Are We Prepared to Give Bad News? An International Survey Analysis

Abstract

SESSION TITLE: Cultural Diversity and Palliative Care SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Delivering news about end-of-life issues is one of the most difficult tasks clinicians encounter during medical practice. This is frequently overlooked during medical training, leaving clinicians unprepared to face such challenges. We aimed to assess if health care providers feel prepared to communicate end-of-life issue and if proper training has been given during their training. METHODS: A 30-question survey was applied to healthcare providers of 174 different institutions in 40 countries. The survey included opinions regarding ethical issues, religion, attitudes to specific group of patients, and communication skills. RESULTS: A total of 10,106 surveys were completed. Our cohort was represented primarily by physicians 30.6% (n=3092), followed by nurses 22.4% (n=2262) and medical students 28.7% (n=2900) and other health care practitioners. Females were the most prevalent gender, 56.8% (n=5740). 9,074 practitioners answered the question “When a patient under your care dies, who delivers the news to the family?”, 30.2% of health care providers let someone else give this information to the relatives of the patient (p <0.001). Among physicians, 11.5% (n=356) do not deliver news about death of their patients by themselves, they let some else break this information to family members, physicians with less years of experience with patients are the ones who are more likely to have this posture [<25 years’ experience: 69.7% vs. >25 years’ experience: 9%] (p= 0.059). 53.9% (n= 1220) of the nurses do not deliver death news to their patient’s family by themselves, they let some else pass this information, nurses with no experience in the Intensive Care Unit (ICU) are the ones who do not deliver bad news [No ICU experience 55.9% vs. ICU experience 49.7%] (p< 0.001). This attitude was present in 15.3% (n=444) of medical students. Female gender was more tend to let some else deliver news about death in comparison to the male gender [31.5%[(n=1808) vs. 20.5% (n=810)], (p <0.001). Only 33.5% (n=3303) of all the health care providers have undergone formal training to deliver bad news, from these, 40.5 % (n=1239) of the physicians and 37.1% (n=840) of the nurses have had training compared to 26.9% (n=767) of the medical students and (p=0.001). CONCLUSIONS: Only one third of the health care providers surveyed had undergone formal training in how to deliver bad news. Medical students received less preparation than others. Among physicians, more years of experience compensate the lack of training in delivering bad news. More than half of the nurses do not deliver news about death by themselves, mostly in nurses with no ICUE experience. Females would let someone else to communicate dead issues than males. Efforts to provide tools for communication skills are necessary to deliver a higher quality of service in medical practice. CLINICAL IMPLICATIONS: Learning good interpersonal communication skills that include delivering bad news should be part of any health school educational program worldwide. DISCLOSURE: The following authors have nothing to disclose: Andrea Almaguer, Ismael Garcia, Daniel Arnaud, Yamely Mendez, Salim Surani, Paul Marik, Sharon Einav, Joseph Varon No Product/Research Disclosure Information