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Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting.

ABSTRACT: Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for "knowledge" (p < 0.001), "emotions," (p = 0.004) and "strategy and summary" (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

SUBMITTER: Oliveira FF

PROVIDER: S-EPMC8241325 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionBreaking bad news is a difficult skill that can elicit significant distress among learners. As such, it is important for learners to practice this skill in a controlled environment, which affords time to address any distress that arises and the opportunity to receive supportive feedback on performance. This breaking bad news module was designed for preclerkship students with previous training in basic communication skills and served as capstone to the preclerkship portion of the communication skills curriculum.MethodsThe small-group session was delivered to groups of 10-12 students and facilitated by a faculty member with expertise in communication skills. The small-group session included approximately 60 minutes of didactics and discussion, followed by a 30-minute faculty demonstration with simulated patients (SPs). Learners then had 30 minutes to practice with the SPs and received constructive feedback from the SPs and the faculty facilitator. Approximately 1 week following the small-group module, learners participated in an individual encounter with an SP and were assessed on physical examination skills and communication skills. Learners received detailed evaluations and feedback on breaking bad news skills from the SPs. Finally, learners had individual feedback meetings with their faculty facilitator, who reviewed the videotaped encounters, focusing on performance and experience of breaking bad news to the SP.ResultsIn the 2015-2016 academic year, 217 medical students participated in this module. Learners demonstrated proficiency in the physical exam skills with 90% of learners asking about 5/8 components of the presenting complaint and 85% performing 5/8 physical exam maneuvers correctly. Similarly learners demonstrated expected levels of competence in interpersonal and communication skills.DiscussionThis learning exercise provided training in a critical communication skill but also supplied a framework for assessing and responding to personal and patient distress.

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Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting.

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