Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic

Abstract

In many countries, the COVID-19 pandemic resulted in restricted hospital visiting by relatives.Staff have been forced to deliver unwelcome and bad news over the telephone. There are few training resources around how to do this. We created a bespoke training package consisting of a 15 min eLearning session and a 1-hour facilitated role-play session. Two simulated telephone calls to a professional actor posing as the relative were undertaken on a speakerphone. Following each simulated call, the actor gave feedback to the caller, focusing on the likely experience of a relative during these conversations. Elements specific to telephone conversations included ensuring the safety of the recipient to take the call (eg, not driving a car), ensuring they had adequate local support, and allowing a deliberate silence after delivering the bad news. Silence has a powerful impact, despite being uncomfortable. The opportunity to have written notes before calling and to offer a return call was seen as an opportunity for improving communication. We collated these experiences into a series of phrases found most useful and empathic by the actor and participants. A practical aide- mémoir was created from this learning that could be used to help deliver bad news quickly in the emergency department.

‘I am afraid the news is not good’ – Breaking bad news in the time of COVID: Experiences from a field hospital

“…Although breaking bad news is now an integral part of most healthcare professional training, it is necessary to teach how to do it using different methods, including remotely. 8 , 9 Healthcare providers planning for future pandemics can learn not only from the dynamic multidisciplinary team but also mainstreaming regular, high-quality communication with families.…”

“…Several other settings have reported attempts to train HCWs to break news over the phone, including through simulation, but the efficacy of this approach has not been clearly demonstrated. 7 , 8 , 9 …”

The Disclosure of Bad News Over the Phone vs. in Person and its Association with Psychological Distress: a Systematic Review and Meta-Analysis

“…Recently, proposed adaptations of existing breaking bad news communication strategies for telephone and videoconference disclosure, which were based on clinical experience and experimental pilot studies, have been published. 5 , 13 , 28 – 30 These adaptations include recommendations on ensuring that patients are in an appropriate setting which may involve their significant others, exploring and acknowledging emotions verbally and expressing empathy through tone of voice. These need to be complemented by further research on the topic to facilitate the development of evidence-based communication strategies and should also include virtual patient encounters.…”