Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting...

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Transcript of Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting...

Page 1: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there
Page 2: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Bad News Bad News ––What is it?What is it?

Who breaks it?Who breaks it?

Who teaches it?Who teaches it?

Mandy BarnettMandy Barnett

Associate Clinical Professor in Medical EducationAssociate Clinical Professor in Medical EducationHonorary Consultant in Palliative MedicineHonorary Consultant in Palliative Medicine

Page 3: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Breaking bad news in healthcare setting Breaking bad news in healthcare setting ––definition (Ptacek & Eberhardt, 1996)definition (Ptacek & Eberhardt, 1996)

�� “..pertaining to situations where there is either a “..pertaining to situations where there is either a feeling of no hope, a threat to a person's mental or feeling of no hope, a threat to a person's mental or physical well being, a risk of upsetting an established physical well being, a risk of upsetting an established lifestyle, or where a message is given which conveys lifestyle, or where a message is given which conveys to an individual fewer choices in his or her life”. to an individual fewer choices in his or her life”. to an individual fewer choices in his or her life”. to an individual fewer choices in his or her life”.

�� It is information that “..results in a cognitive, It is information that “..results in a cognitive, behavioural or emotional deficit in the person behavioural or emotional deficit in the person receiving the news that persists for some time after receiving the news that persists for some time after the news is received.”the news is received.”

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Page 4: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Who breaks bad news about what? DoctorsWho breaks bad news about what? Doctors

�� GPs GPs –– often broach initial suspicions of lifeoften broach initial suspicions of life--threatening/limiting diagnosisthreatening/limiting diagnosis

�� GPs GPs –– discuss diagnosis of chronic conditions discuss diagnosis of chronic conditions ––need for lifelong treatment need for lifelong treatment –– limitations on limitations on lifestylelifestylelifestylelifestyle

�� Hospital doctors Hospital doctors –– make original diagnosis of make original diagnosis of many serious illnesses many serious illnesses –– most likely to break most likely to break initial bad news initial bad news

�� Oncologists Oncologists –– recurrence/progression of cancer recurrence/progression of cancer –– limitations/end of treatment optionslimitations/end of treatment options

�� Palliative medicine Palliative medicine –– end of active treatment end of active treatment ––limitations of palliative treatment limitations of palliative treatment -- end of lifeend of life

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Page 5: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Who breaks bad news about what? Who breaks bad news about what?

NursesNurses

�� Specialist nursesSpecialist nurses�� follow up and expand on initial diagnostic informationfollow up and expand on initial diagnostic information

�� discussion of treatment options e.g. stoma carediscussion of treatment options e.g. stoma care

discussion of end of life carediscussion of end of life care�� discussion of end of life carediscussion of end of life care

�� practical limitations on preferred place of carepractical limitations on preferred place of care

�� Health visitors Health visitors �� child development issues, screening for rare child development issues, screening for rare

conditionsconditions

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Who breaks bad news about what? AHPsWho breaks bad news about what? AHPs

�� Clinical/developmental psychologistsClinical/developmental psychologists�� Diagnosis of major psychiatric disorderDiagnosis of major psychiatric disorder

�� Diagnosis of learning disabilityDiagnosis of learning disability

�� Therapeutic radiographersTherapeutic radiographers�� Patient too ill to receive palliative treatmentPatient too ill to receive palliative treatment

�� Dieticians Dieticians �� No improvement in cancer No improvement in cancer cachexiacachexia

�� Diagnostic Diagnostic ultrasonographersultrasonographers�� Diagnostic Diagnostic ultrasonographersultrasonographers�� Abnormal antenatal screening findingsAbnormal antenatal screening findings

�� PhysiotherapistsPhysiotherapists�� Patient recovery e.g. swallowing after strokePatient recovery e.g. swallowing after stroke

�� Occupational therapistsOccupational therapists�� Patient safety for dischargePatient safety for discharge

�� Genetic counsellorsGenetic counsellors�� Results of genetic screeningResults of genetic screening

�� Social workersSocial workers�� Child protection issuesChild protection issues

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Page 7: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Evidence on communication and Evidence on communication and

education in palliative care education in palliative care -- doctorsdoctors

�� Junior medical staff feel prepared for information giving Junior medical staff feel prepared for information giving but not for dealing with psychological distress but not for dealing with psychological distress (Cantwell & (Cantwell & Ramirez, 1997)Ramirez, 1997)

�� General practitioners feel confident in symptom control General practitioners feel confident in symptom control but not in assessing psychological distress or but not in assessing psychological distress or but not in assessing psychological distress or but not in assessing psychological distress or bereavement followbereavement follow--up up (Lloyd(Lloyd--Williams & LloydWilliams & Lloyd--Williams, 1996, Williams, 1996, Low et al, 2006)Low et al, 2006)

�� Consultants working in oncology who have not received Consultants working in oncology who have not received communication skills training are more likely to communication skills training are more likely to experience burnexperience burn--out out (Graham & Ramirez, 2002)(Graham & Ramirez, 2002)

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Evidence on communication and education Evidence on communication and education in palliative care in palliative care –– nurses and AHPnurses and AHP

NursesNurses

�� Nursing education has minimal content on palliative/end Nursing education has minimal content on palliative/end of life care of life care (Lloyd(Lloyd--Williams & Field, 2002)Williams & Field, 2002)

�� Specialist nurses still use blocking behaviours to avoid Specialist nurses still use blocking behaviours to avoid discussing patients emotional concernsdiscussing patients emotional concerns

�� Courses aimed at senior nurses are effective in changing Courses aimed at senior nurses are effective in changing blocking behaviours blocking behaviours (Wilkinson et al, 1999)(Wilkinson et al, 1999)

AHPsAHPs

�� Little evidence for educational approaches to these Little evidence for educational approaches to these groupsgroups

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Page 9: Breaking Bad News.pptBreaking bad news in healthcare setting Breaking bad news in healthcare setting – definition (Ptacek & Eberhardt, 1996) “..pertaining to situations where there

Breaking Bad News ProjectBreaking Bad News Project innovative training for hospital consultantsinnovative training for hospital consultants

20002000--20022002

1-day skills workshop

Casenote audit

2-day experiential workshop

Patient Interviews

Self-directed learning

Consultant questionnaire

Course Self-evaluation

Pre-intervention evaluation

-Simulated consultation

-PC & WERD

-Situation confidence

Consultant questionnaire

1-day skills workshop

Post-intervention evaluation

-Simulated consultation

-PC & WERD

-Situation confidence

2-day experiential workshop Self-directed learning Course Self-evaluation

Immediate post-workshop

Six-month post-workshop

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Doctors’ QuestionnaireDoctors’ Questionnaire

MethodsMethods

�� 285 consultants285 consultants

�� 30 clinical specialties30 clinical specialties

�� Postal questionnairePostal questionnaire

ResultsResults

�� Response rate 54% (155)Response rate 54% (155)

�� 29/30 specialties29/30 specialties

�� Female 15%Female 15%

Age 32Age 32--69 (m 69 (m 46, sd7) 46, sd7) �� Postal questionnairePostal questionnaire

�� DemographicsDemographics

�� Previous training in Previous training in communication skillscommunication skills

�� Current experience in Current experience in breaking bad newsbreaking bad news

�� McMichaelMcMichael--Barnett Attitude Barnett Attitude Measures (1994)Measures (1994)

�� Age 32Age 32--69 (m 69 (m 46, sd7) 46, sd7)

�� Time since qualifying: Time since qualifying:

�� 99--42 years (m22, sd7)42 years (m22, sd7)

�� Time as a consultant: Time as a consultant:

�� <1<1--33 years (m8.31, sd7)33 years (m8.31, sd7)

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Participation by specialityParticipation by speciality

Department Approached Responded Percentage

Maxillo Facial 3 3 100.00

Palliative Medicine 1 1 100.00

Plastic Surgery 4 4 100.00

Rehabilitation 1 1 100.00

Accident and Emergency 12 10 83.33

Dermatology 6 5 83.33

Respiratory Medicine 5 4 80.00

Haematology 6 4 66.67

Neurology 3 2 66.67

Neurosurgery 3 2 66.67

Paediatrics 14 9 64.29

Ophthalmology 8 5 62.50

Cardiothoracic Surgery 5 3 60.00

Genito-Urinary Medicine 5 3 60.00Genito-Urinary Medicine 5 3 60.00

Renal 5 3 60.00

Cardiology 7 4 57.14

Radiology Department 25 13 52.00

Anaesthetics 53 27 50.94

Care of the E lderly 8 4 50.00

C linical Oncology 6 3 50.00

Ear Nose & Throat 8 4 50.00

General Medicine 10 5 50.00

Obstetrics and Gynaecology 20 10 50.00

General Surgery 22 10 45.45

Orthopaedics 20 9 45.00

Gastroenterology 5 2 40.00

Rheumatology 5 2 40.00

Urology 7 2 28.57

D iabetes/Endocrinology 7 1 14.29

Psychogeriatrics 1 0 00.00

Total 30 285 153

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Frequency of Breaking Bad NewsFrequency of Breaking Bad News

20

25

30

35

40

0

5

10

15

20

1-2

per y

ear

2-3

per m

onth

1-2

per w

eek

>3 p

er w

eek

>10 p

er w

eek

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Breakdown of training methods Breakdown of training methods previously undertakenpreviously undertaken

Percentage

Training method UG PG UG & PG

Lectures 9.4 16.8 6.0

Training undertaken for the task of BBN (N=149)

Seminars 6.0 23.5 3.4

Experiential workshoptraining

- 4.7 -

Self-directed learning 0.7 26.8 6.0

Role-play 5.4 17.4 1.3

Video role-play 5.4 4.7 -

Informal 2.0 35.6 22.1

49% received no formaltraining

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Consultants’ recommendations for training Consultants’ recommendations for training

WHICH DO YOU FEEL WOULD BE USEFUL? RESPONDENT COMMENT

AT WHICH POINTS IN YOUR

CAREER? TIME THEME (N=101)

Self-directed learning, guided discussion- Including now Consultant or now (n=44)

Breaking bad news Any time At all stages (18)Seminars and role-play- SpR and consultant Consultant or nowLectures + videos showing different scenarios played by professionals giving guidance +++ (not role play)

UNDERGRAD. & POSTGRAD. training (probably to consultant)

Undergrad. (18)Onwards

All Now Consultant or now

Breaking bad news. Symptom control Now Consultant or nowBreaking bad news. Symptom control Now Consultant or nowSome of the role-play As an undergrad. Undergrad. Only (2)Breaking bad news; Communication skills Now Consultant or nowListening in, videoed role-play- At SR level Junior postgrad. (19)LecturesSeminars Informal training

Undergrad.Postgrad.As a junior

Junior postgrad.

Informal training, specifically accompanying senior doctor

SHO & Registrar stage Junior postgrad.

Guided discussion + role-play on communication skills.Role-play with good actors.

Medical school + continuing SHO/SpR training.

Undergrad. onwards

Seminar in breaking bad news SpR Junior postgrad.

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BBN consultation BBN consultation –– content of clinician talkcontent of clinician talkCommunication Category No. of Utterances

(%)

Combination of RIAS Categories (total no. of utterances)

Data gathering - biomedical 173 (1.8%) Closed question - medical condition/therapeutic regimen – 81

Open question - medical condition/therapeutic regimen – 88

Data gathering -

lifestyle/psychosocial

146 (1.6%) Closed question – lifestyle/psychosocial - 87

Open question – lifestyle/psychosocial - 59

Patient education and

counselling - biomedical

3983 (43%) Gives information - medical condition/therapeutic

regimen/other - 3828

Counsels - medical condition/therapeutic regimen - 155

Patient education and

counselling -

lifestyle/psychosocial

548 (5.9%) Gives information – lifestyle/psychosocial - 216

Counsels – lifestyle/psychosocial - 332

Facilitation and patient 1214 (13%) Asks for opinion/understanding – 323Facilitation and patient

activation

1214 (13%) Asks for opinion/understanding – 323

Asks for permission -2

Asks for reassurance – 2

Paraphrase/check for understanding - 379

Rapport building/positive 932 (10%) Laughs, tells jokes - 37

Shows approval – direct - 43

Gives compliment – general - 14

Shows agreement, understanding - 838

Rapport building/emotional 1893 (20.9%) Empathy/legitimation - 201

Shows concern or worry - 859

Reassures encourages or shows optimism - 700

Partnership statements - 91

Rapport building/negative 24 (0.3%) Shows disapproval – direct - 21

Shows criticism – general - 3

Rapport building/social 124 (1.3%) Personal remarks, social conversation - 1241515

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BBN project conclusionsBBN project conclusions

�� Breaking bad news is a frequent task for Breaking bad news is a frequent task for

consultants in all clinical specialities.consultants in all clinical specialities.

�� 49% have received no formal training for 49% have received no formal training for

breaking bad newsbreaking bad newsbreaking bad newsbreaking bad news

�� The major part of breaking bad news The major part of breaking bad news

consultations focuses on giving bioconsultations focuses on giving bio--medical medical

informationinformation

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Historical Context of Historical Context of

Communication Skills TeachingCommunication Skills Teaching

Three separate strands Three separate strands

�� Medical undergraduate Medical undergraduate –– McMaster (Medical McMaster (Medical School) Canada, 1974; Maguire (Manchester), School) Canada, 1974; Maguire (Manchester), UK, 1976; Kurtz & Silverman, CalgaryUK, 1976; Kurtz & Silverman, Calgary--Cambridge consensus, 1996Cambridge consensus, 1996UK, 1976; Kurtz & Silverman, CalgaryUK, 1976; Kurtz & Silverman, Calgary--Cambridge consensus, 1996Cambridge consensus, 1996

�� General practice postgraduate General practice postgraduate –– Byrne & Long, Byrne & Long, 1976, Pendleton et al, 1984, Neighbour, 1987, 1976, Pendleton et al, 1984, Neighbour, 1987, UK; Stewart, Canada, 1989UK; Stewart, Canada, 1989

�� Cancer care Cancer care –– Maguire, 1985, Maguire, 1985, FallowfieldFallowfield, 1993, , 1993, Wilkinson, 1998, UKWilkinson, 1998, UK

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Key Features of Effective Key Features of Effective

Communication Skills TrainingCommunication Skills Training

�� Didactic overview of evidence baseDidactic overview of evidence base

�� Video feedback to benchmark performanceVideo feedback to benchmark performance

�� Practice of key skills in role playPractice of key skills in role play

�� Feedback on performanceFeedback on performanceFeedback on performanceFeedback on performance

�� Discussion of emotional impactDiscussion of emotional impact

�� Reflection on practiceReflection on practice

�� Training programmes incorporating these Training programmes incorporating these features in selected specialities have features in selected specialities have demonstrated measurable changes in demonstrated measurable changes in participants’ skills participants’ skills ((Fallowfield et al, 1998Fallowfield et al, 1998).).

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Warwick Module - Communication

Skills: Educational Methods and

Effective Clinical Practice

�� October 2004 October 2004 –– 20102010

�� MultiMulti--professionalprofessional

Masters levelMasters level

�� DesignDesign

�� 2x 32x 3--day blocksday blocks

Learner centredLearner centred�� Masters levelMasters level

�� Option for palliative Option for palliative

care, medical education care, medical education

or freestandingor freestanding

�� Learner centredLearner centred

�� ExperientialExperiential

�� 2 full time facilitators2 full time facilitators

�� Max 12 participantsMax 12 participants

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Participants (6 cohorts; n=63)Participants (6 cohorts; n=63)

�� DemographicsDemographics

�� 37 female; 26 male37 female; 26 male

�� Age range 26Age range 26--63 63

(mean 40 yrs)(mean 40 yrs)

�� Route of EntryRoute of Entry

�� 41 via Medical 41 via Medical

EducationEducation

�� 21 via Palliative Care21 via Palliative Care(mean 40 yrs)(mean 40 yrs) �� 21 via Palliative Care21 via Palliative Care

�� 1 as freestanding 1 as freestanding

PGAPGA

2020

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Professional MixProfessional Mix

�� General Practitioners (n=16)General Practitioners (n=16)

�� Nurse specialists in palliative care/oncology/pain Nurse specialists in palliative care/oncology/pain

management (n=15)management (n=15)

�� Specialist doctors (n=25) Specialist doctors (n=25) child and adult psychiatry; child and adult psychiatry;

anaesthetics; O&G; general surgery; ENT; anaesthetics; O&G; general surgery; ENT;

ophthalmology; gastroophthalmology; gastro--enterologyenterology; ; diabetologydiabetology; ; ophthalmology; gastroophthalmology; gastro--enterologyenterology; ; diabetologydiabetology; ;

paediatrics; care of elderlypaediatrics; care of elderly

��14 Cons; 2 Assoc Sp; 9 14 Cons; 2 Assoc Sp; 9 SpRsSpRs

�� Doctors in palliative medicine (n=3)Doctors in palliative medicine (n=3)

��1 Cons; 1 staff grade; 1 1 Cons; 1 staff grade; 1 SpRSpR

�� Others: dentists (1 general, 1 orthodontic surgery); Others: dentists (1 general, 1 orthodontic surgery);

radiotherapy support specialist (1); dietician (1)radiotherapy support specialist (1); dietician (1)

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Outcome MeasuresOutcome Measures

�� Immediate postImmediate post--module module

evaluationevaluation

�� SelfSelf--reported 15 item reported 15 item

questionnaire questionnaire –– perceived perceived

confidence (before and 6 confidence (before and 6

EvaluationEvaluation

�� 63 participants63 participants

�� 60 completed Blocks 1 60 completed Blocks 1

and 2and 2

�� 62/63 completed Block 1 62/63 completed Block 1

evaluationevaluationconfidence (before and 6 confidence (before and 6

weeks post module)weeks post module)

�� Reflection on changes in Reflection on changes in

behaviour 6 weeks post behaviour 6 weeks post

modulemodule

evaluationevaluation

�� 47/60 completed Block 2 47/60 completed Block 2

evaluationevaluation

�� 57/60 completed 6 wk 57/60 completed 6 wk

questionnairequestionnaire

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Immediate Evaluation Part 1Immediate Evaluation Part 1

Overall Positives and Most Overall Positives and Most Useful sectionsUseful sections

�� ‘great to be in a multi‘great to be in a multi--disciplinary module’disciplinary module’

�� ‘enjoyed the group ‘enjoyed the group dynamics’dynamics’

‘working with simulated ‘working with simulated

Changes Recommended Changes Recommended

�� ‘more theoretical discussion re ‘more theoretical discussion re theories of communication’theories of communication’

�� ‘I would have found it useful ‘I would have found it useful for the Palliative Care group to for the Palliative Care group to talk through issues together‘talk through issues together‘

�� ‘perhaps not enough theory ‘perhaps not enough theory �� ‘working with simulated ‘working with simulated patients and rolepatients and role--play’play’

�� ‘working with simulated ‘working with simulated patients, visualisation patients, visualisation and paired listening’ and paired listening’

�� ‘the whole interactive ‘the whole interactive nature of the module, nature of the module, size of the group’size of the group’

�� ‘perhaps not enough theory ‘perhaps not enough theory and too much roleand too much role--play play ––especially about palliative care especially about palliative care issues’ issues’

�� ‘I think it will be easier to see ‘I think it will be easier to see the value of this part of the the value of this part of the module once I have module once I have completed the 2nd part’ completed the 2nd part’

�� ‘too much bad news and ‘too much bad news and death’death’

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Changes identified in consultations with Changes identified in consultations with

patients patients –– 6 weeks post module6 weeks post module

Themes (n=53 responses)Themes (n=53 responses)

�� Empathy (5)Empathy (5)

�� Silence (9)Silence (9)

�� Reflection/selfReflection/self--awareness (5)awareness (5)�� Reflection/selfReflection/self--awareness (5)awareness (5)

�� Active listening (17)Active listening (17)

�� Time management (10)Time management (10)

�� Encouraging patient ‘story’ and concerns (11)Encouraging patient ‘story’ and concerns (11)

�� Partnership in planning management (4)Partnership in planning management (4)

�� Communication in consultation process (16)Communication in consultation process (16)

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Perceived confidence clinical communication prePerceived confidence clinical communication pre--

post module (paired tpost module (paired t--test)test)

2.5

3

3.5

4

0

0.5

1

1.5

2

2.5

Psych Sex Clin

trial

Inf

con

Side

eff

Good

prog

Bad

prog

Pre-mod

Post-mod

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Immediate Evaluation Part 2Immediate Evaluation Part 2Overall Positives/Most UsefulOverall Positives/Most Useful

�� ‘‘Mixture of professionals and Mixture of professionals and experiences’experiences’

�� ‘Excellent group of students ‘Excellent group of students -- we we learned a lot from each other. The learned a lot from each other. The group dynamics was supportive group dynamics was supportive and friendly.’and friendly.’

�� The Toolkits from second half. The Toolkits from second half.

Changes recommendedChanges recommended

�� ‘Make specific ‘Make specific reference to the reference to the literature with each literature with each session.’session.’

�� ‘More practical ‘More practical exercises.’exercises.’�� The Toolkits from second half. The Toolkits from second half.

Such as feedback, the openers Such as feedback, the openers and closers, the microand closers, the micro--teachteach

�� ‘Practical exercise ‘Practical exercise -- micro teach micro teach both with regard to our own both with regard to our own session and watching others’session and watching others’

�� ‘I have never thought of myself ‘I have never thought of myself being in a position to teach being in a position to teach communication skills but will give communication skills but will give myself a shot now’myself a shot now’

exercises.’exercises.’

�� ‘More theoretical ‘More theoretical underpinning’underpinning’

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Changes identified in teaching of effective Changes identified in teaching of effective communication communication –– 6 weeks post module6 weeks post module

Themes (n=53)Themes (n=53)

�� General confidence (6)General confidence (6)

�� Using simulated patients (4)Using simulated patients (4)

�� Using Using roleplayroleplay (6)(6)

�� Confidence to plan/organise training (8)Confidence to plan/organise training (8)�� Confidence to plan/organise training (8)Confidence to plan/organise training (8)

�� Facilitator techniques (9)Facilitator techniques (9)

�� Integrating communication skills with other Integrating communication skills with other clinical training (6)clinical training (6)

�� Feedback (5)Feedback (5)

�� Use/understand theoretical models (5)Use/understand theoretical models (5)

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Perceived confidence teaching communication Perceived confidence teaching communication

prepre--post module (paired tpost module (paired t--test)test)

3

3.5

4

4.5

0

0.5

1

1.5

2

2.5

Smgr SP Des Del Eval Assess

Pre-mod

Post-mod

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What have we learnt? What have we learnt? �� MultiMulti--professional groups can learn professional groups can learn

communication skills togethercommunication skills together

�� Different professions have different Different professions have different communication roles in related clinical situations communication roles in related clinical situations –– learning together helps identify areas of learning together helps identify areas of similarity and differencesimilarity and difference

�� Tensions between ‘patientTensions between ‘patient--centred’ and centred’ and �� Tensions between ‘patientTensions between ‘patient--centred’ and centred’ and ‘practical’ styles need to be acknowledged and ‘practical’ styles need to be acknowledged and actively managedactively managed

�� Facilitators with both educational and clinical Facilitators with both educational and clinical expertise is vital to credibilityexpertise is vital to credibility

�� Two 3Two 3--day blocks is emotionally essentialday blocks is emotionally essential

�� Attendance at Block 1 alone does not equip Attendance at Block 1 alone does not equip participants to deliver communication skills participants to deliver communication skills training independently training independently 2929

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Are we giving mixed messages?Are we giving mixed messages?

�� Undergraduate teaching is largely embedded in Undergraduate teaching is largely embedded in primary care/psychology/palliative care primary care/psychology/palliative care –– yet yet modelling remains a strong educational modelling remains a strong educational influenceinfluence

�� National communication skills programme is National communication skills programme is embedded in Cancer Action Teamembedded in Cancer Action TeamNational communication skills programme is National communication skills programme is embedded in Cancer Action Teamembedded in Cancer Action Team

�� Majority of facilitators in postgraduate training Majority of facilitators in postgraduate training come from psychology/oncology/palliative care come from psychology/oncology/palliative care fields and from nursing/psychology/GP fields and from nursing/psychology/GP disciplinesdisciplines

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Educational Points to PonderEducational Points to Ponder

�� Communication skills training for medical Communication skills training for medical

undergraduates focuses on behavioural aspectsundergraduates focuses on behavioural aspects

�� Communication skills training for nurses truncated in Communication skills training for nurses truncated in

basic trainingbasic training

�� Most postgraduate communication skills training focuses Most postgraduate communication skills training focuses �� Most postgraduate communication skills training focuses Most postgraduate communication skills training focuses

on cancer/palliative/end of life careon cancer/palliative/end of life care

�� Most allied health professionals break bad news in their Most allied health professionals break bad news in their

own areas own areas –– lack of research on training in these groupslack of research on training in these groups

�� Lack of professional recognition of what constitutes bad Lack of professional recognition of what constitutes bad

news to patients and families news to patients and families –– ‘little losses’‘little losses’

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Organisational Issues to be addressedOrganisational Issues to be addressed

�� Increasing access to communication skills training in Increasing access to communication skills training in time of recession and reduced NHS fundingtime of recession and reduced NHS funding

�� Time and selfTime and self--selection selection –– those who come are those who come are educationally motivated and prepared to take time educationally motivated and prepared to take time ––encouraging clinicians who may need training more but encouraging clinicians who may need training more but do not see it as priority do not see it as priority do not see it as priority do not see it as priority

�� Increasing access to facilitator training for AHPs and Increasing access to facilitator training for AHPs and doctors and nurses unconnected to cancer caredoctors and nurses unconnected to cancer care

�� Increasing organisational support to enable clinicians to Increasing organisational support to enable clinicians to offer more patientoffer more patient--centred consultations in actual clinical centred consultations in actual clinical setting setting

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Thank youThank you

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ReferencesReferences�� Barnett M. 2002 ‘Effect of breaking bad news on patients' perceptions of Barnett M. 2002 ‘Effect of breaking bad news on patients' perceptions of

doctors.’ doctors.’ Journal of Royal Society of MedicineJournal of Royal Society of Medicine 9595:343:343--347 347

�� Barnett MM, Fisher JD, Cooke H, James PR, Dale J. 2007 ‘Breaking Bad Barnett MM, Fisher JD, Cooke H, James PR, Dale J. 2007 ‘Breaking Bad News News –– Consultants’ experience, previous education and views on Consultants’ experience, previous education and views on educational format and timing.’ educational format and timing.’ Medical EducationMedical Education 4141: 947: 947--956 956

�� Fisher Fisher J,SandhuJ,Sandhu H, Giles D, Barnett M, Cooke H, Dale J. 2008 'Breaking H, Giles D, Barnett M, Cooke H, Dale J. 2008 'Breaking Bad News:Investigating male and female Bad News:Investigating male and female doctors,communicationdoctors,communication style style Bad News:Investigating male and female Bad News:Investigating male and female doctors,communicationdoctors,communication style style and behaviours using the Medical Interaction Process System(MIPS)' and behaviours using the Medical Interaction Process System(MIPS)' Patient Education And Counselling Patient Education And Counselling (0738(0738--3991)3991)

�� Vail L, Sandhu H, Fisher J, Cooke H, Dale J, Barnett M. 2011. ‘Hospital Vail L, Sandhu H, Fisher J, Cooke H, Dale J, Barnett M. 2011. ‘Hospital consultants breaking bad news with simulated patients: An analysis of consultants breaking bad news with simulated patients: An analysis of communication using the communication using the RoterRoter Interaction Analysis SystemInteraction Analysis System’ ’ Patient Patient Education and CounsellingEducation and Counselling Patient education and Patient education and counselingcounseling 2011 May; 2011 May; 83(2): 18583(2): 185--94 94

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Project Team: Project Team:

Dr. Mandy BarnettDr. Mandy Barnett

Mrs. Heather CookeMrs. Heather Cooke

Breaking Bad News ProjectBreaking Bad News Project innovative innovative tratraining for hospital consultantsining for hospital consultants

Mrs. Heather CookeMrs. Heather Cooke

Professor Jeremy DaleProfessor Jeremy Dale

Dr. Joanne FisherDr. Joanne Fisher

Dr. Clive IrwinDr. Clive Irwin

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