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Lackie K, Miller S, Brown M, Mireault A, Helwig M, Beatty L, Picketts L, Stilwell P, Houk S. Interprofessional collaboration between health professional learners when breaking bad news: a scoping review of teaching approaches. JBI Evid Synth 2024; 22:1071-1102. [PMID: 38328948 DOI: 10.11124/jbies-22-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The objective of this scoping review was to examine teaching approaches used to teach interprofessional health professional learners how to break bad news collaboratively. INTRODUCTION When breaking bad news, health professionals must be equipped to deliver it skillfully and collaboratively; however, the literature shows that this skill receives little attention in program curricula. Consequently, health professionals can feel inadequately prepared to deliver bad news, which may lead to increased burnout, distress, and compassion fatigue. INCLUSION CRITERIA Studies that describe teaching approaches used to teach learners how to break bad news collaboratively were considered for inclusion. Studies must have included 2 or more undergraduate and/or postgraduate learners working toward a professional health or social care qualification/degree at a university or college. Studies including lay, complementary and alternative, or non-health/social care learners were excluded. Due to the primary language of the research team, only English articles were included. METHODS The JBI 3-step process was followed for developing the search. Databases searched included MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Education Resource Complete (EBSCOhost), and Social Work Abstracts (EBSCOhost). The initial search was conducted on February 11, 2021, and was updated on May 17, 2022. Title and abstract screening and data extraction were completed by 2 independent reviewers. Disagreements were resolved through discussion or with a third reviewer. Results are presented in tabular or diagrammatic format, together with a narrative summary. RESULTS Thirteen studies were included in the scoping review, with a range of methodologies and designs (pre/post surveys, qualitative, feasibility, mixed methods, cross-sectional, quality improvement, and methodological triangulation). The majority of papers were from the United States (n=8; 61.5%). All but 1 study used simulation-enhanced interprofessional education as the preferred method to teach interprofessional cohorts of learners how to break bad news. The bulk of simulations were face-to-face (n=11; 84.6%). Three studies (23.1%) were reported as high fidelity, while the remainder did not disclose fidelity. All studies that used simulation to teach students how to break bad news utilized simulated participants/patients to portray patients and/or family in the simulations. The academic level of participants varied, with the majority noted as undergraduate (n=7; 53.8%); 3 studies (23.1%) indicated a mix of undergraduate and graduate participants, 2 (15.4%) were graduate only, and 1 (7.7%) was not disclosed. There was a range of health professional programs represented by participants, with medicine and nursing equally in the majority (n=10; 76.9%). CONCLUSIONS Simulation-enhanced interprofessional education was the most reported teaching approach to teach interprofessional cohorts of students how to break bad news collaboratively. Inconsistencies were noted in the language used to describe bad news, use of breaking bad news and interprofessional competency frameworks, and integration of interprofessional education and simulation best practices. Further research should focus on other interprofessional approaches to teaching how to break bad news; how best to incorporate interprofessional competencies into interprofessional breaking bad news education; whether interprofessional education is enhancing collaborative breaking bad news; and whether what is learned about breaking bad news is being retained over the long-term and incorporated into practice. Future simulation-specific research should explore whether and how the Healthcare Simulation Standards of Best Practice are being implemented and whether simulation is resulting in student satisfaction and enhanced learning.
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Affiliation(s)
- Kelly Lackie
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Stephen Miller
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marion Brown
- School of Social Work, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Amy Mireault
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Melissa Helwig
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Lorri Beatty
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leanne Picketts
- Centre for Collaborative Clinical Learning and Research, Dalhousie University, Halifax, NS, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Shauna Houk
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Ricci L, Toussaint Y, Becker J, Najjar H, Renier A, Choukour M, Buisson A, Devos C, Epstein J, Peyrin Biroulet L, Guillemin F. Web-based and machine learning approaches for identification of patient-reported outcomes in inflammatory bowel disease. Dig Liver Dis 2022; 54:483-489. [PMID: 34588153 DOI: 10.1016/j.dld.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Messages from an Internet forum are raw material that emerges in a natural setting (i.e., non-induced by a research situation). AIMS The FLARE-IBD project aimed at using an innovative approach consisting of collecting messages posted by patients in an Internet forum and conducting a machine-learning study (data analysis/language processing) for developing a patient-reported outcome measuring flare in inflammatory bowel disease meeting international requirements. METHODS We used web-based and machine learning approaches, in the following steps. 1) Web-scraping to collect all available posts in an Internet forum (23 656 messages) and extracting metadata from the forum. 2) Twenty patients were randomly assigned 50 extracted messages; participants indicated whether the message corresponded or not to the flare phenomenon (labeling). If yes, participants were asked to identify excerpts from the text they considered significant flare markers (annotation). 3) The set of annotated messages underwent a vocabulary analysis. RESULTS The phenomenon of flare was circumscribed with the identification of 20 surrogate flare markers classified into five dimensions with their frequency within extracted labeled data: impact on life, symptoms, extra-intestinal manifestations, drugs and environmental factors. Web-based and machine-learning approaches met international recommendations to inform the content and structure for the development of patient-reported outcomes.
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Affiliation(s)
- Laetitia Ricci
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, F-54000 Nancy, France.
| | - Yannick Toussaint
- Laboratoire lorrain de recherche en informatique et ses applications, Université de Lorraine, Nancy, France.
| | - Justine Becker
- Ecole des mines de Nancy, Université de Lorraine, Nancy, France.
| | - Hiba Najjar
- Ecole des mines de Nancy, Université de Lorraine, Nancy, France.
| | - Alix Renier
- Ecole des mines de Nancy, Université de Lorraine, Nancy, France.
| | - Myriam Choukour
- INSERM, U1256 NGERE and gastroenterology Department, CHRU-Nancy, Université de Lorraine, Nancy, France.
| | | | | | - Jonathan Epstein
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
| | - Laurent Peyrin Biroulet
- INSERM, U1256 NGERE and gastroenterology Department, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - Francis Guillemin
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
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Ricci L, Villegente J, Loyal D, Ayav C, Kivits J, Rat AC. Tailored patient therapeutic educational interventions: A patient-centred communication model. Health Expect 2021; 25:276-289. [PMID: 34816546 PMCID: PMC8849242 DOI: 10.1111/hex.13377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/02/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022] Open
Abstract
Background Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. Objectives We used a data‐driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. Design Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. Results Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. Conclusion From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. Short Informative Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient‐centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient‐centred communication model for tailoring patient education intervention.
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Affiliation(s)
- Laetitia Ricci
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France
| | - Julie Villegente
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France.,Université de Reims Champagne-Ardenne, Reims, France
| | | | - Carole Ayav
- CHRU-Nancy, INSERM, Université de Lorraine, CIC 1433 Clinical Epidemiology, Nancy, France
| | | | - Anne-Christine Rat
- Université de Lorraine, APEMAC, Nancy, France.,University of Caen Normandie, Caen, France.,Rheumatology Department, University Hospital Center Caen, Caen, France
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Sleiman J, Savage DJ, Switzer B, Colbert CY, Chevalier C, Neuendorf K, Harris D. Teaching residents how to break bad news: piloting a resident-led curriculum and feedback task force as a proof-of-concept study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:568-574. [DOI: 10.1136/bmjstel-2021-000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2021] [Indexed: 11/04/2022]
Abstract
BackgroundBreaking bad news (BBN) is a critically important skill set for residents. Limited formal supervision and unpredictable timing of bad news delivery serve as barriers to the exchange of meaningful feedback.Purpose of studyThe goal of this educational innovation was to improve internal medicine residents’ communication skills during challenging BBN encounters. A formal BBN training programme and innovative on-demand task force were part of this two-phase project.Study designInternal medicine residents at a large academic medical centre participated in an interactive workshop focused on BBN. Workshop survey results served as a needs assessment for the development of a novel resident-led BBN task force. The task force was created to provide observations at the bedside and feedback after BBN encounters. Training of task force members incorporated video triggers and a feedback checklist. Inter-rater reliability was analysed prior to field testing, which provided data on real-world implementation challenges.Results148 residents were trained during the 2-hour communications skills workshop. Based on survey results, 73% (108 of 148) of the residents indicated enhanced confidence in BBN after participation. Field testing of the task force on a hospital ward revealed potential workflow barriers for residents requesting observations and prompted troubleshooting. Solutions were implemented based on field testing results.ConclusionsA trainee-led BBN task force and communication skills workshop is offered as an innovative model for improving residents’ interpersonal and communication skills in BBN. We believe the model is both sustainable and reproducible. Lessons learnt are offered to aid in implementation in other settings.
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Thiessen M, Sinclair S, Tang PA, Raffin Bouchal S. Information Access and Use by Patients With Cancer and Their Friends and Family: Development of a Grounded Theory. J Med Internet Res 2020; 22:e20510. [PMID: 33118940 PMCID: PMC7661235 DOI: 10.2196/20510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/29/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background Information has been identified as a commonly unmet supportive care need for those living with cancer (ie, patients and their friends and family). The information needed to help individuals plan their lives around the consequences of cancer, such as the receipt of health care, is an example of an important informational need. A suitable theory to guide the development of interventions designed to meet this informational need has not been identified by the authors. Objective The aim of this study is to generate a grounded theory capable of guiding the development of interventions designed to assist those living with cancer in meeting their informational needs. Methods Classic grounded theory was used to analyze data collected through digitally recorded one-on-one audio interviews with 31 patients with cancer and 29 friends and family members. These interviews focused on how the participants had accessed and used information to plan their lives and what barriers they faced in obtaining and using this information. Results The theory that emerged consisted of 4 variables: personal projects, cancer as a source of disruption to personal projects, information as the process of accessing and interpreting cancer-related data (CRD) to inform action, and CRD quality as defined by accessibility, credibility, applicability, and framing. CRD quality as a moderator of personal project disruption by cancer is the core concept of this theory. Conclusions Informational resources providing accessible, credible, applicable, and positively framed CRD are likely key to meeting the information needs of those affected by cancer. Web-based informational resources delivering high-quality CRD focused on assisting individuals living with cancer in maintaining and planning their personal projects are predicted to improve quality of life. Research is needed to develop and integrate resources informed by this theoretical framework into clinical practice.
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Affiliation(s)
- Maclean Thiessen
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.,Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patricia A Tang
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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