Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis

Stress arousal reappraisal and worked example effects on the neuroendocrine stress response during breaking bad news in medical education

Breaking bad news (BBN; i.e., the disclosure of a serious diagnosis) is a necessary but challenging task in the medical field, often raising stress levels among physicians. According to the biopsychosocial model of challenge and threat, stress responses can manifest as adaptive challenge states or maladaptive threat states. Prior research has proposed that specific patterns in neuroendocrine responses may signal challenge and threat. In this study, we employed a 2 × 2 design to examine the effects of stress arousal reappraisal (SAR; i.e., reframing bodily arousal as a functional response) and worked example (WE; i.e., stepwise demonstration of BBN) interventions on salivary cortisol, dehydroepiandrosterone, and alpha-amylase responses. A total of 229 third-year medical students participated in a BBN simulation. While significant activation (rise) and regulation (decline) of neuroendocrine markers were observed in response to the BBN encounter, neither the SAR nor the WE intervention affected their peak levels or the magnitude (area under the curve) of the response. Only the WE intervention decelerated the rise and decline in dehydroepiandrosterone levels around individual peaks, potentially indicating an attenuated stress response. These findings suggest that neither of the interventions induced the expected challenge pattern in neuroendocrine activity. However, due to the low temporal resolution of salivary measurements and the dynamic process of challenge and threat orientations, we propose that the neuroendocrine responses may have limitations in distinguishing between challenge and threat.

Comparison of drama and standardised patient method to develop humanistic approach in breaking bad news training

Medicine is inherently a humanistic profession. However, recent studies have emphasised the need for medical students to develop humane attitudes and behaviours. Breaking bad news is also one topic where a humanistic approach needs to be developed. The purpose of this study is to investigate the effects and differences between drama and the standardised patient (SP) method in objective structured clinical examinations (OSCEs) on fostering a humanistic approach in breaking bad news. This is a comparative case study, a qualitative research method, encompassing content analyses of observer notes and transcripts of audio recordings from debriefing sessions. The study includes fifth-year medical students from Karadeniz Technical University Faculty of Medicine, with 20 volunteer students participating as the sample. The listed students, those with odd numbers, were assigned to the SP-based OSCE group, while those with even numbers were assigned to the drama-based OSCE group. Data was analysed using Creswell's content analysis approach. A total of 20 students participated in the study, with half evaluated through SP-based OSCEs and the other half through drama-based OSCEs. A comparative analysis of drama-based and SP-based OSCE debriefings revealed unique strengths and challenges. Drama-based OSCEs fostered empathy, emotional engagement and reflective practice, aiding students in managing emotions. SP-based OSCEs enhanced structured communication but sometimes led to emotional desensitisation and performative empathy. Overall, the drama method proved to be a more humanistic approach effective in nurturing natural empathy and supportive communication, particularly in breaking bad news. This study highlights the strengths of drama-based OSCEs in fostering empathy and emotional engagement while maintaining structured communication frameworks. By directly comparing drama and SP methods, our findings underscore the potential of drama-based approaches to enhance humanistic medical education and patient communication. Integrating the complementary strengths of both methods into medical training can better prepare students for compassionate, effective patient interactions, addressing both emotional and technical aspects of clinical care.

Improving breaking bad news communication skills through stress arousal reappraisal and worked examples

INTRODUCTION

Breaking bad news (BBN) is a distressing yet essential task in medicine, imposing emotional strain on both physicians and patients. Crucially, effective BBN relies on both verbal and nonverbal communication, which can be impaired by elevated stress associated with the task. Efficient teaching of communication skills continues to present a challenge, and the role of stress management in BBN encounters remains largely overlooked. In this study, we investigated the effects of stress arousal reappraisal (SAR; positive reframing of stress arousal) and worked example (WE; step-by-step demonstration of BBN) interventions on medical students' communication performance.

METHODS

This pre-registered randomised controlled trial employed a 2 × 2 between-subjects design to evaluate the individual and combined effects of SAR and WE interventions on the verbal and nonverbal communication performance of 221 third-year medical students. To do so, students completed a 40-min web-based learning module before disclosing bad news to a simulated patient within a 12-min consultation. Performances were videorecorded and assessed by three independent raters.

RESULTS

The WE intervention significantly improved both verbal and nonverbal communication performance, whereas the SAR intervention enhanced nonverbal communication only. Combining SAR with WE did not yield additional improvements in nonverbal communication beyond those achieved by either intervention alone.

DISCUSSION

These findings highlight the potential of both SAR and WE interventions to optimise resource-intensive simulated BBN training. By demonstrating the efficacy of WE in improving both verbal and nonverbal communication, this study advances the literature on the application of WEs in the BBN context. Furthermore, this study is among the first to demonstrate the importance of stress coping in delivering bad news effectively. Given their low threshold, both SAR and WE interventions represent promising tools for equipping medical students with essential BBN communication skills and are well-suited for integration into already time-constrained medical curricula.

Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses

BACKGROUND

Nurses accompany patients throughout the breaking bad news process.

AIM

The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization.

STUDY DESIGN

A cross-sectional comparative study.

RESULTS

Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%).

CONCLUSIONS

Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented.

RELEVANCE TO CLINICAL PRACTICE

The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.

Experiences of Simulated Phone Death Notification

BACKGROUND

Physicians perform many difficult skills, but notifying loved ones about the death of a family member is a particularly challenging skill that requires specific training. Descriptions of such training are lacking in the literature. We developed a formative standardised patient encounter on death notification over the telephone for fourth-year medical students and evaluated their qualitative perspectives, including emotional safety.

APPROACH

Embedded within a fourth-year advanced communication skills workshop in 2019, a case was introduced to practice telephone death notification. Students had a preparatory didactic lesson, received formative peer feedback, and participated in faculty-led debriefs.

EVALUATION

Eighty-eight medical students at one medical school in the United States participated in debriefing sessions after a communication skills workshop during the fourth-year capstone course. The debriefing sessions were audio-recorded and transcribed. Fifty-seven of those students completed postsession surveys. Transcripts and surveys were qualitatively analysed using content analysis to code responses, extract salient categories, and distil into themes. Three general themes emerged: communication challenges, emotional responses, and appreciation for the experience. Communication challenges included using language about death, experiences of silence, complications of distance and driving, and communication by phone. Students described the case as "challenging," "uncomfortable," "intense," and "emotional." Despite these strong feelings, students expressed appreciation for the experience, noting appropriateness of the preparation and debrief, a sense of safety, and realistic encounters.

IMPLICATIONS

Telephone death notification training was a valued, realistic, and emotionally safe experience. Students felt appropriately challenged, but adequately supported. These skills can be included in formative communication skills curricula.

How to break the news in amyotrophic lateral sclerosis/motor neuron disease: practical guidelines from experts

In amyotrophic lateral sclerosis/motor neuron disease (ALS/MND), it is necessary to communicate difficult news during the initial diagnosis and throughout the disease trajectory as the condition progresses. However, delivering difficult news to people with ALS/MND is an emotionally demanding task for healthcare and allied health professionals-one for which many feel ill-prepared because of limited training in this area. Ineffective communication of difficult news damages the patient-provider relationship and negatively impacts patient quality of life (QoL). To address this issue, we developed the A-L S-PIKES protocol based on available literature and our extensive clinical experience. It provides easy-to-follow, stepwise guidelines to effectively deliver difficult news to people with ALS/MND (PALS) that includes: Advance Preparation (preparing for the discussion logistically and emotionally); Location & Setting (creating a comfortable setting that fosters rapport); Patient's Perceptions (assessing PALS' understanding and perception of their condition); Invitation (seeking PALS' permission to share information); Knowledge (sharing information in a clear, understandable manner); Emotion/Empathy (addressing emotions with empathy and providing emotional support); and Strategy & Summary (summarizing the discussion and collaboratively developing a plan of action). A-L S-PIKES provides practical guidelines on how to prepare for and conduct these challenging conversations. It emphasizes effective communication tailored to the individual needs of PALS and their families, empathy, sensitivity, and support for PALS' emotional well-being and autonomy. The aim of A-L S-PIKES is to both enhance skills and confidence in delivering difficult news and to improve the QoL of PALS and their families. Future studies should systematically evaluate the feasibility and effectiveness of A-L S-PIKES to establish its utility in clinical practice.

Ethical Dilemmas Among Oncology Nurses in China: Cross-Sectional Study

Background

Effective communication about cancer prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms, which can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing related to prognosis communication are understudied in China.

Objective

This study aimed to examine the ethical dilemmas relating to cancer prognosis communication and their associated factors.

Methods

A cross-sectional design was employed to survey 373 oncology nurses in mainland China. Data were collected on ethical dilemmas, attitudes, barriers, experiences with prognosis communication, sociodemographics, and practice-related information. Ordinary least squares regressions were used to identify factors contributing to ethical dilemmas.

Results

Participants reported a moderate level of ethical dilemmas in prognostic communication (mean 13.5, SD 3.42; range 5-20). Significant predictors of these dilemmas included perceived barriers (P<.001), experiences with prognosis communication (P<.001), and years of work experience (P=.002). Nurses who perceived greater communication barriers, had more negative experiences with prognosis communication, and had less work experience were more likely to encounter ethical dilemmas in prognosis-related communication.

Conclusions

Chinese oncology nurses frequently encounter ethical dilemmas, as well as barriers, in communicating cancer prognoses. This study's findings emphasize the importance of culturally tailored communication training. Collaborative interprofessional training, particularly through physician-nurse partnerships, can perhaps enhance the proficiency of cancer prognosis-related communication.

"I'm quite proud of how we've handled it": health professionals' experiences of returning additional findings from the 100,000 genomes project

Participants in the 100,000 Genomes Project (100kGP) could consent to receive additional finding (AF) results, individual variants relating to genes associated with susceptibility to cancer and familial hypercholesterolemia (FH). In the study reported here, qualitative interviews were used to explore the experiences of National Health Service (NHS) professionals from across England who were tasked with returning over 80,000 "no AF" results and 700 positive AF results to 100kGP participants. Interviews were conducted with 45 professionals from a range of backgrounds, including Genetic Counsellors, Clinical Geneticists, FH Clinical Nurse Specialists and Clinical Scientists. Interviews were analysed using a codebook thematic analysis approach. Returning AF results has been a significant endeavour, with challenges for pathways, administrative processes and clinical and laboratory time when the capacity of NHS services is already stretched. Professionals discussed going "above and beyond" to prioritise patient care through pathway design, additional clinics, overtime, longer appointments and provision of follow-up appointments. Professionals also described facing practical and emotional challenges when returning AFs. Benefits for patients from receiving AFs in the 100kGP were highlighted and professionals were generally positive about offering clinically actionable AFs within routine NHS clinical care. Professionals were, however, cautious around the implementation of AFs into routine care and felt more research and discussion was needed to determine which AFs to offer, approaches to consent and communication of results, costs and the potential strain on NHS capacity and resources. Further consultation is required with careful review of pathways and resources before offering AFs in clinical practice.

Health professionals' views and experiences of breaking bad news in the Eastern Mediterranean Region: a scoping review

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.

Sharing Unpleasant Health Information with Patients: A baseline study exploring physician attitudes, practices and adherence to the SPIKES protocol at a tertiary hospital in Muscat, Oman

Objectives

This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman.

Methods

This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments.

Results

A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information ('bad news'), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients' family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6-85.4%, 12.4-34.8% and 1.1-11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts.

Conclusion

Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.

Challenging Case: New-Onset Hallucinations and Developmental Regression in a Child with Autism Spectrum Disorder

CASE

Nick is a 5-year-old boy who began displaying self-stimulating behaviors and decreased social interactions shortly before turning 3 years. At the age of 3.5 years, he was diagnosed with autism spectrum disorder by a local developmental-behavioral pediatrician. His parents recall that the physician described Nick to be "high functioning" and encouraged them to expect that he would attend college and live independently as an adult. Upon receiving the diagnosis, intervention was initiated using an applied behavioral analysis (ABA) approach. With this intervention, he demonstrated initial gains in the use of complex language and improved social interactions.Concerns regarding suspected psychosis emerged just before starting kindergarten when Nick began experiencing ego-dystonic visual and auditory hallucinations. Initially, Nick verbally responded to the hallucinations and vividly described what he was experiencing. Shortly after the onset of these hallucinations, Nick experienced a significant decrease in the frequency and complexity of his expressive language and became more withdrawn. Over time, his hallucinations intensified, and his parents became increasingly fearful for his safety. Various antipsychotic and mood-stabilizing medications, steroids, and immunotherapy have been trialed with limited improvement of his symptoms.An extensive medical evaluation yielded the following:1. Magnetic resonance imaging of the brain: dilated perivascular spaces.2. Urine organic acids: ketosis and increased lactic acid.3. Antinuclear antibody: minimally positive.4. Vitamin B12: elevated.All other studies, including lumbar puncture, electroencephalogram (awake and asleep), genetic studies (chromosomal microarray, fragile X testing, and whole exome sequencing), metabolic studies, inflammatory markers, and thyroid panel, were negative/normal.Nick is enrolled in a special education classroom within a school that utilizes an ABA-based approach for all students. As part of his educational programming, he receives 25 hours of ABA in a 1:1 setting, 2 hours of speech therapy, 3 hours of occupational therapy, 1 hour of physical therapy, and 30 minutes of music therapy weekly. Current concerns include significant head-banging and thrashing before falling asleep, hyperactivity, unsafe behaviors (e.g., banging on windows, climbing high to reach desired items), aggression toward caregivers, limited ability to complete self-care tasks (e.g., personal hygiene, toileting), significant decline in expressive language, and continued response to internal stimuli.Nick's parents now present to a multidisciplinary center seeking guidance regarding additional therapies/interventions to assist in management of his current developmental and behavioral challenges as well as information regarding his expected developmental trajectory as he reaches adulthood.

Small Patients but a Heavy Lift: Workload and Burnout of Advanced Practice Providers and Physicians in a Level IV Neonatal Intensive Care Unit

OBJECTIVE

This study explored the association between workload and the level of burnout reported by clinicians in our neonatal intensive care unit (NICU). A qualitative analysis was used to identify specific factors that contributed to workload and modulated clinician workload in the NICU.

STUDY DESIGN

We conducted a study utilizing postshift surveys to explore workload of 42 NICU advanced practice providers and physicians over a 6-month period. We used multinomial logistic regression models to determine associations between workload and burnout. We used a descriptive qualitative design with an inductive thematic analysis to analyze qualitative data.

RESULTS

Clinicians reported feelings of burnout on nearly half of their shifts (44%), and higher levels of workload during a shift were associated with report of a burnout symptom. Our study identified 7 themes related to workload in the NICU. Two themes focused on contributors to workload, 3 themes focused on modulators of workload, and the final 2 themes represented mixed experiences of clinicians' workload.

CONCLUSION

We found an association between burnout and increased workload. Clinicians in our study described common contributors to workload and actions to reduce workload. Decreasing workload and burnout along with improving clinician well-being requires a multifaceted approach on unit and systems levels.

Difficulties experienced by dentists and orthodontists regarding ethical issues when announcing the diagnosis of a rare oral disease: a qualitative study in Marseille, France

PURPOSE

It is traditionally considered that breaking bad news to patients does not represent a cause for concern for dental professionals. However, there are situations where they will be confronted with this task, as in the case of rare dental diseases. Little information is available regarding the feelings of healthcare professionals on this subject. There are no qualitative studies that explore how a diagnosis of oligodontia is announced to patients by dentists and orthodontists. The aim of our study is to explore the difficulties and ethical issues experienced by dental health professionals when they have to announce a diagnosis of oligodontia to a patient and their family.

METHODS

This study relied on a qualitative research method using focus groups of dentists and orthodontists and a thematic analysis procedure.

RESULTS

The difficulties experienced could be summarised within five topics: organisational difficulties, difficulties with the management of dental treatment and with the administrative management associated with this anomaly, difficulties with the content of the announcement, and relational difficulties. These could be grouped in two categories: practical difficulties and ethical difficulties.

CONCLUSION

This survey allowed us to understand the difficulties encountered by dentists and orthodontists when announcing oligodontia. The participants felt uncomfortable with this task and were under stress. They reported difficulties in delivering the medical information and in adapting to the message. It is essential that dental professionals develop skills in medical communication.

Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study

BACKGROUND

Moral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses' moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms.

METHOD

This is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman's approach.

RESULTS

One hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the 'role of healthcare providers'. The experiences of the participants in the theme 'Inductive process of moral distress development' were categorized into three categories: 'Melting into the faulty system', 'Power and the system as distress promotors', and 'Perceived unpleasant consequences'.

CONCLUSION

The results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the "inductive moral process of distress development" was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences.

Physicians' Self-Perceived Competence on Breaking Bad News to Parents of Children with Neurodisabilities

Delivering difficult news to parents of children with neurodisabilities, often involving new diagnoses, prognosis changes, or declines in function or health, presents a complex task. Our aim was to assess physicians' self-perceived competence in breaking bad news (BBN) within this context. An online survey was administered to neuropediatricians and developmental and rehabilitation pediatricians in Switzerland. Among 247 invited physicians, 62 (25.1%) responded (age of 51 ± 11 years; M/F ratio of 2:3). They rated their BBN competence at 7.5 ± 1.6 out of 10. Factors significantly associated with self-perceived competence in uni- and multivariate analyses included years of professional experience (≤10 years: 6.2 ± 1.8; >10 years: 8.2 ± 0.8), and region of pregraduate training (Switzerland: 7.3 ± 1.6; European Union: 8.3 ± 0.9). The respondents highlighted the positive roles of professional and personal experience, quality relationships with families, and empathy in BBN. In summary, physicians generally expressed a sense of competence in delivering difficult news to parents of children with neurodisabilities. They underscored the significance of life experiences and certain individual qualities in their effectiveness. These findings provide valuable insights into enhancing professional training and support in this crucial yet underexplored aspect of medical practice.

From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial

BACKGROUND

Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition.

METHODS

In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances.

DISCUSSION

Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05037318), September 8, 2021.