Difficult News Research Articles

Confronting Adversity: How the COVID-19 Pandemic Impacted Receiving Difficult News in Neonatal Intensive Care Units.

In neonatal intensive care, the communication of difficult news can have lingering repercussions throughout the lives of those receiving such information. Uncertainty and stress associated with the COVID-19 pandemic may negatively influence this sensitive yet essential communication process. To analyze the communication of difficult news during the COVID-19 pandemic from the perspective of parents of newborns admitted to a neonatal intensive care unit. A qualitative, descriptive research study was completed in a hospital in Brazil. Individual and semistructured interviews were conducted with 21 parents of newborns hospitalized in an intensive care unit and submitted to thematic analysis. Three themes were built: "Tools and strategies to manage difficult news," "What makes difficult news hard to listen," and "The importance of being prepared to receive difficult news." When comparing these findings with prepandemic literature, the COVID-19 period changed communication dynamics, including coping tools and altered family dynamics. Additionally, assessing healthcare providers' positive and negative behaviors by parents could clarify essential skills to support the family's hospitalization process during a crisis. Applying and investing in skills training such as spirituality assessment, providing clear and straightforward information, and empathy can reduce the impact of difficult news and, thus, requires both recognition and action from healthcare professionals. Knowing some of the effects COVID-19 had on the communication process for parents with critically ill infants, healthcare providers can better prepare themselves for communication in several scenarios and establish successful interactions.

Curriculum Innovations: Enhancing Skills in Serious Illness Communication in Neurology Residents Using Simulation: A Pilot Study.

Patients with acute ischemic stroke are faced with prognostic uncertainty, progressive decline, and early mortality. Many neurologists report a lack of education and experience in providing palliative care. We developed a simulation-based curriculum to improve residents' confidence and comfort with conducting late-stage goals of care (GOC) conversations. To assess and improve neurology residents' self-reported confidence and comfort around GOC discussions, prognostication, and hospice; encourage neurology residents to conduct GOC conversations early in the illness; introduce neurology residents to a structured framework for conducting GOC conversations; facilitate the residents to build rapport and convey a mindful presence during GOC conversations; provide direct, real-time feedback and an opportunity for redo and practice; and identify gaps for education. The 3-hour experience included a didactic session followed by an interactive simulation and debriefing. The residents' objectives were to deliver difficult news, discuss prognosis, explore goals, navigate treatment options, and discuss end-of-life care including hospice. The faculty observed each interaction and called time-outs to allow the residents to self-assess and obtain feedback. Residents and faculty debriefed to identify take-home points and to reflect on their emotions, self-care, and sense of purpose in medicine. Twenty-six neurology residents filled out an anonymous presurvey to self-assess their confidence and comfort surrounding GOC conversations. More than 50% of residents reported being confident in conducting GOC discussions, whereas only 42% reported adequate prior training. Postsession, more than 90% of residents reported that training was relevant, helpful, organized, and clear. Faculty identified that residents had difficulty addressing prognosis, assessing goals, planning treatment, and using silence, responding to emotion, and displaying empathy. Fifteen residents filled out a postsurvey that revealed improved comfort with delivering prognosis, discussing hospice, and initiating early GOC discussions. Our project uniquely focuses on late-stage GOC conversations and builds on existing literature that supports a structured program with both didactic and simulation components to improve residents' abilities to effectively navigate GOC conversations with patients and families. Future work will focus on reinforcement and reassessment of communication skills.

Navigating obstetric bad news: Insights from tertiary care medical teams

ObjectivesTo analyze the self-reported perception of obstetric medical teams regarding the practice of delivering bad news in public and private hospitals. MethodsCross-sectional study considering physicians delivering obstetric care at the Municipal Hospital Vila Santa Catarina, Municipal Hospital Dr. Moysés Deutsch, and Albert Einstein Israelite Hospital, in São Paulo, Brazil. The applied questionnaire reflected the steps of the SPIKES protocol for delivering difficult news, with the questions adapted to obstetric and fetal medicine practice context. ResultsSpecialists self-reported higher levels of knowledge, better emotional management, and superior strategy planning and summarization skills than residents. Participants with more than five years of experience reported higher knowledge levels, better emotional management, and superior strategy development skills. When comparing professionals from private and public hospitals, no significant differences emerged in self-reported communication aspects. ConclusionsExperience duration significantly influences professionals' impressions in their ability to provide information, manage emotions, and plan post-diagnosis. Specialists and those with more years of experience self-report enhanced readiness in executing communication steps effectively.Practice implications:Our findings underscore the importance of tailored training and experience in navigating sensitive medical conversations in the field of Obstetrics.

Oral cancer diagnosis communication: Impact of an educational intervention using the SPIKES protocol.

This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses. A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube. Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased. A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative. Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.

Assessing“Breaking Bad News” Communication Competency in Midwifery Students

The communication task of conveying difficult news to patients by health care providers, described in the literature as “breaking bad news,” is one that is often performed poorly. There is, at the same time, a relatively small amount of research in the health sciences education literature devoted to the assessment of this particular competency. Like other health care providers, registered midwives in Canada are expected to have knowledge and skill in this domain of communication. In the Ontario Midwifery Education Program, senior students are expected to develop competence in managing situations involving loss during the childbearing year; however, there is little guidance for preceptors with respect to the assessment of performance for this skill. This article reviews the relevant literature on the assessment of “breaking bad news” and workplace assessment tools in health education, and proposes the use of a clinical encounter card that uses a modified Breaking Bad News Assessment Scale to assist and guide preceptors. Further investigation of the tool’s reliability, validity, and acceptability to preceptors is needed. This article has been peer reviewed.

Breaking bad news: A mix methods study reporting the need for improving communication skills among doctors in Pakistan

BackgroundEffective skills and training for physicians are essential for communicating difficult or distressing information, also known as breaking bad news (BBN). This study aimed to assess both the capacity and the practices of clinicians in Pakistan regarding BBN.MethodsA cross-sectional study was conducted involving 151 clinicians. Quantitative component used a structured questionnaire, while qualitative data were obtained through in-depth interviews with 13 medical educationists. The responses were analyzed using descriptive statistics and thematic analysis.ResultsWhile most clinicians acknowledged their responsibility of delivering difficult news, only a small percentage had received formal training in BBN. Areas for improvement include time and interruption management, rapport building, and understanding the patients’ point of view. Prognosis and treatment options were not consistently discussed. Limited importance is given to BBN in medical education.DiscussionTraining in BBN will lead to improved patient and attendants’ satisfaction, and empathetic support during difficult times.

10 tips to make difficult conversations easier

The world of higher education offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

10 tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less‐rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

Ten tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

Ten tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures, including commencement, awards ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

10 tips to make difficult conversations easier

Academia offers plenty of rewarding pleasures; consider commencement, award ceremonies, and student “a‐ha” moments, among others. We also face daily stresses and challenges. One less rewarding academic duty is the delivery of difficult news. This need arises for multiple reasons, including policy violations, negative performance reviews, academic dishonesty, and conflict resolution.

Communicating difficult news in pediatric radiology.

Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish… I worry… I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations.

Embedding simulation in genetic counselor education from the first week of training: Learning outcomes, standardized clients, and students' satisfaction.

Health professional educators routinely utilize simulation to prepare students for practice. However, there is little evidence to show whether simulation enhances learning for genetic counseling students. This study aimed to (i) develop simulation learning outcomes and standardized clients for genetic counselor student education and (ii) evaluate students' experiences of learning from face-to-face and virtual simulation in the first week of training in an Australasian master of genetic counseling program. Using the principles of co-design, eight experienced genetic counselors from across Australasia attended an online discussion and one-to-one meetings to develop simulation learning outcomes and build detailed authentic standardized clients. Six learning outcomes were identified: establishing an effective counseling relationship, eliciting information, assessing need, delivering difficult news and helping clients cope with complex emotions, effective communication and facilitating adaptation. Standardized clients were mapped to the learning outcomes and other requirements of the program. Between 2019 and 2022, 106 first year students participated in face-to-face or virtual simulation workshops with two standardized clients on Day 5 of their training. Following the experience, 103 students completed an anonymous survey using a modified version of a validated satisfaction with simulation scale (n = 49 face-to-face in 2019 and 2020 and n = 54 virtual in 2021 and 2022). Responses were analyzed using descriptive statistics and content analysis. Mean satisfaction overall was 95.9% (SD 3.5), 96.2 (SD 4.0) face-to-face, and 95.8 (SD 3.7) virtual. Overall, responses indicated that simulation-based learning and working with standardized clients was a valuable learning experience (100%), developed communication skills and created a sense of reality (99%). For a minority of participants (n = 4), the simulation was too challenging. Key learning related to consolidation of counseling skills, reflective practice, and preparation for clinical placement. In conclusion, exposing novice student genetic counselors to authentic clinical scenarios using standardized clients in face-to-face or virtual classrooms enhanced clinical learning.

The interaction of nurses with patients and family when expressing difficult news: A study using video recordings

Objectives: To evaluate and explore nurses’ communication skills when providing difficult news to patients and their family members. Methods: A cross-sectional study was performed. The study employed a combination of qualitative and quantitative observations to analyze 49 videos recorded nurses’ interaction with standardized patients in a communication training course from 2019 to 2021. A validated checklist named The Liverpool Communication Skills Assessment Scale was used to quantitatively evaluate the level of nurses’ communication skills, and qualitative comments provided by observers were explored to explain quantitative results found. Results: The “nonverbal behavior” component of nurses’ communication was at acceptable levels, however, other components including “introduction”, “respect and empathy”, “questioning” and “giving information” were at poor levels. Conclusion: Communication skills of “introduction”, “respect and empathy”, “questioning” and “giving information” of nurses in adverse situations need to be improved, and hospital’s leader board should have viable measures to raise nurses’ awareness about providing truth to the patients or family.

Pediatric palliative care and childhood neurosurgery: reflections based on a quantitative analysis of a survey data

INTRODUCTION: In recent years, the profile of pediatric patients has changed, with the need for assistance for children living with chronic and life-threatening diseases becoming increasingly frequent. In this scenario, Pediatric Palliative Care (PPC) emerges as an integral and respectful form of assistance for these patients and their families. Understanding that neurosurgery is an extremely important area within Pediatric Palliative Care, as there are many intersections between the two areas, this research aimed to reflect on how this interaction is being carried out in practice. MATERIAL AND METHODS: It is an observational, descriptive, cross-sectional study, of survey type, in which the study population was composed of a convenience sample, using the snowball strategy. Analyses were performed with the aid of the statistical program Stata version 13.0 (Stata Corp, L. C.). Results are presented as frequencies and 95% confidence intervals, graph, and table. RESULTS: The sample represented 90 PPC services, almost all of which have physicians (97.90%). Among the medical specialties, none of the services reported having a neurosurgeon on the team. DISCUSSION: Several themes required by the National Medical Residency Commission for the training of neurosurgeons cover Pediatric Palliative Care, such as pain, bioethics, communicating difficult news and others. Therefore, the real rapprochement of the two areas is extremely important to ensure comprehensive care for the patient. CONCLUSIONS: There are important gaps between Pediatric Palliative Care and Pediatric Neurosurgery, reinforcing the importance of including the topic for neurosurgery residents and continuing education for those already trained.

Early phase clinical trials in pediatric oncology: Swedish pediatric oncologists' experiences of balancing hope and expectations in life-threatening illnesses.

To study Swedish pediatric oncologists' practical and emotional experiences of referring, including and/or treating children in early-phase clinical trials. A nationwide study was conducted using a mixed-method approach. Structured interviews based on a study-specific questionnaire and participants' personal reflections were utilized. Survey responses were analyzed using descriptive statistics, while participants' comments were analyzed using thematic analysis. All interviews were recorded and transcribed verbatim. In total, 29 physicians with 4 to 32 years of experience in pediatric oncology participated, with 19 (66%) having > 10 years of experience. Three themes appeared: 1) Optimization-based approach focused on finding the most suitable treatment and care for every child with a refractory/relapsed cancer eligible for an early-phase clinical trial; 2) Team-based approach aimed at establishing local and national consensus in decision-making for treatment options, including early-phase clinical trials and palliative care; 3) Family-based approach in which the physicians provided families with actionable information, listened to their desires, and endeavored to maintain hope in challenging circumstances. Several participants (40% with ≤ 10 years of experience and 58% with > 10 years of experience) viewed the early-phase clinical trial as a potential "chance of cure". A majority (80%) of physicians with ≤ 10 years of experience, reported that they often or always felt personally and emotionally affected by communication regarding early-phase clinical trials. Delivering difficult news in cases of uncertain prognosis was identified as the major challenge. None of the study participants felt adequately prepared in terms of sufficient knowledge and experience regarding early-phase clinical trials. The physicians expressed a need for guidance and training in communication to address these challenges. Working with early-phase clinical trials highlight a field where physicians cannot solely rely on their expertise or past experiences, and where they are likely to be deeply emotionally involved. Physicians who care for children eligible for such studies require targeted educational initiatives and supervision.

Physicians' Self-Perceived Competence on Breaking Bad News to Parents of Children with Neurodisabilities.

Delivering difficult news to parents of children with neurodisabilities, often involving new diagnoses, prognosis changes, or declines in function or health, presents a complex task. Our aim was to assess physicians' self-perceived competence in breaking bad news (BBN) within this context. An online survey was administered to neuropediatricians and developmental and rehabilitation pediatricians in Switzerland. Among 247 invited physicians, 62 (25.1%) responded (age of 51 ± 11 years; M/F ratio of 2:3). They rated their BBN competence at 7.5 ± 1.6 out of 10. Factors significantly associated with self-perceived competence in uni- and multivariate analyses included years of professional experience (≤10 years: 6.2 ± 1.8; >10 years: 8.2 ± 0.8), and region of pregraduate training (Switzerland: 7.3 ± 1.6; European Union: 8.3 ± 0.9). The respondents highlighted the positive roles of professional and personal experience, quality relationships with families, and empathy in BBN. In summary, physicians generally expressed a sense of competence in delivering difficult news to parents of children with neurodisabilities. They underscored the significance of life experiences and certain individual qualities in their effectiveness. These findings provide valuable insights into enhancing professional training and support in this crucial yet underexplored aspect of medical practice.

Cross-college collaboration to implement an interdisciplinary simulation for healthcare students to deliver difficult news: A short report

Cross-college collaboration to implement an interdisciplinary simulation for healthcare students to deliver difficult news: A short report

Exploring the impact of virtual SPIKES training on genetic counselors' confidence to deliver difficult news.

Delivering difficult news is a common occurrence in genetic counseling. This is evidenced by widespread instruction among genetic counseling programs. There is a disconnect in the confidence level of being able to deliver difficult news (DDN) following educational training across healthcare disciplines. Other healthcare professions have addressed this issue with simulation-based training based on the SPIKES protocol, a stepwise process for delivering difficult news. To our knowledge, there is limited research that investigates the impact of simulation-based training in delivering difficult news for genetic counselors. Our aim was to develop simulation-based training in how to deliver difficult news for genetic counselors and analyze the extent to which it increased their confidence to deliver difficult news. Board-certified genetic counselors from all specialties were recruited to participate in a 2-h training session which included the opportunity to practice delivering difficult news. We collected self-reported confidence scores in each of the SPIKES steps from 16 genetic counselors pre- and post-intervention. Participants answered open-ended evaluations about the program's strengths, weaknesses, and gaps in delivering difficult news content. Almost all participants (N = 15) stated that they had gained confidence in delivering difficult news following training completion. Confidence significantly improved in four of seven SPIKES steps. Participants found strengths of the training program to be in their ability to practice with a simulated patient, to reference concrete examples, and to follow the program easily. The results of this study suggest that post-graduate training in how to deliver difficult news using the SPIKES protocol may strengthen genetic counselors' confidence in performing this important skill.

NeoTalk: Communication Skills Training for Neonatal Clinicians.

Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after "NeoTalk" and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses. We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course. Wilcoxon signed rank tests and Kruskal-Wallis tests were performed to compare participant responses across time points. 34 providers completed NeoTalk training. Complete pre- and post-course data was available for 29 participants. Participants reported increased comfort with skills including 'sharing difficult news' (P = .018), and 'responding to emotion' (P = .002). Participants did not report increased frequency in using target skills 2 months after training. A multi-disciplinary cohort of NICU providers endorsed increased confidence in key communication skills but not increased skill application 2-months post-course completion. While a single course can successfully teach skills, additional exposure may be necessary to build new communication habits. Our experience developing NeoTalk helped elucidate some of the ways in which conversations about seriously ill infants may be different from conversations about seriously ill adults.