Breaking Bad News Training Program Based on Video Reviews and SPIKES Strategy: What do Perinatology Residents Think about It?

Abstract

Objective Resident doctors usually face the task to communicate bad news in perinatology without any formal training. The impact on parents can be disastrous. The objective of this paper is to analyze the perception of residents regarding a training program in communicating bad news in perinatology based on video reviews and setting, perception, invitation, knowledge, emotion, and summary (SPIKES) strategy.

Methods We performed the analysis of complementary data collected from participants in a randomized controlled intervention study to evaluate the efficacy of a training program on improving residents' skills to communicate bad news. Data were collected using a Likert scale. Through a thematic content analysis we tried to to apprehend the meanings, feelings and experiences expressed by resident doctors in their comments as a response to an open-ended question. Half of the group received training, consisting of discussions of video reviews of participants' simulated encounters communicating a perinatal loss to a “mother” based on the SPIKES strategy. We also offered training sessions to the control group after they completed participation. Twenty-eight residents who were randomized to intervention and 16 from the control group received training. Twenty written comments were analyzed.

Results The majority of the residents evaluated training highly as an education activity to help increase knowledge, ability and understanding about breaking bad news in perinatology. Three big categories emerged from residents' comments: SPIKES training effects; bad news communication in medical training; and doctors' feelings and relationship with patients.

Conclusions Residents took SPIKES training as a guide to systematize the communication of bad news and to amplify perceptions of the emotional needs of the patients. They suggested the insertion of a similar training in their residency programs curricula.

Resumo

Objetivo Médicos residentes, em geral, enfrentam a tarefa de comunicar más notícias em perinatologia sem um treino formal prévio. O impacto nos pais pode ser desastroso. O objetivo deste artigo é analisar as percepções dos residentes sobre um programa de treinamento para a comunicação de más notícias em perinatologia baseado na revisão de vídeos e na estratégia SPIKES.

Métodos Analisamos os dados complementares coletados dos participantes de um estudo de intervenção controlado e aleatorizado que avaliou a eficácia de um programa de treinamento para ampliar as habilidades dos residentes em comunicar más notícias. Os dados foram coletados utilizando um questionário em escala Likert. Através da análise temática de conteúdos buscamos apreender os significados, sentimentos e experiências descritos nos comentários dos residentes em resposta a uma questão aberta avaliando o treinamento. Metade do grupo recebeu treinamento, que consistiu de discussões do vídeo da consulta simulada de cada participante em que ele comunicava uma perda perinatal para uma “mãe” baseado na estratégia SPIKES. Ofereceu-se treinamento também para o grupo controle após encerraram sua participação na pesquisa. Vinte e oito residentes aleatorizados para a intervenção e 16 do grupo controle receberam treinamento. Vinte comentários escritos foram analisados.

Resultados A maioria dos residentes avaliou o treinamento como uma ótima atividade educativa para ajudá-los a aumentar conhecimento, habilidades e compreensão sobre o processo de comunicar más notícias em perinatologia. Três grandes categorias emergiram dos comentários: Efeitos do treinamento SPIKES, comunicação de más notícias no treinamento médico; e os sentimentos dos médicos e sua relação com os pacientes.

Conclusão Residentes de perinatologia entenderam o treinamento SPIKES como um guia para sistematizar a comunicação de más notícias e ampliar suas percepções sobre as necessidades emocionais dos pacientes. Eles sugeriram que treinamentos similares fossem inseridos nos currículos dos programas de residência.

Keywords

health communication - simulation training - program evaluation - qualitative analysis

Descritores

comunicação em saúde - treinamento com simulação - avaliação de programa - análise qualitativa

Contributions

Setubal MSV, Gonçalves AV, Rocha SR and Amaral EM have participated in the project concept, analysis and interpretation of data, drafting and revising of the manuscript and they have approved the manuscript as submitted.

• References

• 1 Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet 2004; 363 (9405): 312-319
• 2 Jacques AP, Adkins EJ, Knepel S, Boulger C, Miller J, Bahner DP. Educating the delivery of bad news in medicine: Preceptorship versus simulation. Int J Crit Illn Inj Sci 2011; 1 (02) 121-124
• 3 Henley A, Schott J. The death of a baby before, during or shortly after birth: good practice from the parents' perspective. Semin Fetal Neonatal Med 2008; 13 (05) 325-328
• 4 Peters MD, Lisy K, Riitano D, Jordan Z, Aromataris E. Caring for families experiencing stillbirth: Evidence-based guidance for maternity care providers. Women Birth 2015; 28 (04) 272-278
• 5 Prinds C, Hvidt NC, Mogensen O, Buus N. Making existential meaning in transition to motherhood--a scoping review. Midwifery 2014; 30 (06) 733-741
• 6 Lisy K, Peters MD, Riitano D, Jordan Z, Aromataris E. Provision of meaningful care at diagnosis, birth, and after stillbirth: A qualitative synthesis of parent's experiences. Birth 2016; 43 (01) 6-19
• 7 Sullivan AM, Warren AG, Lakoma MD, Liaw KR, Hwang D, Block SD. End-of-life care in the curriculum: a national study of medical education deans. Acad Med 2004; 79 (08) 760-768
• 8 Gough JK, Frydenberg AR, Donath SK, Marks MM. Simulated parents: developing paediatric trainees' skills in giving bad news. J Paediatr Child Health 2009; 45 (03) 133-138
• 9 Saviani-Zeoti F, Petean EB. Breaking bad news: doctors' feelings and behaviors. Span J Psychol 2007; 10 (02) 380-387
• 10 Ministério da Educação. Residência Médica em Pediatria com Duração de Três Anos Áreas de Atuação Pediátrica com Duração de Dois Anos: Proposta da Sociedade Brasileira de Pediatria . http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=6532-pediatria-sesu-rm&category_slug=agosto-2010-pdf&Itemid=30192 . Accessed February 24, 2016
• 11 Bowyer MW, Hanson JL, Pimentel EA. , et al. Teaching breaking bad news using mixed reality simulation. J Surg Res 2010; 159 (01) 462-467
• 12 Vail L, Sandhu H, Fisher J, Cooke H, Dale J, Barnett M. Hospital consultants breaking bad news with simulated patients: an analysis of communication using the Roter Interaction Analysis System. Patient Educ Couns 2011; 83 (02) 185-194
• 13 Peters MD, Lisy K, Riitano D, Jordan Z, Aromataris E. Providing meaningful care for families experiencing stillbirth: a meta-synthesis of qualitative evidence. J Perinatol 2016; 36 (01) 3-9
• 14 Tobler K, Grant E, Marczinski C. Evaluation of the impact of a simulation-enhanced breaking bad news workshop in pediatrics. Simul Healthc 2014; 9 (04) 213-219
• 15 Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 2000; 5 (04) 302-311
• 16 Orgel E, McCarter R, Jacobs S. A failing medical educational model: a self-assessment by physicians at all levels of training of ability and comfort to deliver bad news. J Palliat Med 2010; 13 (06) 677-683
• 17 Buckman R, Kason Y. How to Break Bad News: A Guide for Health Care Professionals . Baltimore, MD: Johns Hopkins University Press; 1992
• 18 Baile WF, Buckman R, Schapira L, Parker PA. Breaking bad news: more than just guidelines. J Clin Oncol 2006; 24 (19) 3217 , author reply 3217–3218
• 19 Defey D, Diaz Rossello JL, Friedler R, Nuñez M, Terra C. Duelo por un Niño que Muere antes de Nacer: Vivencias de los Padres y del Equipo de Salud. 3ª ed. Montevideo: Gnosos; 1997
• 20 Kelley MC, Trinidad SB. Silent loss and the clinical encounter: Parents' and physicians' experiences of stillbirth-a qualitative analysis. BMC Pregnancy Childbirth 2012; 12: 137
• 21 Hammoud MM, Morgan HK, Edwards ME, Lyon JA, White C. Is video review of patient encounters an effective tool for medical student learning? A review of the literature. Adv Med Educ Pract 2012; 3: 19-30
• 22 Daetwyler CJ, Cohen DG, Gracely E, Novack DH. eLearning to enhance physician patient communication: a pilot test of “doc.com” and “WebEncounter” in teaching bad news delivery. Med Teach 2010; 32 (09) e381-e390
• 23 Turato ER. Tratado da Metodologia da Pesquisa Clínico-Qualitativa: Construção Teórico-Epistemológica, Discussão Comparada e Aplicação nas Áreas da Saúde e Humanas . Petrópolis: Vozes; 2003
• 24 Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013; 13: 117
• 25 Meert KL, Eggly S, Pollack M. , et al; National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Parents' perspectives on physician-parent communication near the time of a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2008; 9 (01) 2-7
• 26 Kingdon C, O'Donnell E, Givens J, Turner M. The role of healthcare professionals in encouraging parents to see and hold their stillborn child: A meta-synthesis of qualitative studies. PLoS One 2015; 10 (07) e0130059
• 27 Ellis A, Chebsey C, Storey C. , et al. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16: 16
• 28 Nuzum D, Meaney S, O'Donoghue K. The impact of stillbirth on consultant obstetrician gynaecologists: a qualitative study. BJOG 2014; 121 (08) 1020-1028
• 29 Stillbirth 2011: The Lancet Series on Stillbirth. Lancet. 2011. http://www.thelancet.com/series/stillbirth . Accessed February 16, 2016
• 30 Scott J. Stillbirths: breaking the silence of a hidden grief. Lancet 2011; 377 (9775): 1386-1388
• 31 Homer CSE, Malata A, ten Hoope-Bender P. Supporting women, families, and care providers after stillbirths. Lancet 2016; 387 (10018): 516-517
• 32 Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD. Difficult conversations: improving communication skills and relational abilities in health care. Pediatr Crit Care Med 2009; 10 (03) 352-359
• 33 Reed S, Kassis K, Nagel R, Verbeck N, Mahan JD, Shell R. Breaking bad news is a teachable skill in pediatric residents: A feasibility study of an educational intervention. Patient Educ Couns 2015; 98 (06) 748-752
• 34 Rosenbaum ME, Ferguson KJ, Lobas JG. Teaching medical students and residents skills for delivering bad news: a review of strategies. Acad Med 2004; 79 (02) 107-117
• 35 Reed S, Shell R, Kassis K. , et al. Applying adult learning practices in medical education. Curr Probl Pediatr Adolesc Health Care 2014; 44 (06) 170-181
• 36 Karkowsky CE, Chazotte C. Simulation: improving communication with patients. Semin Perinatol 2013; 37 (03) 157-160