Abstract
BackgroundBreaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios.MethodsFifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients.ResultsSix discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members.ConclusionsWhen delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.
Highlights
Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients
The six communication patterns identified include how medical students communicate with patients, such as how they deliver bad news, direct patients to their primary concerns, explain treatment plans and build rapport with patients
They include the kinds of question types and turn-taking patterns that medical students use when communicating with patients
Summary
Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. Apart from the verbal component of passing on the message, it requires a range of other communication skills These include making appropriate responses to patients’ emotional reactions, engaging patients in the decisionmaking process, managing stress arising from patients’ expectations, communicating with family members, and dealing with the difficulty of giving hope in a bleak situation [1]. Due to this complexity, doctors frequently report emotional intensity, communication difficulty and being underprepared for the responsibility when breaking bad news [2,3,4]. Insensitively or inadequately conducted discussion could pose serious challenges to patients’ and their family’s longterm adjustments to the outcome of the bad news [7]
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