Telehealth Training for Surgeons to Empathetically Deliver Bad News Via Video-Mediated Communication

Abstract

Background The COVID-19 pandemic resulted in a sudden increase in the need to effectively use telehealth in all realms of health care communication, including the delivery of bad news. Methods A single arm, unblinded, feasibility study was performed at a tertiary care center located in Central Virginia to explore the value and utility of providing a telehealth training program based on SPIKES to teach surgical residents and faculty best practice for disclosing difficult news via video-mediated communication (VMC). Surgical interns (categorical and preliminary), surgical residents, and surgical faculty from General, Neuro, Pediatric, Plastics, Oncology, Urology, and Vascular surgical specialties were recruited via email to voluntarily participate in a telehealth simulation-based workshop, with 33 surgical learners participating in the training and 28 completing evaluation surveys. Results Only six respondents (22%) indicated they had prior formal training on telehealth communication with patients or families, while 13 (46%) said they had prior experience giving bad news via telehealth. Comments about improving the training focused on providing more scenarios to practice and more time for feedback. Overall, 25 learners (86%) agreed the activity was a valuable learning experience and the majority (61%) of responses were positive for future use of telehealth for breaking bad news. Discussion Practicing communication skills with VMC was found to be valuable by surgical interns, residents, and faculty. Formal training should be provided for surgeons at every stage of training and practice to improve skill in the delivery of bad news to patients and their families.

From chaos to creativity: Designing collaborative communication training for the delivery of bad news

“…In our previous work, we learned that a single case scenario was not enough for learners to practice and integrate these skills and that a larger number and more varied cases would be helpful. 14 , 15 We also observed that real-time critique from the SPs was highly valued and that learners expressed the desire for even more comprehensive feedback.…”

“…The survey was developed by study investigators and was modified from our previous programs. 14 , 15 Although it was reviewed by learners and faculty not part of the study for clarity, it was not otherwise piloted or changed before its use for this project. The survey collected basic demographic information about the learner, their prior experience with engaging in difficult conversations virtually, reactions to the training sessions, and perceived ability to have difficult conversations with patients independently without supervision.…”

“…Although this study represented an advance from our initial single-institution studies, we remained on the “can it work?” stage of the continuum described by Bowen. 14 , 15 , 21 We hypothesized that a comprehensive, multi-institutional virtual training curriculum for communicating difficult information would be feasible and would lead to provider confidence, competence, and self-reflection.…”

The “CONNECT” Protocol: Delivering Bad News by Phone or Video Call

“… 25 Psychological stress on the physicians might have been exacerbated by the lack of skills associated with remote delivery of bad news regarding medical care. 33 As pointed out by Vitto et al, the “don’t do it over the phone!” approach was common before the pandemic. 34 Remote communication skills had not been generally taught in medical schools.…”

Fetal and Newborn Management of Cloacal Malformations

“…Although in-person counseling may be ideal, virtual visits allow families to receive expert counseling even when centers of excellence are not local, and web-based protocols have been described to help providers accomplish this [ 22 , 23 , 24 , 25 ]. Regardless of visit modality, the portion of the counseling session focusing on education should be comprehensive and include five key aspects:…”