Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for ''knowledge'' (p < 0.001), ''emotions,'' (p = 0.004) and ''strategy and summary'' (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

RESUMO:Malformações fetais acometem cerca de 3% das gestações, e a possibilidade desse diagnóstico é uma das principais preocupações vivenciadas pelos pais e familiares. Quando é diagnosticado uma malformação que implique em possível mortalidade da criança, é necessário o planejamento do seguimento da gestação, o que abrange diversos aspectos que incluem avaliação minuciosa do prognóstico, organização do cuidado após o parto, e seguimento da família de forma abrangente e integrada. Recentemente os conceitos de cuidados paliativos foram introduzidos na perinatologia com essa finalidade, e o presente artigo tem como objetivo discutir o modelo de cuidado paliativo aplicado no atendimento a gestantes e familiares de fetos com malformação.Descritores: Cuidados paliativos; Feto/anormalidades; Perinatologia.ABSTRACT: Fetal malformations affect approximately 3% of pregnancies, and the possibility of this diagnosis is one of the main concerns of parents and family members. When a malformation that implies potential mortality for the child is diagnosed, the pregnancy's follow-up needs to be planned, including diverse aspects such as thorough evaluation of the prognosis, organization of post-partum care, and follow-up with the family in a broad and integrated manner. Recently, palliative care concepts have been introduced into perinatology for this purpose. This article discusses the application of the palliative care model to the care of pregnant women and family members of fetuses with malformations.

Comunicação de más notícias em obstetrícia: impacto de treinamento institucional na percepção dos profissionais de saúde

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