Ability of primary care physician's to break bad news: A performance based assessment of an educational intervention
Introduction
There was a time when it was an acceptable practice to break bad news to a patient who was suffering from a terminal illness by mail, often without even seeing the patient [1]. Fortunately, the medical profession has made tremendous strides in dealing with this area of practice [2], [3]. Consensus guidelines on how to break bad news to patients as outlined by Rosenbaum et al. [4] Buckman [5] and by Baile et al. [6] represent some of the many attempts to establish basic principles for breaking bad news (BBN).
A number of studies have shown that physicians experience difficulty when required to deliver bad news [7]. Lack of skills and the reluctance to deal with the patient's feelings have been reported as the main causes for physicians’ avoidance of this task [8], [9]. To overcome these problems, courses for breaking bad news have been implemented [10]. Of crucial importance is the effectiveness and outcome of such interventions, i.e. do they improve the ability of participating physicians to breaking bad news, and to what degree do participants retain these skills. Assessment of the impact of such courses on competence is rare [2]. We were unable to find studies that reported on the development of a reliable performance based assessment of the ability of physicians to deliver bad news to patients. The purpose of this study was to: (1) evaluate the reliability and validity of a competence based assessment, utilizing simulated patients as evaluators, to assess primary care physicians’ ability to deliver bad news; (2) evaluate the effectiveness of a training program in breaking bad news offered to a group of general practitioners (GPs) as part of a continuing medical education (CME) program.
Section snippets
Course framework and teaching modalities
In 1991, a mandatory course for second year family medicine trainees on how to break bad news was introduced into our residency training program. Since 1996, this course has also been offered as a CME course for practicing GPs. The guiding textbook for this course has been ’How to break bad news’ by Buckman [5].
A group of certified family physicians and a social worker identified common and important situations dealing with bad news in primary care that served as the basis for developing the
Results
All 34 physicians took both the pre- and post-tests (Table 3). Overall mean score for the pre-test was 57.3, S.D. 11.3 (range: 20–100). No significant difference on the pre-test was found between the scores of the GPs from the study and control groups (58.5, S.D. 12.7 versus 57, S.D. 10.4, respectively; range: 20–100). Overall reliability of the pre-test was high for a 2 h OSCE (α = 0.81).
The GPs in the study group significantly increased their average grade on the post-test as compared to the
Discussion
At no time is effective communication more important and challenging than when a physician is required to deliver bad news or tragic information to patients and their families. Receiving a medical diagnosis may be overwhelming regardless of the care the physician takes in communicating the news. Jonsen et al. have stated, “the truth may be brutal, but the telling of it should not be”. ([15]).
Little is known to date about actual physician performance in providing bad news and the emotional
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The assessment of medical competencies
2017, Revista Clinica EspanolaBreaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention
2015, Patient Education and CounselingCitation Excerpt :There are few studies, however, that evaluate the objective skill of trainees in the delivery of bad news and/or the effectiveness of an educational intervention to improve bad news delivery. A few studies demonstrate improvement in this skill after an educational intervention for oncology trainees [29–31] and family practice trainees [32], but there is little evidence in pediatric trainees. Residents have indicated less preparation and training in breaking bad news in the pediatric setting compared to adult patient encounters [11].
Research on Balint groups: A literature review
2015, Patient Education and CounselingCitation Excerpt :Often these modified groups have different names such as ‘Balint-style group’, ‘Balint clinical reflection group’ or ‘Balint-like group’. Generally, the number of participants in a BG is between 6 and 12, with extremes of 4 [34] to 15 [19,24,46] and 17 participants [47]. Meeting frequency is often once per week or once every fortnight, sometimes once per month.
Seeing beyond the hearing aids. Congenital deafness: The unique perspective of a father and an otolaryngologist
2014, Patient Education and CounselingTeaching and evaluating breaking bad news: A pre-post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters
2012, Patient Education and CounselingCitation Excerpt :Various study groups have published guidance on the professional handling of this difficult communication situation over the last few years [4,5] and teaching courses on breaking bad news have been implemented as part of the undergraduate and postgraduate curricula in North America and several European countries [3,6,7]. There is evidence that small group teaching interventions which incorporate experiential methods (i.e. role play, standardised patients) and principles of a learner-centred approach improve course participants’ perceived self-efficacy [8,9] and observable communication skills [10–12]. The methods which have been used to measure breaking bad news competency differ with respect to the type of the instruments (e.g. detailed checklist, global rating scales) and the raters (e.g. standardised patients, independent raters) [3,13].
A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self-efficacy and performance
2011, Patient Education and CounselingCitation Excerpt :Often it is both. Well known examples of difficult conversations in healthcare include breaking bad news, responding to an angry patient, disclosing medical errors, and admitting inability to diagnose or cure [7–9]. The need for undergraduate, graduate, and continuing professional training in effective communication skills is widely recognized.