Die Ausbildung kommunikativer Fähigkeiten in der Medizin - Eine Übersicht empirischer Studien zum Thema „Wahrheit am Krankenbett - schlechte Nachrichten mitteilen” -

Improving end-of-life care in hospitals: a qualitative analysis of bereaved families' experiences and suggestions

OBJECTIVES

To explore and document the experiences and expectancies of bereaved family members concerning the end-of-life (EOL) care of their deceased relative in a general hospital setting.

METHODS

Cross-sectional study using a questionnaire that included open-ended questions. Free-text answers were evaluated with qualitative content analysis. A total of 270 family members provided information about improvements in inpatient care.

RESULTS

Families described structural deficiencies. Furthermore, they requested a more holistic patient health care beyond medical treatment and expressed the wish for more professional support for families.

DISCUSSION

The view of bereaved families confirmed the need for improvement in general hospital EOL care. The results underline the importance of a more holistic EOL care. The application of communication skills training, structured family meetings, and integrated pathways is recommended.

Teaching and evaluating breaking bad news: a pre-post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters

OBJECTIVE

To investigate changes of different domains of breaking bad news (bbn) competences after a teaching module for medical students, and to collage the results generated by different approaches of evaluation.

METHODS

Rating of medical student-SP interactions by means of a global rating scale and a detailed checklist used by SPs and independent raters.

RESULTS

Students improved their breaking bad news competency. However, the changes vary between the different domains of bbn competency. In addition, results generated by different evaluation instruments differ.

CONCLUSION

This study serves as a stimulus for further research on the training of specific elements of bbn and different approaches of evaluating bbn competency.

PRACTICE IMPLICATIONS

In light of the different facets of bbn competency, it is important to set priorities regarding the teaching aims and to provide a consistent approach.

[The "bad news consultation assessment scale" (Aufklärungsgesprächbewertungsskala, AGBS): a tool for assessing communication competencies when breaking bad news to cancer patients]

INTRODUCTION

In German-speaking countries "breaking bad news" courses are increasingly included in the medical undergraduate curriculum. In this paper we present an instrument (Aufklärungsgesprächbewertungsskala, AGBS) for the evaluation of communication competencies in the context of disclosing the diagnosis of cancer to patients as well as the results of the reliability analysis for this instrument.

METHODS

Following a systematic literature review we selected the "breaking bad news assessment schedule" (BAS) as a model for developing the AGBS. The checklist was translated into German and modified. Following the use of the instrument in a teaching module for 4th year medical students Cronbach's alpha was calculated for the estimation of internal consistency, the intraclass coefficient (ICC) was used for the estimation of interrater reliability.

RESULTS

58 videotaped interactions between students and simulated patients were used for reliability analysis. The AGBS shows good values with respect to internal consistency (Cronbach's alpha 0.88) and overall interrater reliability (ICC 0.86). Further analysis indicates that the values for interrater reliability differ depending on the communication competencies evaluated when using the AGBS.

CONCLUSION

The AGBS is a reliable instrument which may be used in medical undergraduate courses to evaluate student-simulated patient interaction during the disclosure of cancer diagnosis. The varying values for the interrater reliability in the different parts of the AGBS may serve as a basis for the further development of instruments for the evaluation of communication skills.

Breaking bad news: evaluation study on self-perceived competences and views of medical and nursing students taking part in a collaborative workshop

GOALS OF THE WORK

To identify possible effects of an interprofessional breaking bad news course for medical and nursing students on perceived key communication skills and to elicit the views of participants on interprofessional aspects of breaking bad news.

PARTICIPANTS AND METHODS

Medical and nursing students attending an optional course on breaking bad news received a structured questionnaire on self-perceived communication skills and views on interprofessional aspects at the beginning and end of the course.

MAIN RESULTS

Forty-seven out of 54 students completed the evaluation questionnaires (response rate=87%). Medical students and nursing students rated their key communication skills after the course as significantly better compared with the beginning of the course. Medical students and nursing students disagreed with the statement that a course format for only one of the professional groups would have been more effective than the interprofessional course concept.

CONCLUSIONS

Students valued the concept of the interprofessional course positively. The improvement of self-perceived communication skills may be interpreted as a positive effect of the teaching session. Further research is necessary to develop strategies to implement a collaborative approach in breaking bad news in clinical practice.

Breaking bad news: experiences, views and difficulties of pre-registration house officers

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.