Improving the skills of doctors in giving distressing information

Abstract

In response to the growing awareness of the need to convey distressing information effectively, four workshops were held for doctors across Britain with the aim of improving skills, knowledge and attitudes. From the unexpectedly large response of 441 nominations, 20 participants were selected for each workshop. Participants identified four major concerns: how to do it; where to give distressing information; how to deal with collusion; and how to survive mentally in the work. After sessions on these areas, participants interviewed a simulated patient and were recorded on videotape for subsequent feedback. The results showed that after brief training, 91% of all participants gave a warning of distressing information, 85% gave the information at the patient's pace, but only 5% attempted to 'pick up the pieces'. Further work is required on this key aspect of clinical work.

Cancer survival in Kampala, Uganda

“…However, as with pain management, there is a need for specific training in communication skills (Faulkner et al, 1995).…”

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness

“…The other studies reviewed were all grade III (six IIIc and three IIIb). Seven were carried out in the United Kingdom [12,7,10,17,18,29,31], one in Hong Kong [1] and one in the United States [2].…”

“…Training objectives were directed towards improving the medical interview in three studies [15,17,18], assessment of psychological distress among patients in five studies [12,17,18,29,31], imparting distressing information in three studies [10,1,2], counselling in one study [17], problem solving in one study [2] and assessment of patients' needs for information in one study [8]. Fallowfield's studies [8,7,9] were more comprehensive and combined knowledge, awareness and general skills.…”

“…A similar broad approach was taken in a later study [23] to improve communication skills in general and empathy in particular. A number of studies targeted attitudes, knowledge and awareness as part of their interventions [8,15,22,7,10,29], and it was the central focus of the Jenkins and Fallowfield study [14]. Eleven studies targeted practising health professionals, and two targeted undergraduate students during their training in medicine [15,1].…”

“…The grade I randomised controlled trials had a large number of subjects ranging from 72 to 233. Faulkner et al [10], Maguire et al [18], Fallowfield et al [7] and Wilkinson et al [29,31] also included many participants (441, 212, 178, 110 and 308 [12] reported 50% attrition. Of the studies assigned grade III without randomisation or a control group, six were conducted with a single group pre-test/post-test design [12,7,17,18,31,2].…”