Qualitative Assessment of Bad News Delivery Practices during Miscarriage Diagnosis

Abstract

Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women’s distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women’s experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.

Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction

“…Intern OSCEs from the graduating classes of 2015-2018 were identified and reviewed (n = 40) [ 21 ]. OSCEs in that time frame consisted of counseling a patient on an unexpected miscarriage.…”

“…Specific behaviors the focus group identified as important positive and negative behaviors exhibited by healthcare providers when delivering sensitive information [21].…”

“…The women identified specific behaviors as important do's and don'ts of breaking bad news [21], which are in agreement with behaviors identified in previous literature [3,[22][23][24][25] including the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Summarize) protocol [26]. Other important behaviors cited in the literature that were not specified by this group include ensuring patients receive bad news in person [25], allotting enough time to address all patient questions [25], arranging for the proper setting [26], asking for an invitation to share information and determining with the patient how much information is desired [26], and warning the patient bad news is coming prior to sharing [26].…”

“…These identified behaviors [21], along with evidence from previous literature [3,[22][23][24][25][26] and reviews of our prior OSCE performances, formed the basis of a novel four-minute video highlighting a patient encounter. In this video, members of the study team (T.S., T.T.)…”

Reframing How Early Pregnancy Loss Is Viewed in the Emergency Department

“…Unfortunately, despite the high frequency of miscarriages, studies from around the world continue to report that emergency departments (EDs) often fail to support women through the complexity of this experience by not providing the compassionate care and emotional support required during this traumatic time (Lee & Slade, 1996; MacWilliams et al, 2016). Other research has shown that these difficult experiences are compounded by ineffective communication with providers, who struggle to deliver bad news using patient-centered dialogue (Brann et al, 2020). Health care providers tend to focus on the physical aspect of miscarriage and overlook the social and psychological components of this experience, which coupled with a societal shroud of silence around miscarriage, leads to women feeling a lack of support and vulnerable to mental distress (Evans et al, 2002).…”