Breaking bad news in amyotrophic lateral sclerosis: The need for medical education

Abstract

The manner in which physicians deliver difficult diagnoses is an area of discontent for patients with amyotrophic lateral sclerosis (ALS). The American Academy of Neurology's Practice Parameter for care of the ALS Patient recommended teaching and evaluating strategies for disclosing the diagnosis (10). Our objective was to examine residents' ability in and perceptions of communicating the diagnosis of ALS. Twenty-two resident physicians were videotaped and rated by two ALS neurologists as they delivered an ALS diagnosis to a standardized patient (SP) during an objective structured clinical examination (OSCE). Residents self-rated immediately after the OSCE, again after viewing their videotape, and completed a survey regarding the OSCE and delivering difficult diagnoses. OSCE performance was suboptimal, particularly for communication skills and empathy. The two examiners' scores correlated except for the empathy subscore. Residents' self-assessments did not align with the examiners' scores either before or after watching their videotape. The survey uncovered residents' apprehension and dissatisfaction with their training in diagnosis delivery. The results highlight a need for resident education in delivering an ALS diagnosis. The lack of correlation between residents' and examiners' scoring requires further study. Evaluation of empathy is particularly challenging. Residents agreed that OSCE participation was worthwhile.

Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach

“…Support and education systems need to be developed that help health care professionals to manage the emotional and moral distress that they encounter in ALS practice 97. Connolly et al55 called for a recognition of the emotional burden that health care professionals encounter when caring for people with ALS, “with structures and procedures developed to address compassion, fatigue, and the moral and ethical challenges related to providing end-of-life care” (p. 435).…”

Habilidade de Comunicação da Má Notícia: o Estudante de Medicina Está Preparado?

“…Devido à importância de fortalecer esse laço e na tentativa de corrigir essa falha curricular, treinamentos de estratégias de comunicação da má notícia estão sendo realizados também no âmbito da residência médica 32,33,34 . 25 reportam um aumento na confiança dos estudantes após aulas e treinamentos com paciente ator.…”

Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis

“…Small studies have highlighted that, unfortunately, many patients and their families are dissatisfied with diagnosis delivery (Borasio, Sloan, & Pongratz, 1998; McCluskey, Casarett, & Siderowf, 2004) and that better training in delivering challenging diagnoses is needed during medical education (Schellenberg, Schofield, Fang, & Johnston, 2014). Importantly, clinical experience supports the view that the way the diagnosis is communicated is the very first step in the rehabilitative process as it will have a major bearing on patient attitudes towards the disease and the medical team’s recommendations (Silani & Borasio, 1999).…”