Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

Abstract

Objective This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. Methods This randomized control study (N=66) compared intervention and control groups of students (n=28) and residents' (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. Results Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=.007, r=-.47; breast cancer (BC), p=.003, r=-.53), attention to patient responses after BBN (CC, p < .001, r=-.74; BC, p=.001, r=-.65), and addressing feelings (BC, p=.006, r=-.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=.004, r=-.43), communication related to emotions (p=.034, r=-.30), determining patient's readiness to proceed after BBN and communication preferences (p=.041, r=-.28), active listening (p=011, r=-.37), addressing feelings (p<.001, r=-.65), and global interview performance (p=.001, r=-.51). Conclusion This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. Practice Implications Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.

What Skills Really Improve After a Flipped Educational Intervention to Train Medical Students and Residents to Break Bad News?

“…Our results are also similar to the findings of Gorniewicz et al (2017), who studied the effect of an intervention using a BBN training module that incorporated patients' story preferences. They found that participants improved at their highest levels of CS with regard to "attention to patient responses after breaking bad news" and "communication related to patient emotions."…”

“…Some of them have evaluated subjective outcomes, such as trainees' satisfaction with the program and confidence in BBN (Orgel et al, 2010;Balzora et al, 2015;Reed et al, 2015;Schildmann et al, 2006). Other studies have evaluated objective outcomes, such as performance with standardized or much less frequently, real patients (Daetwyler et al, 2010;Szmuilowicz et al, 2010;Alexander et al, 2006;Yedidia et al, 2003;Lienard et al, 2010;Merckaert et al, 2013;Fallowfield et al, 2013;Gorniewicz et al, 2017).…”

Investigating the association between physicians self-efficacy regarding communication skills and risk of “burnout”

“…The Oncotalk/VitalTalk teaching model is based on evidence-based principles and includes brief didactic sessions to provide specific communication skills, demonstration of those skills by faculties, intensive skill practice with simulated patients during which group and faculties give feedbacks to the trainee focusing on trainee's needs and attending to trainee's attitudes and emotions [13]. The survey was based on previously published researches exploring physician communication of bad news through self-administered questionnaires, investigating the attitudes and problems in disclosure BBN, perceived confidence and outcome of physicians' own communication skills, knowledge and self-efficacy about BBN, the usual practice, frequencies and format of communication with patients and/or family members [4,[14][15][16][17][18][19][20].…”

Medical and information needs among young women with breast cancer in Mexico

“…Efforts must be made to encourage clinicians to address their patients' information and supportive needs, along with delivering adequate oncological care. Improved communication between cancer patients and their physicians could be achieved by developing training programmes focused on communication skills and, thus, achieve a better doctor-patient relationship (Gorniewicz et al, 2017;Kuzari, Biderman, & Cwikel, 2013;Thewes, Meiser, Rickard, & Friedlander, 2003).…”