Barriers to breaking bad news among medical and surgical residents

Abstract

Introduction Communicating ‘bad news’ to patients and their families can be difficult for physicians. Objective This qualitative study aimed to examine residents’ perceptions of barriers to delivering bad news to patients and their family members. Design Two focus groups consisting of first‐ and second‐year medical and surgical residents were conducted to explore residents’ perceptions of the bad news delivery process. The grounded theory approach was used to identify common themes and concepts, which included: (1) guidelines to delivering bad news, (2) obstacles to delivering bad news and (3) residents’ needs. Setting McMaster University, Hamilton, Ontario, Canada. Subjects First‐ and second‐year residents. Results Residents were able to identify several guidelines important to communicating the bad news to patients and their family members. However, residents also discussed the barriers that prevented these guidelines from being implemented in day‐to‐day practice. Specifically, lack of emotional support from health professionals, available time as well as their own personal fears about the delivery process prevented them from being effective in their roles. Residents relayed the need for increased focus on communication skills and frequent feedback with specific emphasis on the delivery of bad news. The residents in our study also stressed the importance of processing their own feelings regarding the delivery process with staff. Conclusions Although most residents realize important guidelines in the delivery of bad news, their own fears, a general lack of supervisory support and time constraints form barriers to their effective interaction with patients.

Predictors and Correlates of Burnout in Residents Working With Cancer Patients

“…Among personrelated variables, being a men [3], young [4], unmarried [5] and introverted [6] have been reported to be weakly or moderately related to residents" burnout. Other variables such as stress to deliver bad news are reported by residents as preventing them from being effective in their roles [7] and may thus also contribute to their burnout. Among work-related variables, organization-related variables such as work overload [8] and work-home interference [9] have been reported to be strongly related to residents" burnout.…”

An Overview of Teaching Communication of Bad News in Medical School: Should a Lecture be Adequate to Address the Topic?

“…4 Nowadays, there is growing evidence that patients often want to know everything about their disease, 5 increasing doctor's responsibility in delivering bad news in the right way to strengthen the patient-doctor relationship, and avoid litigation.…”

A Simulation-Based Curriculum To Address Relational Crises in Medicine

“…Review of the literature reveals this ubiquitous task is distressing for health care professionals and cites inadequate training, absence of supervisor support, and lack of skill as barriers to effectiveness. [1][2][3][4] Poorly communicated bad news can lead to patient and family misunderstanding, adjustment difficulties, negative attitudes toward health care providers, and decreased satisfaction with care. 1,[5][6][7] We sought to address this situation by developing a simulation-based curriculum to enhance the skills of health care professionals in communicating difficult news, hereafter termed relational crises.…”