Can Doctors Be Taught To Deliver Bad News?

Communication: Yes, is the short answer given in this meta-analysis of 17 studies evaluating interventions to “improve the communication of bad or difficult news”.  Most interventions were fairly brief stand-alone interventions involving simulation or role-play; the SPIKES model was the most commonly used framework for instruction.  The two most commonly assessed outcomes were observer-rated skill during a simulation exercise and physician self-rated confidence.  Both of these measures showed robust short-term improvement following training.  The authors mention the desirability of looking at longer-term outcomes and patient-centered outcomes.  This reviewer would advise some caution on measuring the latter.  Prior work has shown that patients with Stage 4 incurable cancers who did not understand they were terminally ill rated their oncologists’ communication skills better than patients who accurately understood their situation. — Laura Willett, MD

Johnson J, Panagioti M. Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis. Acad Med. 2018 Jun

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