When physicians lack proper training, breaking bad news can lead to negative consequences for patients, families, and physicians. A questionnaire was used to determine whether a didactic program on delivering bad news was needed at our institution. Results revealed that 91% of respondents perceived delivering bad news as a very important skill, but only 40% felt they had the training to effectively deliver such news. We provide a brief review of different approaches to delivering bad news and advocate for training physicians in a comprehensive, structured model.

Study design: Qualitative research design involving semi-structured focus groups. Objectives: To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others. Setting: Inpatient rehabilitation program in a large urban city in the Southwestern United States. Methods: A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators. Results: Through a constant comparative analysis of the data, six themes emerged in participants' responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others. Conclusion: Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI. INTRODUCTIONTraumatic spinal cord injuries (SCI) present serious public health and quality of life concerns. Costs associated with SCI are estimated at US$9.7 billion annually, with average yearly expenses per individual ranging from $508 904 to $1 044 197 in the first year following injury, and from $67 415 to $181 328 each subsequent year. 1 SCI can result from an array of issues that affect physical, psychological and social functioning, which is reflected in the high cost of health-related services. Individuals who acquire an SCI experience numerous associated and chronic conditions (for example, spasticity, heart disease) and secondary complications (for example, pressure sores, chronic pain). Depression is a significant secondary complication for B30% of individuals with SCI, which often impacts physical health. 2 In turn, depression has been associated with frequency of pressure sores, 3 urinary tract infections, spending more time in bed and longer hospital stays. 4 Given the interaction between psychological and physical health, an understanding of psychosocial functioning in the SCI population is essential. Despite an emphasis in the literature on less adaptive psychological outcomes following SCI, recent research shows that B60% of individuals who acquire SCI are not in fact depressed. 2 Recent research also demonstrates that many individuals with SCI report moderate to very high resilience and a strong sense of self-efficacy. 5 Recently, investigators have begun to explore the association between resilience and adaptation to traumatic injuries (and

Objectives: To identify (1) changes in psychosocial factors, (2) relationships between psychosocial factors, and (3) significant predictors of resilience in adults with spinal cord injury (SCI) during inpatient rehabilitation and at 3-month post-discharge. Design: Cross sectional with convenience sample based on inclusion/exclusion criteria. Setting: Inpatient rehabilitation hospital and community-based follow-up. Participants: Individuals with a SCI. Interventions: Not applicable. Outcome measures: Demographic, resilience, self-efficacy for managing a chronic health issue, depression, social roles/activity limitations, and pain. Results: The final sample consisted of 44 respondents (16 women and 28 men). Results of repeated measure analyses of variance indicated no significant changes in variables between inpatient and 3-month follow-up. Bivariate correlations revealed associations between resilience and self-efficacy at inpatient (r = 0.54, P < 0.001), and resilience and depression (r = −0.69, P < 0.001) and self-efficacy (r = 0.67, P < 0.001) at 3-month follow-up. Hierarchical regression analyses a significant model predicting resilience at inpatient stay (R = 0.61; adjusted R 2 = 0.24, P = 0.023), and at 3-month follow-up (R = 0.83; adjusted R 2 = 0.49, P = 0.022). Self-efficacy was the strongest predictor at inpatient stay (β = 0.46, P = 0.006) and depression was strongest at 3-month follow-up (β = −0.80, P = 0.007). Conclusion: Results suggest that although resilience appears to be stable from inpatient to 3-month follow-up, different factors are stronger predictors of resilience across time. Based on current results, an assessment of self-efficacy during inpatient rehabilitation and an identification of depression at 3-month follow-up may be important factors to help identify those at risk of health issues overtime.

Objective: People living with spinal cord injury (SCI) are often immunocompromised, and at increased risk of respiratory infection. Given the restrictions in response to the COVID-19 pandemic, those with SCI may be at increased risk of health deterioration, though how this is experienced is poorly understood. This study explored the experiences of people living with SCI during the COVID-19 pandemic. Design: Participants completed an online survey consisting of demographic questions, and open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized for the analytical approach. Setting: Community-based sample in the UK. Participants: Participants were recruited via social media outlets of UK-based SCI-specific support charities, and snowball sampling (N = 42, F = 34, M = 8). Results: Key themes included: (1) lost access to health services and support, capturing concerns surrounding barriers to healthcare and rehabilitation, which intensified secondary consequences of SCI such as spasm and pain; (2) health anxiety, which was perpetuated by perceived heightened vulnerabilities to respiratory complications; (3) social isolation, with significantly reduced social contact, even with care providers, compounding health experiences. Conclusion: People living with SCI during the COVID-19 pandemic experienced a variety of personal physical, psychological, and social challenges, each of which could disrupt daily functioning and quality of life. Increased utilization of telehealth is recommended to support continued engagement in rehabilitation, and foster connection and community amongst others with SCI and health professionals.

The delivery of care for people with SCI with low socioeconomic status may be remodeled to include patient-centered medical homes where care is directed by an SCI physiatrist. Further increased telehealth efforts would allow for SCI physiatrists to monitor health conditions remotely and focus on preventative treatment.