1
|
Bai S, Wu B, Yao Z, Zhu X, Jiang Y, Chang Q, Bai X, Tong T. Effectiveness of a modified doctor-patient communication training Programme designed for surgical residents in China: a prospective, large-volume study at a single Centre. BMC MEDICAL EDUCATION 2019; 19:338. [PMID: 31488118 PMCID: PMC6727532 DOI: 10.1186/s12909-019-1776-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/30/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Effective doctor-patient communication (DPC) is important to improve the quality of care and treatment outcomes. This study aimed to evaluate the effectiveness of a modified DPC training programme designed for surgical residents in China. METHODS A total of 210 surgical residents from 7 specialties were recruited to participate in a communication skills training programme. The extended SEGUE scale was administered to supervisors, and a visual analogue scale (VAS) was administered to standardized patients (SPs) and trainees. Evaluations were conducted by comparing the pre-post scale scores (before, immediately after and 1 month after the programme). Training effects were assessed using the Friedman test and the intraclass correlation coefficient (ICC). RESULTS Compared to the extended SEGUE scale total scores before the programme, the scores both immediately after and 1 month after the program increased significantly (15.88 ± 1.93 vs. 26.40 ± 1.47 and 26.15 ± 1.36, respectively, p < 0.001). The scores of five of the six dimensions in the extended SEGUE scale significantly increased (p < 0.001), except for the patient's perspective dimension score, which had no change (p = 0.162). With respect to this dimension, a subgroup analysis by gender indicated an increase among females (p < 0.001) and a decrease among males (p < 0.001). The VAS scores, which were evaluated for the SPs and trainees, increased significantly compared to the scores before the program, both immediately after and 1 month after the programme (4.31 ± 1.35 vs. 7.36 ± 1.62 and 7.34 ± 1.24, p < 0.001; 7.31 ± 1.25 vs. 8.39 ± 1.32 and 8.30 ± 1.24, p < 0.001, respectively). The consistency of the VAS between the SPs and surgical residents was 0.26 (p < 0.001), 0.70 (p < 0.001), and 0.70 (p < 0.001) before, immediately after and 1 month after the programme, respectively. CONCLUSION This training programme improved the DPC competency of surgical residents, effectively increased the levels of satisfaction of both SPs and surgical residents, and improved the consistency of evaluation between SPs and surgical residents during doctor-patient encounters. The registration UIN is ChiCTR1800019790 from November 28, 2018.
Collapse
Affiliation(s)
- Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yunzhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Qing Chang
- Department of Graduate Medical Training, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xue Bai
- Department of Graduate Medical Training, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Tong Tong
- Department of Student Affairs Department, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, China.
| |
Collapse
|
2
|
Abstract
BACKGROUND There has been an evolution of various consultation models in the literature. Men affected by prostate cancer can experience a range of unmet supportive care needs. Thus, effective consultations are paramount in the delivery of supportive care to optimize tailored self-management plans at the individual level of need. OBJECTIVE The aim of this study is to critically appraise existing models of consultation and make recommendations for a model of consultation within the scope of clinical practice for prostate cancer care. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines. Electronic databases were searched using a wide range of keywords and free text items to increase the sensitivity and inclusiveness of the searches. Findings were integrated in a narrative synthesis. RESULTS A total of 1829 articles were retrieved and 17 papers were included. Beneficial features ranged across a number of models that included a person-centered consultation, shared management plans, and safety netting. None of the reviewed models of consultation are suitable for use in prostate cancer care because of a range of limitations and the clinical context in which models were developed. A Cancer Care Consultation Model was informed from critical appraisal of the evidence and expert clinical and service user comment. CONCLUSION Further research is needed to empirically test consultation models in routine clinical practice, specifically for advanced cancer specialist nurses. IMPLICATIONS FOR PRACTICE The Prostate Cancer Model of Consultation can be used to structure clinical consultations to target self-management care plans at the individual level of need over the cancer care continuum.
Collapse
|
3
|
Bousquet G, Orri M, Winterman S, Brugière C, Verneuil L, Revah-Levy A. Breaking Bad News in Oncology: A Metasynthesis. J Clin Oncol 2015; 33:2437-43. [DOI: 10.1200/jco.2014.59.6759] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The delivery of bad news by oncologists to their patients is a key moment in the physician-patient relationship. We performed a systematic review of qualitative studies (a metasynthesis) that focused on the experiences and points of view of oncologists about breaking bad news to patients. Methods We searched international publications to identify relevant qualitative research exploring oncologists' perspectives about this topic. Thematic analysis, which compensates for the potential lack of generalizability of the primary studies by their conjoint interpretation, was used to identify key themes and synthesize them. NVivo qualitative analysis software was used. Results We identified 40 articles (> 600 oncologists) from 12 countries and assessed their quality as good according to the Critical Appraisal Skills Programme (CASP). Two main themes emerged: the patient-oncologist encounter during the breaking of bad news, comprising essential aspects of the communication, including the process of dealing with emotions; and external factors shaping the patient-oncologist encounter, composed of factors that influence the announcement beyond the physician-patient relationship: the family, systemic and institutional factors, and cultural factors. Conclusion Breaking bad news is a balancing act that requires oncologists to adapt continually to different factors: their individual relationships with the patient, the patient's family, the institutional and systemic environment, and the cultural milieu. Extending the development of the ability to personalize and adapt therapeutic treatment to this realm of communications would be a major step forward from the stereotyped way that oncologists are currently trained in communication skills.
Collapse
Affiliation(s)
- Guilhem Bousquet
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| | - Massimiliano Orri
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| | - Sabine Winterman
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| | - Charlotte Brugière
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| | - Laurence Verneuil
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| | - Anne Revah-Levy
- Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière
| |
Collapse
|
4
|
Abstract
Objective: In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. Materials and Methods: 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Results: Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease. Conclusions: There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.
Collapse
Affiliation(s)
| | - Triada Exiara
- Department of Internal Medicine, General Hospital of Komotini, Komotini, Greece
| |
Collapse
|
5
|
Aein F, Delaram M. Giving bad news: a qualitative research exploration. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e8197. [PMID: 25068066 PMCID: PMC4102999 DOI: 10.5812/ircmj.8197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 11/18/2013] [Accepted: 02/15/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The manner in which healthcare professionals deliver bad news affects the way it is received, interpreted, understood, and dealt with. Despite the fact that clinicians are responsible for breaking bad news, it has been shown that they lack skills necessary to perform this task. OBJECTIVES The purpose of this study was to explore Iranian mothers' experiences to receive bad news about their children cancer and to summarize suggestions for improving delivering bad news by healthcare providers. MATERIALS AND METHODS A qualitative approach using content analysis was adopted. Semi-structured interviews were conducted with 14 mothers from two pediatric hospitals in Iran. RESULTS Five major categories emerged from the data analysis, including dumping information, shock and upset, emotional work, burden of delivering bad news to the family members, and a room for multidisciplinary approach. CONCLUSIONS Effective communication of healthcare team with mothers is required during breaking bad news. Using multidisciplinary approaches to prevent harmful reactions and providing appropriate support are recommended.
Collapse
Affiliation(s)
- Fereshteh Aein
- Nursing Faculty, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
- Corresponding Author: Fereshteh Aein, Nursing Faculty, Shahrekord University of Medical Sciences, Rahmatieeh, Shahrekord, IR Iran. Tel: +98-9131024581, E-mail:
| | - Masoumeh Delaram
- Nursing Faculty, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
| |
Collapse
|
6
|
El proceso de comunicar y acompañar a los padres y al paciente frente al diagnóstico de discapacidad. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Tang WR, Chen KY, Hsu SH, Juang YY, Chiu SC, Hsiao SC, Fujimori M, Fang CK. Effectiveness of Japanese SHARE model in improving Taiwanese healthcare personnel's preference for cancer truth telling. Psychooncology 2013; 23:259-65. [DOI: 10.1002/pon.3413] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/30/2013] [Accepted: 08/31/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Kuan-Yu Chen
- Department of Psychiatry; Taipei City Hospital; Taipei Taiwan
| | - Sheng-Hui Hsu
- Department of Psychiatry; Koo Foundation Sun Yat-Sen Cancer Center; Taipei Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Shin-Che Chiu
- Department of Radiation Oncology; Mackay Memorial Hospital; Hsinchu Taiwan
| | - Shu-Chun Hsiao
- Cancer Control and promotion division, Bureau of Health Promotion; Department of Health; Taipei Taiwan
| | - Maiko Fujimori
- Psycho-Oncology Division, Research Center for Innovative Oncology; National Cancer Center Hospital East; Chiba Japan
| | - Chun-Kai Fang
- Department of Psychiatry and Suicide Prevention Center; Mackay Memorial Hospital; Taipei Taiwan
- Department of Medicine; Mackay Medical College; New Taipei Taiwan
| |
Collapse
|
8
|
Harnett A, Bettendorf E, Tierney E, Guerin S, O'Rourke M, Hourihane JO. Evidence-based training of health professionals to inform families about disability. Arch Dis Child 2013; 98:413-8. [PMID: 23606710 DOI: 10.1136/archdischild-2012-303037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The development, delivery and evaluation of a training programme for medical and nursing professionals on best practice for informing families of their child's disability. DESIGN A 2 h training course on 'Best practice guidelines for informing families of their child's disability' was designed based on the findings of a nationally representative study of parents and professionals. The classroom-based course comprised a presentation of the research and recommendations of the best practice guidelines; a DVD film of parent stories and professional advice; group discussion; and a half-hour input from a parent of two children with disabilities. An anonymous, pretraining and post-training questionnaire was administered to measure knowledge and confidence levels, using scales adapted from a study by Ferguson et al (2006). PARTICIPANTS 235 participants, including medical students, nursing students, and junior hospital doctors (JHDs). OUTCOME MEASURES Knowledge of best practice and confidence in communicating diagnosis of disability. RESULTS Significant improvements in knowledge (time 1 mean (M)=14.31, SD=2.961; time 2 M=18.17, SD=3.068) and confidence (time 1 M=20.87, SD=5.333; time 2 M=12.43, SD=3.803) following training were found. In addition, a significant interaction between time and cohort (medical students, nurses and JHDs) was found for knowledge. Further examination suggested medical students' knowledge was developing to the extent that post-training, their scores were higher than nurses, but not significantly different to JHDs. CONCLUSIONS The increase in reported levels of knowledge and confidence following training in best practice for informing families of their child's disability indicates the potential for providing communication skills training in this area.
Collapse
Affiliation(s)
- Alison Harnett
- Department of Research, National Federation of Voluntary Bodies Providing Services to People with Intellectual Disability, Oranmore Business Park, Oranmore, Galway, Ireland.
| | | | | | | | | | | |
Collapse
|
9
|
van Weel-Baumgarten EM, Brouwers M, Grosfeld F, Jongen Hermus F, Van Dalen J, Bonke B. Teaching and training in breaking bad news at the Dutch medical schools: a comparison. MEDICAL TEACHER 2012; 34:373-81. [PMID: 22455655 DOI: 10.3109/0142159x.2012.668247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Physicians consider breaking bad news (BBN) a difficult task, and training is therefore necessary. There is much variety in what schools consider to be best practice and best timing for such training. This article discusses BBN-programmes at the Dutch medical schools. We studied how students value their training and offer recommendations. METHODS We developed two questionnaires to obtain programme information from course co-ordinators and student opinions about BBN-training. We compared student opinions right after BBN-training (T1) and towards the end of the medical curriculum (T2). RESULTS BBN-programmes in Dutch medical schools vary in timing, models used and training methods. Overall, students are satisfied with the timing. They appreciate feedback by physicians and simulated patients most. At T2, some groups of students reported that BBN-training had given them slightly less guidance than was reported by T1-students at the same institution. DISCUSSION T2-students perhaps realised they had not received the amount of support they needed and may have shifted from being unconsciously incompetent to being consciously incompetent. RECOMMENDATIONS We recommend: (a) longitudinal programmes with experiential skills-training sessions and clinical practice, (b) to involve simulated patients, physicians and psychologists in training programmes as well as practising physicians who supervise students during clinical work and (c) to ensure ongoing support and feedback in the clinical phase.
Collapse
Affiliation(s)
- E M van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research.
Collapse
Affiliation(s)
- Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
| | | | | |
Collapse
|
11
|
UITTERHOEVE R, BENSING J, GROL R, DEMULDER P, VAN ACHTERBERG T. The effect of communication skills training on patient outcomes in cancer care: a systematic review of the literature. Eur J Cancer Care (Engl) 2009; 19:442-57. [DOI: 10.1111/j.1365-2354.2009.01082.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Tapajós R. A comunicação de notícias ruins e a pragmática da comunicação humana: o uso do cinema em atividades de ensino/aprendizagem na educação médica. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2007. [DOI: 10.1590/s1414-32832007000100017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atividades de ensino-aprendizagem no campo da Competência Comunicacional (tais como aquelas que dizem respeito à comunicação de notícias ruins para pacientes) podem usar as Artes Cinemáticas e ser informadas por um corpo de princípios teóricos derivados da Teoria Comunicacional (que estuda a comunicação humana nos seus aspectos sintáticos, semânticos e pragmáticos). Tópicos na sintática da comunicação de notícias ruins incluem o uso de eufemismos médicos e linguagens não-verbais. A semântica das notícias ruins foca naquilo que está sendo comunicado, e não em como está sendo comunicado. Aspectos pragmáticos são discutidos aqui com mais detalhes e envolvem a desqualificação e os discursos médicos desqualificadores.
Collapse
|
13
|
|
14
|
Wakefield A, Cocksedge S, Boggis C. Breaking bad news: qualitative evaluation of an interprofessional learning opportunity. MEDICAL TEACHER 2006; 28:53-8. [PMID: 16627325 DOI: 10.1080/01421590500312805] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper analyses the effects of bringing together a small group of nursing and medical students to learn the skills needed to break bad news to patients. It outlines the qualitative and quantitative methods used, to provide the reader with a comprehensive account of the teaching, learning and research strategies drawn on during the study. The paper examines the evaluation phase, as this aspect is of greatest import if such initiatives are to flourish. The facet of the study analysed in detail concerns the students' responses to the open-ended qualitative questionnaires. In coding the data, three researchers independently highlighted a series of themes associated with the benefits and hazards of nursing and medical students learning and working together. Finally, the paper closes by arguing that trust and mutual respect are vital ingredients if collaborative working is to become part of the medical and nursing curriculum.
Collapse
Affiliation(s)
- Ann Wakefield
- School of Nursing Midwifery and Health Visiting, University of Manchester, South Manchester, UK.
| | | | | |
Collapse
|
15
|
Bragard I, Razavi D, Marchal S, Merckaert I, Delvaux N, Libert Y, Reynaert C, Boniver J, Klastersky J, Scalliet P, Etienne AM. Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum. Support Care Cancer 2006; 14:454-61. [PMID: 16418828 DOI: 10.1007/s00520-005-0008-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 11/29/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ineffective physicians' communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians' key communication skills, contributing to improvements in patients' satisfaction with care and physicians' professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients. CURRICULUM DESCRIPTION The 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians' knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice. CONCLUSIONS The BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.
Collapse
Affiliation(s)
- Isabelle Bragard
- Faculté des Sciences Psychologiques et de l'Education, Université de Liège, Belgium
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Schildmann J, Cushing A, Doyal L, Vollmann J. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med 2005; 19:93-8. [PMID: 15810746 DOI: 10.1191/0269216305pm996oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To obtain information regarding the involvement of pre-registration house officers (PRHOs) in the discussions on bad news, and the competency and difficulties they perceive in clinical practice. DESIGN Structured telephone interviews. PARTICIPANTS 104 PRHOs. MAIN OUTCOME MEASURES Information about frequency and quality of involvement of PRHOs in discussions on bad news with patients and relatives, perceived competency and difficulties related to this task as well as ethical views concerning the disclosure of bad news. RESULTS 82 PRHOs (78.9%) had initiated the breaking of bad news to a patient at least once, whilst patients themselves had initiated discussions of bad news by asking the doctors questions (92.3%). Almost all (96.2%), indicated that they had broken bad news to relatives of a patient. The majority of the junior doctors participating in our study felt fairly or very confident (90.4%) to break bad news. 'Often' quoted difficulties for over a fifth of the sample included 'Thinking I was not the appropriate person to discuss the bad news', 'Having all the relevant information available', 'Dealing with emotions of patient/relative', 'Lack of privacy' and 'Patients/relatives do not speak English'. Although 99 PRHOs (95.2%) believed that patients should be informed about a serious life threatening illness, 30.8% of the participants stated that doctors need to judge whether or not to tell a patient bad news. Factors most frequently selected by the PRHOs from a given list of possible factors contributing to a gap between theory and practice included problems with the organization of clinics (73.1%), insufficient postgraduate training (63.5%) and lack of staff (54.8%). CONCLUSIONS The results indicate that PRHOs are frequently involved in the breaking of bad news. Whilst no claims can be made for their,actual performance in practice, their perceptions of competency would indicate that the extensive and compulsory undergraduate teaching they had received on this subject has served to prepare them for this difficult task. Organizational and structural aspects need to be taken into account as factors assisting or undermining doctors in their efforts to put into practice ethically sound and skilled communication when disclosing bad news.
Collapse
Affiliation(s)
- Jan Schildmann
- Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen.
| | | | | | | |
Collapse
|