Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program

Abstract

BACKGROUND: This study aims to assess the efficacy of a 40-h training programme designed to teach residents the communication skills needed to break the bad news. METHODS: Residents were randomly assigned to the training programme or to a waiting list. A simulated patient breaking bad news (BBN) consultation was audiotaped at baseline and after training in the training group and 8 months after baseline in the waiting-list group. Transcripts were analysed by tagging the used communication skills with a content analysis software (LaComm) and by tagging the phases of bad news delivery: pre-delivery, delivery and post-delivery. Training effects were tested with generalised estimating equation (GEE) and multivariate analysis of variance (MANOVA). RESULTS: The trained residents (n ¼ 50) used effective communication skills more often than the untrained residents (n ¼ 48): more open questions (relative rate (RR) ¼ 5.79; Po0.001), open directive questions (RR ¼ 1.71; P ¼ 0.003) and empathy (RR ¼ 4.50; P ¼ 0.017) and less information transmission (RR ¼ 0.72; P ¼ 0.001). The pre-delivery phase was longer for the trained (1 min 53 s at baseline and 3 min 55 s after training) compared with the untrained residents (2 min 7 s at baseline and 1 min 46 s at second assessment time; Po0.001). CONCLUSION: This study shows the efficacy of training programme designed to improve residents' BBN skills. The way residents break bad news may thus be improved.

The effect of communication skills training on residents’ physiological arousal in a breaking bad news simulated task

“…Results of this study show that, after training, heart rate is more elevated in trained residents compared to untrained residents. This higher elevation in heart rate in trained residents -which is associated with higher self-efficacy and satisfaction about their performance in the task, with less stress to communicate [33] and with an improvement in residents communication skills [22] -may be an indicator, as hypothesized, of their engagement in performing the task. An additional explanation for these higher elevations in trained residents' heart rate may be that trained residents are more aware of the challenges of BBN and the impact for the patient of poor communication and may therefore be more motivated to engage in the task.…”

“…It should be underlined that the efficacy of the training program assessed in this study has already been shown on residents' selfefficacy about their communication, on their ability to manage their stress to communicate (residents' subjective performance) [33], on communication skills (residents' objective performance) [22] but not on their burnout levels [33]. It was hypothesized that the improvement in subjective and objective performance would be associated with an increased mental effort invested in the BBN simulated task and consequently with an elevated physiological arousal.…”

“…Residents were given immediate feedback on the communication skills performed. The three phases of the BBN process were introduced gradually [22,37]. The choice of the skills taught was based on results of studies having shown the positive impact of using specific communication skills on patients' disclosure of concerns [38].…”

“…Utterances are categorized in three main types: assessment (open and open directive questions), support (acknowledgement and empathy) and information (procedural information, negotiation and other types of information) types. A more precise description can be found in Lienard et al [22].…”

“…These programs have been shown to improve not only physicians' and nurses' self-efficacy (subjective performance) [19] but also their communication skills (objective performance) [20][21][22]. No study however has yet assessed, in a randomized controlled trial design, the effect of a communication skills training on residents' physiological arousal in a BBN simulated task.…”