Physicians need more formal training on delivering bad news: study

To announce death, to inform about a terminal disease, to explain the details of extremity- or organ-function loss. Through their careers, doctors have no choice but to deliver a wide variety of unfortunate news.A a new cross-sectional study led by Dr. Eray Serdar Yurdakul, a medical professor at the Univeristy of Health Sciences in Instanbul found this task to be a source of anxiety for about half (50.8%) of physicians“These rates may have increased with the increase of having to break the news regarding COVID-19 infections before the pathology is known,” he wrote with his co-authors.Published in Humanities and Social Sciences Communications, the study surveryed 120 physicians working in COVID-19 wards and looked at both physicians working in internal medicine and surgical branches.“The COVID-19 pandemic revealed the physicians’ need for education on “breaking bad news”,” wrote the authors, who found approximately 68.3% of the physicians did not received any kind of training on breaking bad news, and of the 120 physicians that the coauthors surveyed, only 14.2% of them stated they “always” felt competent when doing so. Institutional support is needed to protect healthcare workers from associated mental health problems, the authors concluded. The anxiety around breaking bad news is an added pressure to the mental load of healthcare workers, which during a pandemic in particular, is already heavy.The study found the most common underlying cause of that anxiety (50%) was the patient’s response to bad news.The most distressing aspects of breaking bad news to patients or their relatives were announcing a death (65.8%), informing patients about a fatal disease (13.3%), and informing patients about extremity- or organ-function loss (8.3%). Announcing the death of a COVID-19 patient to relatives also caused anxiety for physicians, since the physician in these circumstances is also at risk of developing an infection themselves.The researchers suggest the current “SPIKES” six-step protocol (setting preparation, perception of the condition, invitation to give information, knowledge, explore emotions, and strategy and summary) may not be sufficient in pandemic processes, when there are uncertain medical conditions. “It is important to plan the training of clinicians, starting from the undergraduate period, to be both practically and theoretically adequate in terms of communication techniques, especially when breaking bad news,” wrote the researchers. While face-to-face training remains invaluable, the researchers suggest digital technologies like video conferences and webinars are alternatives for physicians. Establishing supportive policies and providing training through both online and simulation-based platforms can help alleviate the stress physicians feel with this responsibility.

Physicians need more formal training on delivering bad news: study

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