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Darrason M, Souquet PJ, Couraud S. Standardized vs peer-played patients for learning how to break bad news in lung cancer: A prospective crossover study. Respir Med Res 2021; 80:100856. [PMID: 34481303 DOI: 10.1016/j.resmer.2021.100856] [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: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Residents in respiratory medicine are often confronted with breaking bad news to patients. In communication skill training, a recurring question is whether to use standardized or peer-played patients for simulation METHODS: In this prospective single-center crossover study in pulmonology residents, a range of scenarios were performed during training sessions using standardized or peer-played patients. The aim was to assess whether patient type did alter the quality of the role-play. The residents completed post-scenario questionnaires about the role-play of each scenario, but also pre- and post-session questionnaires about their perception of the effectiveness of both modalities, and pre- and post-testing questionnaires about the psychological impact of the training. RESULTS Collectively, 4 scenarios were performed 52 times and evaluated 208 times by 52 residents. The use of standardized patients appeared to improve the quality of the patient role (8.8 ± 1.0 vs. 8.3 ± 1.1; p = 0.001) and the general quality of role-play (8.8 ± 1.0 vs. 8.2 ± 0.9; p = 0.008), without affecting the quality of the physician role played by the resident. There were no significant differences between standardized and peer-played patients regarding learning interest or psychological impact. Regardless of the modality, the training sessions did appear to significantly affect the residents' evaluations of their ability to break bad news to patients (5.7 ± 1.1 vs. 7.4 ± 1.1; p < 10-4). CONCLUSION Our results did not point to a superiority of either of these modalities for learning how to break bad news. Both may be used, depending on the local resources.
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Affiliation(s)
- Marie Darrason
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France.
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Plateforme Lyon Sud de Simulation en Santé (PL3S), Faculté de médecine et de maïeutique Lyon Sud, Université de Lyon, Lyon, France
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Novaes LMS, Paiva EMDC, O'Mahony A, Garcia ACM. Roleplay as an Educational Strategy in Palliative Care: A Systematic Integrative Review. Am J Hosp Palliat Care 2021; 39:570-580. [PMID: 34350773 DOI: 10.1177/10499091211036703] [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: 11/16/2022] Open
Abstract
INTRODUCTION Simulation activities, such as roleplay, have become established in undergraduate and graduate education in several subjects of healthcare. The objective of this study was to synthesize the evidence available in the literature on the use of roleplay as an educational strategy in palliative care. METHODS Using the method proposed by Whittemore and Knafl, this integrative systematic review was carried out based on the following guiding question: "What is the available evidence in the literature on the use of roleplay as an educational strategy in the teaching of palliative care?" The databases used for the selection of articles were the following: Web of Science, Scopus, Cochrane Library, PubMed, CINAHL, EMBASE, and LILACS. There were no limitations regarding the year of publication or language. RESULTS The articles (n = 34) were grouped into 3 categories, according to the purpose of roleplay use: 1) Use of roleplay as an educational strategy to teach communication in palliative care; 2) Use of roleplay as an educational strategy to teach the communication of bad news, and 3) Use of roleplay as an educational strategy to teach end-of-life care. CONCLUSION Roleplay has been employed in the teaching of palliative care in order to develop skills related to communication and to the provision of end-of-life care. These educational activities have mainly been directed to healthcare students and professionals. Future investigations should further evaluate the efficacy of this teaching strategy, based on studies with more robust designs that allow the establishment of cause-and-effect relationships.
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Affiliation(s)
| | | | - Aoife O'Mahony
- School of Psychology, 2112Cardiff University, Cardiff, Wales, United Kingdom
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Yazdanparast E, Arasteh A, Ghorbani S, Davoudi M. The Effectiveness of Communication Skills Training on Nurses' Skills and Participation in the Breaking Bad News. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:337-341. [PMID: 34422614 PMCID: PMC8344626 DOI: 10.4103/ijnmr.ijnmr_150_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/26/2020] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news. MATERIALS AND METHODS This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t-test) in SPSS software. RESULTS The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between-group difference was statistically significant (t59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses' participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between-group difference was statistically significant (t75,48 = 3.94, p < 0.001). CONCLUSIONS It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.
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Affiliation(s)
- Elnaz Yazdanparast
- Department of Nursing, School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Azadeh Arasteh
- Department of Nursing, School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - SeyedHasan Ghorbani
- Emergency Department, Hazrat Rasool Educational, Research and Therapeutic Hospital, Birjand University of Medical Sciences, Birjand, Iran
| | - Malihe Davoudi
- Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Carroll E, Nelson A, Kurzweil A, Zabar S, Lewis A. Using Objective Structured Clinical Exams (OSCE) to Teach Neurology Residents to Disclose Prognosis after Hypoxic Ischemic Brain Injury. J Stroke Cerebrovasc Dis 2021; 30:105846. [PMID: 33984743 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurologists need to be adept at disclosing prognosis and breaking bad news. Objective structured clinical examinations (OSCE) allow trainees to practice these skills. METHODS In 2017, in conjunction with the NYU School of Medicine Simulation Center, neurology faculty designed an OSCE case in which a resident had to inform a standardized patient (SP) her father had severe global hypoxic ischemic injury. The residents were surveyed on the experience using a Likert scale from 1 (worst) to 5 (best). The SP completed a behavioral anchored checklist and marked items as "not done," "partly done," or "well done". RESULTS 57 third and fourth year neurology residents completed the case from 2018 to 2020, 54 (95%) of whom completed the post-OSCE survey. Residents reported feeling moderately prepared for the simulation (mean Likert score 3.7/5), and thought their performance was average (3.4/5). Overall, they found the case to be very helpful (4.6/5). The residents performed well in the realms of maintaining professionalism (64% rated "well done"), developing a relationship (62% rated "well done"), and information gathering (61% rated "well done"). There was room for improvement in the realms of providing education and presenting the bad news (39% and 37% rated "partly/not done," respectively). CONCLUSIONS OSCE cases can be used to teach neurology trainees how to discuss prognosis and break bad news. Feedback about this simulation was positive, though its efficacy has yet to be evaluated and could be a future direction of study.
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Affiliation(s)
- Elizabeth Carroll
- Department of Neurology, NYU Langone Medical Center, 530 1st Ave, HCC-5A, New York 10016, NY, United States.
| | - Aaron Nelson
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States.
| | - Arielle Kurzweil
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States.
| | - Sondra Zabar
- Department of Medicine, NYU Langone Medical Center, New York, NY, United States.
| | - Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY, United States; Department of Neurosurgery, NYU Langone Medical Center, New York, NY, United States.
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Campbell EY, Lawson TG, Urban S, Vaughan L, Kamal AH, Jones CA, Higgins EA. Top Ten Tips Palliative Care Clinicians Should Know About Teaching Trainees How to Conduct a Family Meeting. J Palliat Med 2020; 24:267-272. [PMID: 33306932 DOI: 10.1089/jpm.2020.0687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The family meeting is an essential component of effective palliative care (PC); however, medical students and junior doctors-in-training often consider leading a family meeting to be a daunting task. The old "see one, do one, teach one" axiom should not apply in preparing trainees to conduct a family meeting. After a review of the literature on established PC curricula, trainee perceptions of their PC educational experiences, and documented educational interventions in preparing trainees to conduct a family meeting, we have compiled a list of 10 tips for clinical educators to consider in assisting their students to feel better equipped to conduct productive family meetings.
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Affiliation(s)
- Emily Young Campbell
- Department of Internal Medicine, Division of General Internal Medicine, Geriatrics and Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theresa Gunter Lawson
- Department of Internal Medicine, South University College of Nursing and Public Health, Savannah, Georgia, USA
| | - Sophia Urban
- Department of Internal Medicine, Division of General Internal Medicine, Geriatrics and Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Leigh Vaughan
- Department of Internal Medicine, Division of General Internal Medicine, Geriatrics and Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Arif H Kamal
- Department of Internal Medicine, Division of Medical Oncology, Duke Cancer Institute, Duke Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Christopher A Jones
- Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth A Higgins
- Department of Internal Medicine, Division of General Internal Medicine, Geriatrics and Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
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Collini A, Parker H, Oliver A. Training for difficult conversations and breaking bad news over the phone in the emergency department. Emerg Med J 2020; 38:151-154. [PMID: 33273038 DOI: 10.1136/emermed-2020-210141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022]
Abstract
Due to the COVID-19 pandemic, there have been strict limits on visitors to hospitals. This has led to clinicians having an increasing number of difficult conversations with patients and their relatives over the phone. There is a lack of published literature examining how to do this well, but it is recognised that phone communication does differ from face to face interactions, and requires specific training. What is most important to patients and their families when receiving bad news is privacy, adequate time without interruptions, clarity and honesty when delivering the information, and an empathetic and caring attitude. Much of the work done on breaking bad news has been done in oncology and focusses on face to face interaction; there has been an assumption that this is transferrable to the emergency department, and more recently that this is applicable to conversations over the phone. Multiple educational interventions to improve the delivery of bad news have been developed, with differing frameworks to help clinicians carry out this stressful task. Simulation is widely used to train clinicians to break bad news, and has solid theoretical foundations for its use. The psychological safety of participants must be considered, especially with emotive subjects such as breaking bad news. We believe there is a need for specific training in breaking bad news over the phone, and developed an innovative simulation-based session to address this. The training has been well received, and has also highlighted the need for a space where clinicians feel able to discuss the emotional impact of the difficult conversations they are having.
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Affiliation(s)
- Anna Collini
- Education Academy, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Helen Parker
- Emergency Department, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Amy Oliver
- Role Plays for Training (RPfT), London, UK
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Evans CS. Early Pregnancy Loss in the Emergency Department: Lessons Learned as a Spouse, New Father, and Emergency Medicine Resident. Ann Emerg Med 2020; 77:233-236. [PMID: 33077250 DOI: 10.1016/j.annemergmed.2020.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Christopher S Evans
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
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Pétré B, Servotte JC, Piazza J, Ghuysen A, Margat A, Gagnayre R, Leclercq D. CEdRIC: Strategy for Patient Education During COVID-19 Triage. West J Emerg Med 2020; 21:52-60. [PMID: 33052818 PMCID: PMC7673883 DOI: 10.5811/westjem.2020.7.47907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/10/2023] Open
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic is forcing healthcare systems around the word to organise care differently than before. Prompt detection and effective triage and isolation of potentially infected and infectious patients are essential to preventing unnecessary community exposure. Since there are as yet no medications to treat or vaccines to prevent COVID-19, prevention focuses on self-management strategies, creating patient education challenges for physicians doing triage and testing. This article describes a five-step process for effectively educating, at discharge, patients who are suspected of being infectious and instructed to self-isolate at home. We are proposing the CEdRIC strategy as a practical, straightforward protocol that meets patient education and health psychology science requirements. The main goal of the CEdRIC process is to give patients self-management strategies aimed at preventing complications and disease transmission. The COVID-19 pandemic is challenging clinicians to rapidly teach their patients self-management strategies while managing the inherent pressures of this emergency situation. The CEdRIC strategy is designed to deliver key information to patients and standardize the discharge process. CEdRIC is currently being tested at triage centres in Belgium. Formal assessment of its implementation is still needed.
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Affiliation(s)
- Benoit Pétré
- University of Liège, Department of Public Health, Wallonia, Belgium
- Member of Be.Hive, Interdisciplinarity Primary Care Chair
| | | | - Justine Piazza
- University Hospital Centre of Liège, Department of Emergency Medicine, Wallonia, Belgium
| | - Alexandre Ghuysen
- University of Liège, Department of Public Health, Wallonia, Belgium
- University Hospital Centre of Liège, Department of Emergency Medicine, Wallonia, Belgium
| | - Aurore Margat
- University of Sorbonne Paris Nord, Education and Health Practices Laboratory UR3412, Sorbonne Paris Cité, France
| | - Remi Gagnayre
- University of Sorbonne Paris Nord, Education and Health Practices Laboratory UR3412, Sorbonne Paris Cité, France
| | - Dieudonné Leclercq
- University of Sorbonne Paris Nord, Education and Health Practices Laboratory UR3412, Sorbonne Paris Cité, France
- University of Liège, Department of Education and Training, Wallonia, Belgium
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