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Mohd Desa SNF, Doss JG, Kadir K, Ch'ng LL, Kok TC, Jelon MA, Yahya MR, Parumo R, Chong SMY, Shim CK. An insight into clinicians' practices in breaking bad news of oral cancer diagnosis. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00059-6. [PMID: 38637182 DOI: 10.1016/j.ijom.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia. An exploratory sequential mixed-methods study design was used. A qualitative study was conducted among 12 clinicians to gather relevant information regarding their practices in BBN of oral cancer diagnosis using a descriptive-interpretive approach. The themes that emerged were preparation for BBN, BBN setting, communication, emotional aspects, and summarizing the session. These themes were used to develop a questionnaire with 34 items. In the quantitative study, this questionnaire was sent to 87 clinicians who had experienced BBN of oral cancer diagnosis in the past 5 years; the response rate was 100%. An arbitrary cut-off score between the third and fourth quartiles was set to distinguish 'good' and 'poor' practice in BBN among the clinicians. The data analysis was performed using IBM SPSS Statistics version 23.0. Overall, at least two-thirds of the clinicians had good practices in BBN of oral cancer diagnosis. The clinicians' designation (oral and maxillofacial surgery consultant/specialist vs dental officer) and BBN experiences were factors associated with their practices in BBN of oral cancer diagnosis.
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Affiliation(s)
- S N F Mohd Desa
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Periodontology and Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - J G Doss
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia; Oral Cancer Research and Coordinating Centre (OCRCC), Universiti Malaya, Kuala Lumpur, Malaysia.
| | - K Kadir
- Oral Cancer Research and Coordinating Centre (OCRCC), Universiti Malaya, Kuala Lumpur, Malaysia; Department of Oral and Maxillofacial and Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - L L Ch'ng
- Oral and Maxillofacial Surgery Department, Hospital Seberang Jaya, Seberang Jaya, Perai, Pulau Pinang, Malaysia
| | - T C Kok
- Oral and Maxillofacial Surgery Department, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - M A Jelon
- Oral and Maxillofacial Surgery Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - M R Yahya
- Oral and Maxillofacial Surgery Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - R Parumo
- Oral and Maxillofacial Surgery Department, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - S M Y Chong
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
| | - C K Shim
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
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Qutob AF. The Need for Protocol-Based Training in Delivering Bad News in Dentistry: A Cross-Sectional Survey Among Dental Professionals in Jeddah, Saudi Arabia. Cureus 2024; 16:e52218. [PMID: 38264178 PMCID: PMC10804172 DOI: 10.7759/cureus.52218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
AIM This study aimed to explore the awareness and utilization of protocols (e.g., the SPIKES protocol) for delivering bad news among dental professionals and the perceived need for such training. METHODS This study employed a cross-sectional design. A web-based self-administered questionnaire was distributed among dental students, general dentists, and dental specialists/consultants in Jeddah City through social media groups. The questionnaire included questions regarding the knowledge, attitudes, and practices of delivering bad news in dentistry and the use of the SPIKES protocol. Descriptive statistics and bivariate and multivariate analyses were performed to determine the research objectives. RESULTS Two hundred and twelve participants responded to the questionnaire, with an almost equal distribution between genders. Specialists/consultants and dental students comprised 87.8% of the respondents. Most respondents (70%) were unaware of any protocols for delivering bad news, and approximately 89% were unaware of the SPIKES protocol. Only 7% reported using the SPIKES protocol to deliver bad news. The bivariate analysis revealed two significant associations. The first association indicated a variation in awareness based on professional status, and the second suggested that experience in delivering bad news affected perceptions of the importance of protocol-based training. Logistic regression models revealed that specialist/consultant status was significantly associated with decreased awareness of protocols (OR = 0.287, 95% CI 0.091-0.903) as compared to general dentists and that other variables, including sex and experience in delivering bad news, did not indicate a statistically significant effect. CONCLUSION Most dentists in Jeddah reported the need to be familiar with and practice delivering bad news in dentistry. They agreed that it would improve patients' acceptance of bad news if it were performed in a systematic and organized manner (e.g., the SPIKES protocol).
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Affiliation(s)
- Akram F Qutob
- Dental Public Health/Pediatric Dentistry, King Abdulaziz University, Jeddah, SAU
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Mansoursamaei M, Ghanbari Jolfaei A, Zandi M, Mansoursamaei A, Salehian R. Self-assessment of residents in breaking bad news; skills and barriers. BMC MEDICAL EDUCATION 2023; 23:740. [PMID: 37803375 PMCID: PMC10559449 DOI: 10.1186/s12909-023-04720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difficult professional tasks of physicians. The main aims of this study are to evaluate residents' practice of BBN and identify perceived barriers to its implementation. METHODS In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. RESULTS 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient's emotions during BBN as good or very good, respectively. The most difficult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient's emotions (61%) and the aggressiveness of the patient or companions (52.6%). A significant proportion of participants identified lack of training (28%) and insufficient skills (21.9%) as significant barriers to BBN. CONCLUSIONS The skill of residents in BBN is insufficient in some aspects and points to the need for BBN training courses during residency. BBN is difficult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents' confidence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended.
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Affiliation(s)
- Maryam Mansoursamaei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, 19857-17443 Tehran, Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
| | - Mehdi Zandi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
| | - Ali Mansoursamaei
- Student Research Committee, School of Medicine, Shahroud University of Medical Science, 36147-73943 Shahroud, Iran
| | - Razieh Salehian
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
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Al Zomia AS, AlHefdhi HA, Alqarni AM, Aljohani AK, Alshahrani YS, Alnahdi WA, Algahtany AM, Youssef N, Ghazy RM, Alqahtani AA, Deajim MA. Examining Saudi Physicians' Approaches to Communicate Bad News and Bridging Generational Gaps. Healthcare (Basel) 2023; 11:2528. [PMID: 37761725 PMCID: PMC10531216 DOI: 10.3390/healthcare11182528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Breaking bad news is an intrinsic aspect of physicians' clinical practices. This study aims to investigate how Saudi physicians manage the process of communicating bad news and explore potential differences in breaking bad news practices between young physicians (interns) and their older colleagues. From 1 March to 15 April 2023, ok an anonymous online cross-sectional survey was conducted to explore the communication practices of Saudi physicians concerning breaking bad news using the Communicating Bad News Questionnaire. The physicians were recruited through convenience and snowball sampling methods, and the survey questionnaire was distributed on various social media platforms, including Facebook, Twitter, LinkedIn, and WhatsApp. Data were analyzed using R version 4.2.1. A total of 782 physicians were included in this study. Male physicians represented 50.9% of the participants. Three-quarters (74.7%) were aged 25-30 years. The largest proportion of physicians (45.3%) were interns, followed by junior residents (22.9%), senior residents (11.0%), and specialists (6.5%). The median years of experience was 1.0, ranging from 0 to 45 years. Regarding the place of work, most physicians (86.6%) worked in hospitals, while 13.4% worked in primary healthcare centers. A total of 14.8% said they were not comfortable with discussing patients'/relatives' issues (20.60 among interns vs. 10.50% among non-interns, χ2 = 27.50, p = 0.0001), 66.6% reported being trained to break bad news (59.60% among interns vs. 72.40% among non-interns, χ2 = 14.34, p = 0.001), 59.1% reported breaking bad news to the patient, 37.9% reported to the family, and 3.1% reported to both, with no significant difference between interns and non-interns. A substantial proportion of physicians reported feeling uncomfortable discussing sensitive issues with patients and their relatives despite having received training to deliver bad news and being willing to communicate bad news directly to patients. Notably, our analysis identified a significant disparity between intern and non-intern physicians, particularly in terms of their comfort level in addressing patient-related concerns and access to breaking bad news training.
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Affiliation(s)
- Ahmed Saad Al Zomia
- Faculty of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (Y.S.A.)
| | - Hayfa A. AlHefdhi
- Department of Family Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | | | | | | | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt;
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Jain V, Ravi A, Thakur V, Mishra A, Dhamor D, Khare S. Breaking bad news: Awareness and practice of the SPIKES protocol among general surgery residents at a tertiary care institute in northern India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:320-322. [PMID: 38759986 DOI: 10.25259/nmji_950_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background In general surgery, a clinician is commonly required to break bad news. However, training in communication is not a part of the formal curriculum either in medical school or in surgical residency and there is a paucity of data on awareness of the SPIKES (Setting up the interview, Perception, Invitation, Knowledge sharing, Emotion, Strategy and Summary) protocol among practising surgeons and residents in India. Methods We did a cross-sectional study in the Department of General Surgery at our institution. Junior residents were invited to take part in a one-on-one interview. Descriptive statistics were used to describe the findings of the study. Comparison for categorical data was done using Fisher exact test or chi-square test (whichever was applicable). Results A total of 82 residents with mean (SD) age of 27 (2.5) years (range 23-37 years) participated in the study. Only 31 (37.8%) had ever received training for breaking bad news, though 80 (97.6%) had broken bad news at least once. Twenty-one (26.3%) participants had a bad experience while breaking bad news. Seventy-seven (93.9%) participants felt the need for training in breaking bad news and 76 of them were willing to attend the same. Although the complete SPIKES protocol was followed only by 25 (31.3%) residents, 46 (56.1%) felt that it was practically possible to follow the SPIKES protocol. Conclusion Resident doctors in general surgery face situations of breaking bad news and adherence to the SPIKES protocol is poor. Formal training at every level may enhance their communication skills and enable better healthcare delivery.
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Affiliation(s)
- Vibhu Jain
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Ashwitha Ravi
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vipul Thakur
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Aniket Mishra
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Devesh Dhamor
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Siddhant Khare
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Alwhaibi A, Alenazi M, Almadi B, Aljabali N, Alkhalifah S, Syed W, Alsaif R, Bablghaith SD, Al-Arifi MN. The Impact of Cancer Relapse and Poor Patient Outcomes on Health Care Providers Practicing in the Oncology Field. Cancer Control 2023; 30:10732748231170930. [PMID: 37122065 PMCID: PMC10134170 DOI: 10.1177/10732748231170930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Devastating cancer-related events are not uncommon, and these events have weakened communication performance and induced stress among health care providers (HCPs), particularly physicians. This study aimed to investigate the perspective of HCPs emotionally affected by poor clinical outcomes due to the failure of cancer therapy. METHODS A cross-sectional, online survey was conducted over 3 months among HCPs practicing in the field of oncology in Saudi Arabia, comprising physicians, pharmacists, and nurses. Data were analyzed using Statistical Package for Social Sciences version 26.0. A P-value <.05 was considered statistically significant. RESULTS This study demonstrated a positive correlation between HCPs' length of experience and emotional impact of treatment failure, albeit this was not statistically significant (P = .071). Analysis of their perspective toward failure of cancer therapies revealed a significant impact of occupation and sex (P = .014 and P = .047, respectively). Moreover, occupation played a significant role in shaping the viewpoint of HCPs toward the need for conducing further research to test the appropriateness of treatment protocols on local patients (P = .022). Despite the emotional responses of HCPs to suboptimal clinical outcomes, factors such as work burnout, lack of concentration and patience, work or personal problems, and under appreciation were frequently identified as triggers of such outcomes. CONCLUSION Our results revealed that poor clinical outcomes observed among cancer patients are emotional triggers for HCPs practicing in the oncology field. The emotional response is often perceived negatively, and can potentially lead to a decline in the quality of care provided to these patients.
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Affiliation(s)
| | - Miteb Alenazi
- Pharmacy Department, Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
| | - Bana Almadi
- Intern at the Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nora Aljabali
- Intern at the Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sahar Alkhalifah
- Pharmacy Department, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Wajid Syed
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Reem Alsaif
- Pharmacy Department,, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Fisseha H, Mulugeta W, Kassu RA, Geleta T, Desalegn H. Perspectives of Protocol Based Breaking Bad News among Medical Patients and Physicians in a Teaching Hospital, Ethiopia. Ethiop J Health Sci 2021; 30:1017-1026. [PMID: 33883848 PMCID: PMC8047232 DOI: 10.4314/ejhs.v30i6.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Discussing potentially bad outcomes is a standard communication task in clinical care. Physicians' awareness on ways to communicate bad news is considered low. SPIKES protocol is the most popular strategy used by physicians, but its practice and patients' perception are not known. This study attempted to fill the knowledge gap on protocol implementation, patient preference and physician effects. Methods Hospital-based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 using structured interviews administered to patients and physicians. Three hundred and sixty patients and 111 physicians were included. Assessment of SPIKES performance, patient satisfaction, patient preference, and physician awareness, attitude and effects were studied. Results Performance of SPIKES protocol was setting (74.5%), perception (51.1%), invitation (56.3%), knowledge (15.9%), emotion (22.3%) and summary (10.1%). Only 30.6% of the patients were entirely satisfied with the interaction, and 19.2% with knowledge attained. Patient satisfaction was associated with physician asking how much information they like (P=0.025). Patient desire and report showed variation. Eighty-two percent of the physicians were not aware of the protocol, and 83.8% had no training. Half of the physicians feel depressed after disclosure. Conclusions Patient satisfaction with communication process and knowledge is poor, as is performance of SPIKES components. Satisfaction is related to being asked how much patients want to know. Patients' desires on how to be told news is different from how it is done. Breaking bad news increases feeling of depression. Awareness and training on the protocol are deficient; medical schools should incorporate it into their studies and implement proper follow-up.
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Affiliation(s)
- Henok Fisseha
- Department of Internal medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wudneh Mulugeta
- Harvard Medical School, Department of Medicine-Cambridge Health Alliance
| | - Rodas A Kassu
- Department of Neurosurgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Temesgen Geleta
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hailemichael Desalegn
- Department of Internal medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Sharma K, Shah J, Talib Z, Ali S. Delivery of Difficult News Among Residents at a Tertiary Hospital In Kenya Using a Short Training Video (UNMASKES). MEDEDPUBLISH 2021; 10:122. [PMID: 38486582 PMCID: PMC10939531 DOI: 10.15694/mep.2021.000122.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background Delivery of difficult news (DDN) remains a challenging task for even the most experienced of providers. Little has been studied about delivery of difficult news among resident physicians in sub-Saharan Africa (SSA). We developed a 4-minute, graphic video using the acronym UNMASKES to help improve delivery of difficult news between resident physicians and their patients. Objective To determine the impact of the UNMASKES training video in improving resident communication when delivering difficult news. Methods We conducted a prospective study amongst all residents at the Aga Khan University hospital in Nairobi, Kenya and Dar es Salaam, Tanzania from February to September, 2019. After completing a pretest survey, residents received a one-hour comprehensive training on delivery of difficult news using UNMASKES. A link to the UNMASKES video was provided to the residents for real-time reference. Post-test surveys were completed at 4 and 12 weeks respectively. Results A total of 102 (68%) residents completed the surveys. At 12 weeks, we found that residents improved in 6 key areas; notified their patients before delivering difficult news, ensured a private and quiet room, provided information in small amounts to patients and family members, provided a summary after delivery of difficult news, followed up with patients at 24-48 hours after delivering difficult news, and felt better prepared to deal with patient and family emotions when delivering difficult news. Conclusions UNMASKES, a 4-minutes, easily accessible, graphic video showed promising results in training our residents to foster effective communication while delivering difficult news to their patients.
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Dafallah MA, Ragab EA, Salih MH, Osman WN, Mohammed RO, Osman M, Taha MH, Ahmed MH. Breaking bad news: Awareness and practice among Sudanese doctors. AIMS Public Health 2020; 7:758-768. [PMID: 33294479 PMCID: PMC7719559 DOI: 10.3934/publichealth.2020058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background Breaking bad news is an important task for doctors in different specialties. The aim of the study was to assess adherence of Sudanese doctors to the SPIKES protocol in breaking bad news. Methods A descriptive cross-sectional study recruited 192 doctors, at Wad Medani teaching hospital, Sudan. A questionnaire-based on SPIKES protocol was distributed among 10 departments in our hospital. Data were analyzed using SPSS and Microsoft excel. Results There were (n = 101, 52.6%) females and (n = 91, 47.4%) males among the participants. 95.3% have been involved in breaking bad news, but only 56.3 received education and training about this issue. 43% admitted bad experience in breaking bad news, while 65.6% mentioned that bad news should be delivered directly to patients. The majority (>90%) agreed training is needed in the area of breaking bad news. Usual adherence to the SPIKES protocol was reported in a range of 35–79%, sometimes adherence was reported in a range of 20–44% while never adherence was reported in a range of zero–13.5%. Consultants, registrars, obstetrician and gynecologists and surgeons achieved high scores in breaking bad news. Training is an important factor in achieving high score in SPIKES protocol. The unadjusted effect of background factors on SPIKES score, showed that only training has significant impact on protocol adherence (P = 0.034, unadjusted; and P = 0.038 adjusted). Conclusion Large number of Sudanese doctors will try to adhere to SPIKES protocol. Training is an important factor in the success of breaking bad news.
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Affiliation(s)
| | | | | | | | | | - Mugtaba Osman
- Armed Forces Centre for Psychiatric Care, Taif, Saudi Arabia
| | - Mohamed H Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, UK
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Portes M, Mousty E, Grosjean F, Lamouroux A, Faure JM, Fuchs F, Letouzey V. [Training simulation during the announcement of fetal malformation discovered on screening ultrasound: Results of a pilot study]. ACTA ACUST UNITED AC 2020; 49:122-127. [PMID: 32919088 DOI: 10.1016/j.gofs.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Breaking bad news (BBN) to a pregnant woman with fetal abnormalities (FA) on ultrasound (US) examination is a challenge. Announcement technique influences patient reaction. Physicians receive little training in BBN. The simulation and using a BBN protocol as the English SPIKES protocol which guides the announcement consultation according to 6 steps (Setting Up, Perception, Invitation, Knowledge, Emotions and Empathy, Strategy and Summary) can be used for this teaching. The objective was to assess feasibility simulation scenarii of BBN for FA discovered during US and to evaluate the usefulness of SPIKES protocol in this situation. METHODS Two scenarios have been created combining US simulator (US Mentor, Symbionix®) with simulated patient (SP). Scenarii objectives were to diagnose FA and break it to SP. Checklist derived from SPIKES was fulfilled by two investigators thanks to video recording, the SP and every participant (residents, physicians, fetal medicine specialists [FMS]). Participants filled out survey about the usefulness of this exercise too. RESULTS Nine physicians (3 residents, 4 physicians, 2 FMS) produced 18 scenarii. Seventy-eight percent of physicians thought simulation was like real situation of BBN during US examination. Majority of participant (88%) found that this simulation training could help them to increase their ability to BBN and that it can be used to teach residents (89%) or physicians (100%). FMS had better SPIKES checklist than physicians (P<0,05). CONCLUSION Simulation scenario of BBN for FA discovered during US is feasible by combining US simulator and SP. SPIKES protocol can be useful but a validated checklist should be created.
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Affiliation(s)
- M Portes
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France.
| | - E Mousty
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - F Grosjean
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - A Lamouroux
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - J M Faure
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - F Fuchs
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - V Letouzey
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
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Yi J, Kim MA, Choi KH, Bradbury L. Oncologists' Experience of Delivering Bad News in Korea. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:285-302. [PMID: 32698675 DOI: 10.1177/0030222820944087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored oncologists' experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists' perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient-physician relationships in communication of bad news.
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Affiliation(s)
- Jaehee Yi
- College of Social Work, University of Utah, Salt Lake City, USA
| | - Min Ah Kim
- Department of Social Welfare, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kwon Ho Choi
- School of Social Welfare, Kyungpook National University, Daegu, Republic of Korea
| | - Laura Bradbury
- College of Social Work, University of Utah, Salt Lake City, USA
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Jackson L, Cichon M, Kleinert H, Trepanier A. Teaching medical students how to deliver diagnoses of Down syndrome: Utility of an educational tool. PATIENT EDUCATION AND COUNSELING 2020; 103:617-625. [PMID: 31669046 DOI: 10.1016/j.pec.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study assessed whether using an educational tool increased the knowledge and perceived comfort level of first-year medical students in giving a diagnosis of Down syndrome. METHOD A total of 295 students taking a genetics course completed a knowledge questionnaire and Situations Inventory (aimed at assessing comfort with sharing certain information), prior to and following use of Brighter Tomorrows, a web-based educational module on giving parents a diagnosis of Down syndrome. RESULTS The pre-intervention mean on the knowledge survey was 3.67, which significantly increased to 5.47 following the intervention. Mean Situational Inventory scores were significantly higher pre-intervention (M = 45.5), which indicates greater discomfort, compared to post-intervention (M = 36.7). Qualitative analysis of responses regarding lessons learned fell into 5 major themes. The most common theme (48% of responses) was related to communication skills. The most frequently cited lesson learned was the importance of demonstrating empathy. CONCLUSIONS This study found that knowledge and perceived comfort levels of first-year medical students in giving a postnatal diagnosis of Down syndrome were significantly increased following use of an educational tool. PRACTICE IMPLICATIONS Educational modules can provide medical students with foundational knowledge on providing distressing information to help prepare for future clinical encounters.
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Affiliation(s)
- Lauren Jackson
- Cytogenetics, Beaumont Hospital, Dearborn, Dearborn, MI, United States.
| | - Michelle Cichon
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
| | - Harold Kleinert
- The Human Development Institute, University of Kentucky, Lexington, KY, United States
| | - Angela Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
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Sharma K, Shah J, Ali SK. Delivering Difficult News in a Tertiary Hospital in Sub-Saharan Africa-A Consensus Study Among Residents. J Pain Symptom Manage 2019; 58:e1-e4. [PMID: 31415802 DOI: 10.1016/j.jpainsymman.2019.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022]
Affiliation(s)
| | | | - Sayed K Ali
- Palliative Care, Aga Khan University, Nairobi, Kenya.
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Dahn H, Watts K, Best L, Bowes D. Transition to practice: creation of a transitional rotation for radiation oncology. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e89-e96. [PMID: 30140351 PMCID: PMC6104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Implementation of Competence by Design (CBD) will require residency training programs to develop formalized "Transition to Practice" (TTP) experiences. A multidisciplinary group of Radiation Oncology stakeholders from tertiary care centres in Atlantic Canada were surveyed regarding a proposed TTP rotation. METHODS The survey asked participants to quantitatively rank various learning objectives based on defined CanMEDS skills that are expected to be mastered by a graduating resident. Mean perceived importance scores were calculated for each objective as well as for their CanMEDS category. Specific written qualitative feedback was also collected. RESULTS The survey was circulated to 59 participants with a response rate of 73%. The three objectives with the highest mean importance score were "Independently assessing and managing patients seen in consultation," "Developing and demonstrating communication skills with patients at an advanced level," and "Independently assessing and managing follow up patients," respectively from highest to lowest. The CanMEDS roles with the highest importance score was "Communicator." CONCLUSION Quantitative and qualitative data from a multidisciplinary survey based on CanMEDS roles guided the implementation of a TTP rotation for PGY-5 residents at a tertiary care centre in Atlantic Canada. These results may be relevant to other training programs developing TTP experiences.
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Affiliation(s)
- Hannah Dahn
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - Karen Watts
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - Lara Best
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
| | - David Bowes
- Department of Radiology Oncology, Dalhousie University, Nova Scotia, Canada
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Gold R, Gold A. Delivering Bad News: Attitudes, Feelings, and Practice Characteristics Among Speech-Language Pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:108-122. [PMID: 29242920 DOI: 10.1044/2017_ajslp-17-0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/04/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to examine the attitudes, feelings, and practice characteristics of speech-language pathologists (SLPs) in Israel regarding the subject of delivering bad news. METHOD One hundred and seventy-three Israeli SLPs answered an online survey. Respondents represented SLPs in Israel in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed emotions involved in the process of delivering bad news, training on this subject, and background information of the respondents. Frequency distributions of the responses of the participants were determined, and Pearson correlations were computed to determine the relation between years of occupational experience and the following variables: frequency of delivering bad news, opinions regarding training, and emotions experienced during the process of bad news delivery. RESULTS Our survey showed that bad news delivery is a task that most participants are confronted with from the very beginning of their careers. Participants regarded training in the subject of delivering bad news as important but, at the same time, reported receiving relatively little training on this subject. In addition, our survey showed that negative emotions are involved in the process of delivering bad news. CONCLUSIONS Training SLPs on specific techniques is required for successfully delivering bad news. The emotional burden associated with breaking bad news in the field of speech-language pathology should be noticed and addressed.
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Affiliation(s)
- Rinat Gold
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Azgad Gold
- Psychiatry, Law and Ethics Unit, Beer Yaakov Mental Health Center, Israel
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Burns R, Mangold K, Adler M, Trainor J. Pediatric Boot Camp Series: Obtaining a Consult, Discussing Difficult News. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10437. [PMID: 31008216 PMCID: PMC6464432 DOI: 10.15766/mep_2374-8265.10437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Transitioning from medical student to intern requires individuals to possess medical knowledge, clinical skills, and the ability to communicate with a wide variety of health care professional as well as patients and their families. New doctors may be expected to function within the health care team without having received explicit instruction in communication previously. The materials associated with this publication are intended to be used as resources for small-group education of graduating medical students entering into pediatric, family medicine, or emergency medicine residencies. METHODS Four pediatric cases serve as the focus points for discussion and role-play around calling consultants and discussing difficult news with families and patients. Brief didactics and detailed facilitator notes help prime learning and guide discussion. The included facilitator notes and slide sets are part of the comprehensive materials necessary to implement this 4-hour course at your own institution. RESULTS This curriculum has been used since 2012 with graduating medical students entering into pediatric, family medicine, and emergency medicine residencies at two institutions within the United States. Feedback has been overwhelmingly positive, and students have reported increased confidence in their ability to communicate with families and other health care providers. DISCUSSION This publication is the second part of a two-part curriculum but may be used independently of the first part. Although the cases are based on pediatrics, the content regarding communication is universal to many medical specialties.
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Affiliation(s)
- Rebekah Burns
- Assistant Professor in Pediatrics, University of Washington School of Medicine
- Attending Physician, Division of Emergency Medicine, Seattle Children's Hospital
- Corresponding author:
| | - Karen Mangold
- Assistant Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Attending Physician, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Mark Adler
- Attending Physician, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
- Associate Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Director of Educational Research and Innovation, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Jennifer Trainor
- Associate Professor in Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine
- Associate Chair for Education, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago
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