The development of a structured rating schedule (the BAS) to assess skills in breaking bad news

Abstract

Summary There has been considerable interest in how doctors break bad news, with calls from within the profession and from patients for doctors to improve their communication skills. In order to aid clinical training and assessment of the skills used in breaking bad news there is a need for a reliable, practical and valid, structured rating schedule. Such a rating schedule was compiled from agreed criteria in the literature. Video-taped recordings of simulated consultations breaking bad news were independently assessed by three raters using the schedule and compared to three experts who gave global ratings. The primary outcome measures were internal consistency of the schedule and level of agreement between raters. The internal consistency was high with a Cronbach's alpha of 0.93. Agreement between raters using the schedule was moderate to good. The majority of the variation in scores was due to the differences in skills demonstrated in the interviews. The agreement between raters not using the schedule was poor. The BAS provides a simple to use, reliable, and consistent rating schedule for assessing skills used in breaking bad news. It could be a valuable aid to teaching this difficult task.

Assessing students’ communication skills: validation of a global rating

“…One way to approach a gold standard would be to ask patients how they experienced the encounter (Mazor et al 2005). Another possibility is to compare the scores to ratings of experts (Boon and Stewart 1998;Miller et al 1999). Agreement between examiners and experts poses a measure of concurrent validity and would reveal that trained observers can provide assessment similar to experts (Lang et al 2004).…”

Breaking bad news in medical practice

“…Der Aufwand der Beurteilung hält sich in Grenzen. Eine Anwendung zur unmittelbaren Überprüfung eines Trainings ist folglich möglich [7,16,19,21].…”

“…Dort wurde der Bedarf an Schulung in Gesprächsführung als besonders dringend empfunden. Er führte zur Entwicklung und Überprüfung einer Reihe von Trainingskonzepten [3,15,16,18,21]. Der vorliegende Beitrag beruht auf den Ergebnissen von Trainingsveranstaltungen zur Arzt-Patient-Kommunikation mit Ärzten in Kliniken und Praxen und mit Medizinstudenten [11,12].…”

An investigation of the use of simulated patients in audiology student education

“…The ACE was adapted from the "Breaking bad news assessment schedule" (BAS) developed by Miller et al (1999), which incorporated principles of patient-centred communication (Schmid et al, 2005) where opportunities were given to give both information and emotional support to a patient on a topic that was difficult or upsetting. To measure the efficacy of the ACE, English et al (2007) examined three audiologists using this tool to evaluate ten graduate audiology students counselling an SP playing the role of a client whose baby had just been diagnosed with significant hearing loss.…”

“…These questions incorporate 77 desirable counselling behaviours and are organized into seven categories: getting started, breaking the news, assessing parents' understanding of/reaction to the situation, eliciting concerns, giving a time frame for action, suggesting specific actions while waiting for the follow-up appointment, and general considerations. The ACE was adapted from the "Breaking bad news assessment schedule" (BAS) developed by Miller, Hope & Talbot (1999) which incorporated principles of patient-centred communication (Schmid, Kindlimann, & Langewitz, 2005) where opportunities were given to give both information and emotional support to a patient on a topic that was difficult or upsetting. To measure the efficacy of the ACE, English et al (2007) examined three audiologists using this tool to evaluate ten graduate audiology students counselling an SP playing the role of a client whose baby had just been diagnosed with significant hearing loss.…”