Breaking Bad News in Obstetrics and Gynecology: We Must Talk About It

Abstract

Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors' performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty's particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies' results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic.

An exploratory study of obstetrics trainees' experiences of breaking bad news

“…The SPIKES protocol (setting up, perception, invitation, knowledge, emotions, strategy and summary) is a six‐step strategy for breaking bad news that was initially developed in the 1990s to provide oncologists with a framework to use for breaking bad news 21 . Since that time it has been adapted for use in a number of different fields 12 . One trainee specifically mentioned it, while others alluded to aspects of it.…”

“…One trainee specifically mentioned it, while others alluded to aspects of it. It has been shown to improve performance and increased personal satisfaction while breaking bad news 12 . However, all elements may not always be applicable in obstetrics, for example during ultrasound, diagnosis and communication may occur simultaneously, with no time for preparation 12 .…”

“…Pregnancy losses are considered one of the most stressful events for adults to experience and can trigger grief reactions 12 . The patient experience was central to the trainees' experience of the consultation.…”

“…The trainees in this group placed strong emphasis on communication techniques across the cases. A number of trainees also made reference to patient‐centred care in these consultations, which has been shown to increase patient satisfaction 12 …”

“…1,2,9 There is a lack of clear evidence as to the most effective way to teach these skills and how to maintain these skills over time. 12 Previous studies have shown simulation followed by feedback to be an effective training strategy for breaking bad news. 10 The task of breaking bad news has been described as one of the most difficult activities in clinical practice, placing a significant emotional toll on the doctors.…”