Difficult Conversations Research Articles

Supporting Hard Conversations in Close Relationships Through Design

Relationships are perhaps the single greatest source of human happiness, and as part of building strong relationships, conflict and hard conversations are unavoidable. As people increasingly rely on digital communication to initiate and resolve conflicts, we examine how design can improve the experience of working through hard conversations within close relationships. We interviewed six psychotherapists and twenty-one social media users to understand both theoretical best practices for navigating conflict and users' experiences with hard conversations online, particularly on text-based messaging platforms. We used our findings to create a temporal model of how digital design could intervene to support users and their relationships during these conversations. Specifically, we find that design can help to facilitate more mutually consensual difficult conversations, support emotional regulation during the conversation, and help facilitate pauses when necessary. We explore the tensions between balancing the needs of relationships and the individuals in them in digital design, and how to center relationships in digital design.

Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: an 11-Year Review

Context: Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience. Objectives: To report 11-years’ experience simulating difficult conversations with bereaved parent-actors. Methods: PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A de-novo evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation. Results: For the first simulated scenario (N=194 residents; N=16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (N=118 residents; N=14 fellows), residents improved significantly on 10/21 criteria. Fellows’ performance did not improve significantly in either scenario, but they presented with high baseline scores. Conclusions: Simulations with bereaved parent actors improved general pediatrics residents’ performance and comfort during difficult conversations and are transportable to diverse settings.

The Impact of Leadership Training on Burnout and Fulfillment Among Direct Reports

SUMMARY Goal Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports’ perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports. Methods We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment. Principal Findings Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports). Practical Applications The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

Cultivating Critical Consciousness

Anti-Black racism, rooted in white supremacy, is a public health crisis in the US that infects and affects every aspect of life. Critical consciousness (CC) and its derivatives, such as Transformative Potential, have been elucidated as the antidote to the disease of white supremacy. Further, with the current focus on anti-racism and diversity, equity, inclusion, and belonging (DEIB) initiatives, strategies aimed at raising CC are becoming the norm. One strategy to develop critical consciousness is engaging in critical dialogue, difficult conversations that connect macro and micro contexts by exploring issues of power, privilege, and oppression. This paper considers a case study of participant data obtained from the critical dialogue component of Community Wise, an innovative, multilevel, behavioral health, group intervention grounded in critical consciousness theory. The purpose of the paper is to identify and discuss the best practices for critical dialogue facilitation that emerged via a qualitative analysis of the selected Community Wise sessions.

Incorporation of Diversity, equity, inclusion and anti-racism (DEIA) principles into the pharmacy classroom: An exploratory review

IntroductionThe objective is to gather evidence on ways to integrate DEIA into the didactic and experiential pharmacy classroom based on AACP's 2021–2024 Strategic Plan Objective 3.3.1. to “compile and publish resources related to best practices in inclusive pedagogy, creating inclusive classrooms, navigating difficult conversations, and promoting equitable campus climates for use by schools and colleges of pharmacy.”.3 MethodsAn exploratory review was conducted to identify literature using journals, including Academic Medicine, the American Journal of Pharmaceutical Education (AJPE), AACP poster abstracts from 2018 and onward, Currents in Pharmacy Teaching and Learning (CPTL), JAMA Surgery, Journal of Dental Education (JDE), and Minority Nurse Magazine. Keywords used were “DEIA,” “DEIA in classrooms,” “diversity,” “equity,” “inclusion,” “microaggression,” “disabilities,” “pharmacy education,” “health equity,” “discrimination,” “unconscious bias,” “cultural humility,” and “cultural competence.” Excluded were literature focused on DEIA in “curriculum,” “recruitment,” and other topics unrelated to integrating DEIA in the classroom. Poster abstract authors were contacted directly to get a copy of the poster so that more information could be gathered from the poster. ResultsSixteen publications were identified (14 peer-reviewed manuscripts and two poster abstracts). Of those, two explored the utilization of technology to make lesson plans more inclusive; seven discussed ways for students to address implicit biases, microaggressions, and navigating difficult conversations; five focused on accommodating students with disabilities; one discussed developing better pronunciation of students' names; and one discussed a method to improve student's self-awareness and awareness of other cultures. ConclusionAlthough evidence was found on integrating DEIA into the didactic and experiential settings, the amount of evidence found is limited, warranting further research.

Serious Games in EDI Education: A Preliminary Discursive Literature

In Higher Education Institutions Equality, Diversity, and Inclusion (EDI) training sometimes has great variability and may lack sensitivity. As a result, the process often lacks depth and does not provide the ability to make mistakes in a more risk free/simulated practice environment in a simulated practice way. EDI can often encompass and touch on rather uncomfortable subjects that people would much prefer to avoid such as racism, discrimination, sexuality, religion, disabilities, marginalisation, lack of representation, unconscious bias and micro-aggressions, professional dilemmas, and ambivalence. People tend to avoid having difficult conversations and asking questions to enhance understanding. Serious games can offer a vehicle to explore some of these issues in a simulated, risk free, immersive environment with no real world consequences. They are a legitimate academic discipline used in a number of diverse fields such as business, mathematics, and soft skills. This paper will perform a preliminary discursive review of the use of games-based learning and serious games in EDI education and associated terms to produce valuable empirical evidence. The study will review developmental, evaluation and development frameworks for developing serious games for potentially difficult contexts in line with EDI i.e. resistance, ambivalence, and challenging confrontational discussions.

When Saying "No" is the Right Choice: Tactfully Declining Managerial Promotions

This article discusses best practices for respectfully declining premature promotions into management roles as a consultant or academic, in order to avoid sabotaging one's career or damaging relationships. It emphasizes the importance of self-reflection to understand one's skills and interests before committing, and encourages politely but firmly communicating priorities and boundaries. Specific techniques are presented, such as expressing gratitude for the confidence in one's abilities while reinforcing current focus on individual work. Offering compromises like trial periods can demonstrate continued commitment while avoiding premature transitions. Validating others' perspectives and emphasizing shared goals helps smooth potential hurt feelings. The article notes the importance of providing thoughtful rationale, validating concerns, proposing alternatives, and focusing on mutual benefit over the long run. Earlier missteps are contrasted with refined approaches developed through situations navigated over time. The conclusion stresses how even difficult conversations can strengthen dynamics when both self-interests and the relationship are kept in mind, with a solution-oriented focus on constructive exchange and partnership beyond any individual opportunity. Overall, the article presents concrete methods for declining roles respectfully while preserving professional integrity and valuable working relationships.

Teaching Ain’t Easy, but Somebody Has Gotta Do It: Education in an Age of Anti-Diversity and Civil Rights Rollbacks

In the aftermath of Supreme Court decisions and the consistent assault on public education, educators must focus on discovering the best methods and approaches for addressing diversity within the classroom and the importance of learning different perspectives as part of a solid education. Diversity, Equity, Inclusion, and Belonging (DEIB), while criticized by political operatives and demonized in the court of public opinion, the tenants of inclusion, creating space for marginalized voices, and assisting students in seeing the gift in the differences each person brings to the classroom and society at large is still valid and essential as a methodology in education while navigating difficult conversations in an anti-diversity climate. Civil and human rights rollbacks are becoming more prevalent, it is crucial to reimagine how we discuss, teach, and embody DEIB or human-focused methodology as an educational tool. Educators must explore how to develop, question, learn, and reimage relationships, community, and educational institutions as incubators for people of diverse cultural backgrounds to share dynamic learning and teaching together.

Indigeneity, Nationhood, Racialization, and the U.S. Settler State: Why Political Status Matters to Native ‘Identity’ Formation

This essay is a chapter excerpted from my forthcoming book, Who Gets to be Indian: Ethnic Fraud and Other Difficult Conversations about Native American Identity The chapter shows the ways that Indianness, framed as Indian or Native American “identity”, is inseparable from state subjectivity based on the history of political relations between tribes and the United States. It argues that tribes’ political status and relationship to the state are central to how Native American identity is shaped, rejecting the understanding of Native identity as race-based. The term “Indigenous” is discussed as not being equivalent to “Native American” and is not a racial formation in international fora. Social changes during the twentieth century brought new ways to diffuse and co-opt Nativeness through disaggregating it from political status and reinforcing racialization with the rise in urban pan-Indianism and neo-tribalism. Distinguishing Nativeness as political status from racialization is critical given ongoing attacks on tribal sovereignty in Supreme Court challenges based on alleged violations to the equal protection principle. Native American “identity” is inextricable from tribal nationhood and state formation, and thus cannot simply be dismissed as a colonial construct.

Mitigating Misinformation Toolkit: Addressing COVID-19 Misinformation Through Interprofessional Learning and Collaboration Using a Standardized Patient-Based Educational Module.

Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

Insights into maternal pertussis vaccination counselling: a qualitative study on perspectives and experiences among midwives and gynaecologists in the Netherlands

BackgroundHealthcare professionals (HCPs) play a significant role in the decision-making process of pregnant women on maternal vaccinations. Whereas a high proportion of HCPs discuss maternal vaccinations with pregnant women, confidence in discussing maternal vaccinations is lacking and HCPs experience inadequate training to discuss maternal vaccinations with pregnant women. Furthermore, different practical barriers might influence the consultation process, such as lack of time. More studies on the barriers, as well as facilitators, to discussing maternal vaccinations is needed and will help us to better understand and support HCPs in discussing maternal vaccinations.MethodsThis qualitative study involved semi-structured interviews with fourteen HCPs working as midwives or gynaecologists in the Netherlands. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis was conducted using inductive and deductive approaches. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.ResultsThe thematic analysis of the data pointed to the following five themes of HCP counselling: the consultation process, attitude, perceived norm, perceived control and improvement ideas. Most HCPs follow a similar approach in maternal pertussis vaccination consultations, beginning by assessing clients’ understanding, providing basic information, and addressing questions. However, consultation timing and prioritization vary among HCPs. Challenges in consultations include client requests for clear advice, with HCPs trained to remain neutral, emphasizing client autonomy in decision-making. Most HCPs acknowledge the importance of their consultations in informing pregnant women about maternal pertussis vaccination.ConclusionsThis study offers a confirmation of the awareness of the pivotal role of HCPs in informing pregnant women about the maternal pertussis vaccination. HCPs stress the importance of neutral counselling, enabling pregnant women to make well-informed decisions independently. Because of upcoming vaccine hesitancy nowadays, HCPs must be equipped with the knowledge and confidence to navigate difficult conversations. Continuous education and training might help to increase HCPs’ confidence in handling difficult consultations. Additionally, making the information materials for pregnant women available in multiple languages and incorporating more visuals to enhance comprehension could support HCPs in reaching a broader group of pregnant women.

Life and Death: A Multicenter Study Evaluating Cardiologists' Approach to Difficult Conversations with Fontan Patients and Families.

Outpatient cardiologists provide longitudinal care for Fontan patients. As these patients age, they face mounting morbidities, necessitating challenging conversations about prognosis and goals of care. We created a novel survey to evaluate cardiologists' attitudes surrounding risk counseling for patients/caregivers. Cardiologists were recruited during concomitant outpatient enrollment of individuals with Fontan operation > age 10. Physician demographic data, expectations of timing in discussing adverse event risk, and perceived barriers were collected. Barriers were analyzed using a thematic approach. 40 cardiologists (9 institutions) responded regarding 155 patients (mean age 21.2years, SD 7.7). Physicians were mostly male (58%) with mean practice of 21years post-fellowship (SD 12). Most felt the time was right to have a conversation with patient (55%) and family (62%), and majority thought patient (53%) and family (75%) were ready for such a conversation. Most had previously discussed prognosis with patient (72%) and family (75%). Providers were inclined to discuss risk with caregivers earlier (mean patient age 9years, SD 11) than patients (mean patient age 17years, SD 6.4). Nevertheless, 42% of physicians perceived significant barriers and provided 58 narrative comments categorized into 4 major themes: (1) Patient-related (53.4%), including cognitive limitations and mental health; (2) Provider-related (16.4%), including lack of familiarity, preservation of happiness, and discomfort; (3) Family related (12.3%), including protection/denial and psychosocial stressors; (4) Other (26%), including social barriers. Experienced cardiologists are willing to have difficult conversations; nearly half reported largely patient-related barriers. Facilitating these conversations is critical for the adolescent/young adult with Fontan physiology.

Geographical storylines and the Russian invasion of Ukraine: Narrative power and narrative taboos, a (difficult) conversation

Geographical storylines and the Russian invasion of Ukraine: Narrative power and narrative taboos, a (difficult) conversation

How to have a positive “Adult Conversation” in the workplace

Have you ever dreaded a coaching session at work, worried it might turn into an argument? “How to Have a Positive ‘Adult Conversation’ in the Workplace,” offers practical advice to make these tough talks easier and more productive. Author Douglas Pflug, draws from his book *Ironwill 360° Leadership*, provides a step-by-step guide to help you handle these conversations smoothly. The article starts by showing you how to prepare: set clear goals, gather facts, and make a plan. It also stresses the importance of choosing a quiet, private space where you and the employee can talk openly. Start the conversation on a positive note, be clear about the issues, and listen to the employee’s side. Instead of focusing on personal faults, address specific behaviours and work together on solutions. Pflug’s approach is all about making these discussions clear, respectful, and effective. By following his tips, you can turn difficult conversations into chances for growth and improvement, creating a better work environment for everyone.

Designing and Teaching Courses on Sex, Gender, and the Brain: Two Implementations in the Undergraduate Classroom.

Courses on the neuroscience of sex and gender can support inclusive and integrative neuroscience curricula. Developing and teaching such courses, however, can be intimidating for educators due to the subject's complexities and nuances, the increasingly politicized nature of the subject material, and the difficult conversations that the material invites. In this article we discuss how we approached the development of two undergraduate courses on sex, gender and the brain. In describing our thought process we discuss the institutional contexts for our courses and the rationale for the selected course structures, learning objectives, and content. We also describe how we fostered inclusive learning environments - particularly within the context of the COVID-19 pandemic - and implemented course activities and diverse assessments aligned to the course learning objectives. We hope that readers of this article can apply our insights into developing courses on sex/gender in neuroscience at their home institutions.

Framing interactivity in complex communication of debate talk show

Abstract The present study explores how disagreement space is managed in a multiparty argumentative activity of debate talk show that focuses on the political situation in Belarus. The communicative activity under study is viewed as a type of difficult conversation that takes place between two groups that differ in their ideologies (Ellis 2020). In particular, drawing on the polylogical framework of argumentation (Lewiński and Aakhus 2023) and communication design approach (Aakhus 2007), the study investigates the communicative practice of framing that the moderators and the debaters use to shape disagreement space. The analysis shows that the activity is polylogical not just in a sense of positions, participants, and places (Lewiński and Aakhus 2023), but also in how argumentative activity is framed, which has consequences for how the interactivity is constructed and how disagreement space is managed in the course of interaction. It also shows how the interweaving of negative and positive features of communication add to the complexity of difficult interaction.

Difficult Conversations as Self-Regulatory Conflicts

Difficult Conversations as Self-Regulatory Conflicts

Fostering Connection, Managing Tension: Navigating Difficult Conversations in Organizations

Fostering Connection, Managing Tension: Navigating Difficult Conversations in Organizations

How Do We Manage Difficult Conversations?

How Do We Manage Difficult Conversations?

Who handles the tough talk? Supervisor sense of power and confronting difficult issues

AbstractAddressing difficult, controversial, or sensitive issues with employees is a critical component of effective leadership, but discussing uncomfortable topics with subordinates can be daunting, even for those with structural power. Distinguishing between the structural power that supervisors hold, and their situationally felt personal sense of power, we consider here how a supervisor's personal sense of power relates to his or her inclination to confront, or to avoid, difficult conversations, as well as to offer social support in such contexts. Integrating a social role theory perspective, we further consider the role of gender. Across an initial study (N = 588), and a follow‐up replication study (N = 567), we show that personal sense of power predicts supervisor's inclination to confront (and not to avoid) difficult issues in the workplace, as well as to offer social support to the target of conversation. We also consider whether such effects vary across male and female supervisors, finding inconsistent results across studies. In Study 1a, we found that power had less of an effect on the avoidance and support intentions of women than men, such that women (but not men) were more likely to constructively confront the difficult issue head on as well as to offer support, even when they felt low in personal power. These effects did not emerge in Study 1b. However, in both studies, we find a main effect of gender on social support such that women were more likely to provide social support when confronting difficult issues. We speculate about reasons for this inconsistency, and further theorize about the role of personal sense of power and gender in explaining supervisor's engagement in difficult conversations.