Teaching Physicians How to Break Bad News

Abstract

Objective To evaluate the effectiveness of a training program using standardized parents (SPs) to improve the performance of pediatric intensive care fellows in communicating bad news to parents. Design Self-controlled crossover design. Setting Tertiary pediatric intensive care unit in a university-affiliated children's hospital. Participants Seven pediatric intensive care fellows and 4 trained volunteers (2 sets of SPs) participated in the study. Methods Two case scenarios of children admitted to the intensive care unit with a near-fatal diagnosis were used for the fellow's interactions with the SPs. The SPs had received 15 hours of training in role playing, performance evaluation, and giving feedback to the physicians. At the end of the first session, SPs provided feedback to the physicians under each of the 5 following categories: communication skills, content issues, support systems, interventions, and parent perceptions. During the second session, the parent meeting was repeated with a new but similar case scenario and a different set of SPs. Both sessions were videotaped, and a rater blinded to the order of the sessions used a weighted scale based on a checklist to score changes in physician performance. Results The performance by the fellows showed a significant mean (±SEM) improvement in scores of 18.1 (±5.2) points ( P =.007) between the first and the second sessions. Ranking of session scores revealed that physician performance improved significantly during the second session (Wilcoxon signed rank test, P =.002). Conclusions To our knowledge this is the first study that demonstrates short-term improvement in physician performance in conveying bad news in a pediatric intensive care setting using SPs in a 1-day workshop.