as direct-observation for resident milestone assessment.
Objective:
Although communication skills represent an increasingly important aspect of medical care, little has been done to assess the best method of teaching these skills. Our study was designed to assess simulation-debriefing compared to lecture in teaching skills for Breaking Bad News (BBN) in obstetrics.
Methods:
This is a randomized prospective trial of house staff from a large academic medical center. Subjects initially underwent baseline simulation, followed by evaluation on BBN skills by themselves, a faculty observer, and the standardized patient (SP). The subjects were then immediately randomized to a debriefing session by faculty or to a lecture about BBN. Subsequently, both groups underwent a second simulation with the same three assessments, yielding post-intervention data.
Results:
35 subjects completed both simulations. Both debriefing and lecture curricula showed improvement in scores by self (p = 0.010) and faculty (p < 0.001). The debriefing group improved significantly more than the lecture group for self-evaluation; additionally, improvements were greater for the debrief group in verbal and nonverbal skills. Long-term follow-up three months after both interventions demonstrated continued improvement in BBN.
Conclusions:
Simulation training with debriefing is effective for teaching communication skills, and superior to lecture for self-perceived improvement. Long-term follow-up suggested retention of confidence in BBN skills.