Changes in Communicating Bad News in the Context of COVID-19: Adaptations to the SPIKES Protocol in the Context of Telemedicine

Júnior, Jucier Gonçalves; Nascimento, Thalya Gonçalves Lôbo do; Pereira, Myllena Maria de Morais; Moreira, Elysyana Barros

doi:10.3389/fpsyt.2020.599722

Cited by 12 publications

(11 citation statements)

References 17 publications

(30 reference statements)

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“…However, clinicians must practice telemedicine skills for difficult conversations and be aware of barriers that are specific to virtual encounters. 8 , 9 Simulated patient feedback is imperative to improve trainee communication skills, and simulation has been shown to improve telemedicine skills, to identify trainee knowledge gaps, and to improve confidence. 10 …”

Section: Discussionmentioning

confidence: 99%

Adapting an Objective Structured Clinical Examination (OSCE) on Conducting Difficult Conversations Between Nephrology Fellows and Patients to a Virtual Platform: A Research Letter

Watson

Howle

Lenz

et al. 2023

Can J Kidney Health Dis

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Background: We previously described a nephrology-specific “Breaking Bad News” Objective Structured Clinical Examination (OSCE) assessing nephrology fellow communication and counseling skills in 3 scenarios: kidney replacement therapy (KRT) in kidney failure, urgent KRT in acute kidney injury (AKI), and kidney biopsy (KBx). Objective: The main objectives of this study is to adapt the OSCE to a virtual platform, simulating nephrology patient telemedicine encounters involving difficult conversations, and to assess fellow and faculty satisfaction with the virtual format. Design: Description of a formative telemedicine simulation for nephrology fellows. Setting: Fully virtual simulation conducted by 2 academic medical simulation centers. Participants: Nephrology faculty and fellows at 3 urban/suburban training programs in the eastern United States. Measurements: Description of the virtual OSCE process. Fellow and faculty satisfaction overall and for each scenario. Faculty and fellow estimates of frequency of virtual patient encounters in the past year. Methods: The OSCE consisted of 3 scenarios: KRT in kidney failure, urgent KRT in AKI, and KBx. Objective Structured Clinical Examinations were administered in May 2021. Each scenario lasted 20 minutes. The AKI scenario was audio only. Fellows telephoned a simulated patient surrogate for urgent KRT consent. Kidney failure and KBx scenarios were video encounters. Faculty observed while muted/video off. Immediately after the OSCE, fellows and faculty were anonymously surveyed regarding their satisfaction with each scenario, the OSCE overall, and their estimate of outpatient encounters and inpatient KRT counseling done virtually in the preceding year. Results: Seventeen fellows completed the OSCE at 2 centers (3 programs). Sixteen (94%) completed the survey. Almost 94% rated the OSCE as a good/very good approximation of telemedicine encounters. Those satisfied/very satisfied with each scenario are as follow: 100% for AKI, 75% for kidney failure, and 75% for KBx. Two commented that they often did urgent KRT counseling by telephone. Fellows estimated a median 20% (interquartile range: 175, 50%) of counseling for acute inpatient KRT and a median 50% (IQR: 33.75, 70%) of outpatient encounters were virtual in the prior year. Two (regarding the kidney failure and KBx scenarios) indicated they would not have counseled similar outpatients virtually. Limitations: The 15-minute interactions may be too short to allow the encounter to be completed comfortably. A small number of programs and fellows participated, and programs were located in urban/suburban areas on the east coast of the United States. Conclusions: Overall, fellows felt that the OSCE was a good approximation of virtual encounters. The OSCE is an opportunity for fellows to practice telemedicine communication skills.

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Section: Discussionmentioning

confidence: 99%

Adapting an Objective Structured Clinical Examination (OSCE) on Conducting Difficult Conversations Between Nephrology Fellows and Patients to a Virtual Platform: A Research Letter

Watson

Howle

Lenz

et al. 2023

Can J Kidney Health Dis

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“… 57 , 58 Recent adaptations have been proposed to improve their feasibility in the virtual context, but this remains an ongoing area of study. 59 , 60 …”

Section: Section 4—unique Aspects Of Telemedicine Encounter In Neuro-...mentioning

confidence: 99%

Practical guidance for telemedicine use in neuro-oncology

Strowd

Dunbar

Gan

et al. 2022

Neuro-Oncology Practice

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While the COVID-19 pandemic has catalyzed the expansion of telemedicine into nearly every specialty of medicine, few articles have summarized current practices and recommendations for integrating virtual care in the practice of neuro-oncology. This article identifies current telemedicine practice, provides practical guidance for conducting telemedicine visits, and generates recommendations for integrating virtual care into neuro-oncology practice. Practical aspects of telemedicine are summarized including when to use and not use telemedicine, how to conduct a virtual visit, who to include in the virtual encounter, unique aspects of telehealth in neuro-oncology, and emerging innovations.

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“…Steps from the SPIKES protocol for breaking bad news can be adapted for communication via telemedicine. 63 , 64 It can be called “tele-SPIKES.” We suggest the following steps for “tele-SPIKES”: (1) Setting–select a suitable platform on which to converse, find a quiet place, breathe and settle down, then phone or video call the patient, introduce oneself and explain purpose of the call, (2) Perception–ask how they are feeling and clarify their understanding of the disease and prognosis, listen carefully without interrupting, (3) Invitation–ask the patient what they want to know further and how much they want to know, (4) Knowledge–speak in a clear and calm manner, communicate medical information in jargon free language at the patient’s pace, explain the diagnosis and prognosis in small chunks, clarify the understanding of the medical information provided, (5) Emotions–the 4 “A”s–be aware of patient’s emotions through their voices and paralanguage throughout the conversation, pause and allow patient to express their feelings whenever necessary, acknowledge , validate or normalize their feelings when appropriate, always give hope, and (6) Strategies–discuss parallel plan: current treatment plan and advance care plan when the patient is ready, provide a plan on regular progress updates.…”

Section: The Role Of Palliative Care In Covid-19mentioning

confidence: 99%

COVID-19, Suffering and Palliative Care: A Review

Beng

Kim

Shee

et al. 2021

Am J Hosp Palliat Care

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According to the WHO guideline, palliative care is an integral component of COVID-19 management. The relief of physical symptoms and the provision of psychosocial support should be practiced by all healthcare workers caring for COVID-19 patients. In this review, we aim to provide a simple outline on COVID-19, suffering in COVID-19, and the role of palliative care in COVID-19. We also introduce 3 principles of palliative care that can serve as a guide for all healthcare workers caring for COVID-19 patients, which are (1) good symptom control, (2) open and sensitive communication, and (3) caring for the whole team. The pandemic has brought immense suffering, fear and death to people everywhere. The knowledge, skills and experiences from palliative care could be used to relieve the suffering of COVID-19 patients.

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Changes in Communicating Bad News in the Context of COVID-19: Adaptations to the SPIKES Protocol in the Context of Telemedicine

Cited by 12 publications

References 17 publications

Adapting an Objective Structured Clinical Examination (OSCE) on Conducting Difficult Conversations Between Nephrology Fellows and Patients to a Virtual Platform: A Research Letter

Adapting an Objective Structured Clinical Examination (OSCE) on Conducting Difficult Conversations Between Nephrology Fellows and Patients to a Virtual Platform: A Research Letter

Practical guidance for telemedicine use in neuro-oncology

COVID-19, Suffering and Palliative Care: A Review

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