Flare in knee and hip osteoarthritis (OA) is more than just an exacerbation of pain. Unstructured, semistructured, and focus group interviews followed by Delphi surveys with patients and health professionals (HP) generated candidate domains of an OA flare. Content analysis of interviews with 29 patients and 16 HP extracted 180 statements, which were grouped into 9 clusters. Delphi consensus with 50 patients (Australia, Canada, and France) and 116 HP (17 countries on 4 continents) identified 5 flare domains: pain, swelling, stiffness, psychological aspects, and effect of symptoms. Elements for a preliminary definition of an OA flare are proposed. Registered at clinicaltrials.govNCT02892058.

BackgroundAlthough most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients’ emotions and the importance of considering the patient’s environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term.ObjectiveThis project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease.MethodsBReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients’ condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians’ relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection).ResultsThe good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning.ConclusionsThe objective of this Web-based assessment tool was to create a “space” for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less t...

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Objective: Although most physicians in a medical setting have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and non-verbal skills, the ability to recognise and respond to patients' emotions and the importance of considering the patient environment such as culture and social level. How bad news is delivered can have consequences that may affect patients sometimes definitively.The goal of the project was to develop an online formative self-assessment tool for physicians to practice delivering bad news so as to minimize the deleterious effects of a poor way of disclosing bad news about a disease, whatever the disease.Methods: BReaking bAD NEws Tool (BRADNET) items were developed by using a review of the existing protocols and recommendations for delivering bad news and patient-physician communication assessment instruments and semi-structured interviews with patients and physicians. From this step, the themes were selected and then pooled before consensus on a good practices communication framework list. Items were then created from this list. To ensure that physicians found the BRADNET acceptable, understandable and relevant to their condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was then used to explore the impact of the items and messages and why and how these messages could change physicians' relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). Results:The good practices communication framework list consisted of 70 specific issues in breaking bad news pooled in 8 main domains: opening, preparing for the delivering bad news consultation, communication techniques, consultation content, attention, physician emotional management, shared decision making and relationship between the physician and the medical team. Following the construction of the items from this list, the items were extensively refined to make it more useful to the target audience.The BRADNET contains 71 items, each including a question, response options and a corresponding message. These 71 items were divided into 8 domains and assessed with 12 self-assessment sessions.2 Conclusion: The self-assessed training tool is Web-based. Its objective is to create a "space" for reflection. It contains items leading to self-reflection and messages introducing recommended communication behaviors. The interest in our approach lies in providing a distance-learning self-assessment tool that is not expensive and is more manageable and less time-consuming for physicians with often overwhelming schedules.