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O'Connell C, Kavanaugh MS, Cummings C, Genge A. How to break the news in amyotrophic lateral sclerosis/motor neuron disease: practical guidelines from experts. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-10. [PMID: 39258740 DOI: 10.1080/21678421.2024.2397517] [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: 04/04/2024] [Revised: 07/29/2024] [Accepted: 08/17/2024] [Indexed: 09/12/2024]
Abstract
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.
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Affiliation(s)
- Colleen O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada
- Physical Medicine & Rehabilitation, Dalhousie University, Faculty of Medicine, Fredericton, Canada
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Cathy Cummings
- International Alliance of ALS/MND Associations (Northampton, England), Coldwater, Canada
| | - Angela Genge
- Clinical Research Unit, Montreal Neurological Institute, Montreal, Canada, and
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Yousuf AAAA, Stewart DC, Kane T, Soltani A, Al-Khal A, Sethi A. Health professionals' views and experiences of breaking bad news in the Eastern Mediterranean Region: a scoping review. Front Med (Lausanne) 2024; 11:1440867. [PMID: 39290389 PMCID: PMC11407430 DOI: 10.3389/fmed.2024.1440867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
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.
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Affiliation(s)
| | | | - Tanya Kane
- QU Health, Qatar University, Doha, Qatar
| | | | - Abdullatif Al-Khal
- QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
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Al Kindi R, Al Mamari H, Al Salmani A, Al Hadhrami R, Al Zaabi A. 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. Sultan Qaboos Univ Med J 2024; 24:345-353. [PMID: 39234322 PMCID: PMC11370943 DOI: 10.18295/squmj.3.2024.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 09/06/2024] Open
Abstract
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.
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Affiliation(s)
- Rahma Al Kindi
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman
| | - Hajar Al Mamari
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asma Al Salmani
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman
| | - Rahma Al Hadhrami
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, University Medical City, Muscat, Oman
| | - Adhari Al Zaabi
- Department of Human & Clinical Anatomy, Sultan Qaboos University, Muscat, Oman
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Haim-Eli L, Benbenishty J, Kienski Woloski Wruble AC. Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses. Nurs Crit Care 2024. [PMID: 39085033 DOI: 10.1111/nicc.13119] [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: 01/14/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024]
Abstract
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.
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Affiliation(s)
- Lilach Haim-Eli
- Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Julie Benbenishty
- Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
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Preti BTB, Sanatani MS. Five ways to get a grip on the personal emotional cost of breaking bad news. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:97-99. [PMID: 39114789 PMCID: PMC11302754 DOI: 10.36834/cmej.78228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Beatrice TB Preti
- Division of Medical Oncology, Western University, Ontario, Canada
- Department of Haematology & Medical Oncology, Emory University, Georgia, USA
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Sharma A, Pappas D, Gonzalez-Heydrich J, Sullivan NR, Nyp SS. Challenging Case: New-Onset Hallucinations and Developmental Regression in a Child with Autism Spectrum Disorder. J Dev Behav Pediatr 2024; 45:e267-e270. [PMID: 38603607 DOI: 10.1097/dbp.0000000000001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
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.
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Affiliation(s)
- Aanchal Sharma
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, MA
| | - Demetra Pappas
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, MA
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nancy R Sullivan
- Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Brookline, MA
| | - Sarah S Nyp
- Department of Pediatrics, Division of Developmental and Behavioral Health, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO
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Dye ME, Runyan P, Scott TA, Dietrich MS, Hatch LD, France D, Alrifai MW. Small Patients but a Heavy Lift: Workload and Burnout of Advanced Practice Providers and Physicians in a Level IV Neonatal Intensive Care Unit. J Perinat Neonatal Nurs 2024; 38:192-200. [PMID: 38758274 PMCID: PMC11104510 DOI: 10.1097/jpn.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
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.
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Affiliation(s)
- M. Eva Dye
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
| | - Patti Runyan
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Theresa A. Scott
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Mary S. Dietrich
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
- School of Nursing, Vanderbilt University, Nashville, TN
| | - L Dupree Hatch
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
- Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN
| | - Mhd Wael Alrifai
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Blanchet I, Michel F, Tardieu C, Camoin A. Difficulties experienced by dentists and orthodontists regarding ethical issues when announcing the diagnosis of a rare oral disease: a qualitative study in Marseille, France. Eur Arch Paediatr Dent 2024; 25:169-179. [PMID: 38457081 DOI: 10.1007/s40368-024-00864-z] [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: 05/05/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
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.
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Affiliation(s)
- I Blanchet
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France.
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France.
| | - F Michel
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
| | - C Tardieu
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
| | - A Camoin
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
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Hosseinpour A, Keshmiri F. Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study. BMC Nurs 2024; 23:191. [PMID: 38515072 PMCID: PMC10956303 DOI: 10.1186/s12912-024-01786-3] [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: 06/21/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024] Open
Abstract
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.
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Affiliation(s)
- Azam Hosseinpour
- Department of Operating Room, School of Allied Medical Sciences, Qom University of Medical Sciences, Qom, Iran
| | - Fatemeh Keshmiri
- Medical Education Department, Education Development Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- The National Agency for Strategic Research in Medical Education, Tehran, Iran.
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Fiorellino O, Newman CJ. Physicians' Self-Perceived Competence on Breaking Bad News to Parents of Children with Neurodisabilities. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1854. [PMID: 38136056 PMCID: PMC10741853 DOI: 10.3390/children10121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
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.
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Affiliation(s)
- Ophélie Fiorellino
- Faculty of Science and Medicine, Medicine Section, University of Fribourg, 1700 Fribourg, Switzerland;
| | - Christopher John Newman
- Pediatric Neurology and Neurorehabilitation Unit, Woman Mother Child Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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Piquette D. The Fuzzy Language of Critical Care Clinicians During Goals-of-Care Conversations: (Some Would Say It Is Probably) Time to Address Intentions and Consequences... Crit Care Med 2023; 51:1610-1613. [PMID: 37902349 DOI: 10.1097/ccm.0000000000006008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Bosshard M, Schmitz FM, Guttormsen S, Nater UM, Gomez P, Berendonk C. 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. BMC Psychol 2023; 11:153. [PMID: 37165406 PMCID: PMC10173625 DOI: 10.1186/s40359-023-01167-6] [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: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
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.
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Affiliation(s)
- Michel Bosshard
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | | | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Urs Markus Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform "Stress of life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Patrick Gomez
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health, University of Lausanne, Lausanne, Switzerland
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