Article
Breaking bad news – concept and evaluation results of a postgraduate course for physicians
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Authors
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Eva Herrmann
- Med. Klinik m. S. Hämatologie, Onkologie, Tumorimmunologie, Robert-Rössle-Klinik, HELIOS Klinikum Berlin-Buch, Charité, Universitätsmedizin Berlin, Campus Buch, Deutschland
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Jan Schildmann
- Abt. für Medizinische Ethik und Geschichte der Medizin, Ruhr Universität Bochum
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Amelie Klambeck
- Klinik und Poliklinik für Allgemeinmedizin, Naturheilkunde, Psychosomatik und Psychotherapie. Abteilung für Psychosomatik und Psychotherapie der Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin
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Heiderose Ortwein
- Klinik für Anästhesiologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Campus Mitte
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Carsten Schwarz
- HELIOS Klinikum Emil von Behring , Lungenklinik Heckeshorn, Berlin
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Jochen Vollmann
- Abt. für Medizinische Ethik und Geschichte der Medizin, Ruhr Universität Bochum
| Published: | March 20, 2006 |
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Outline
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Introduction: Breaking bad news such as the diagnosis of cancer is a frequent task of doctors working in the field of medical or surgical oncology. So far, few physicians in Germany receive any training on this demanding aspect of clinical practice, although international research gives evidence that communication skills can be improved by practical training. We present the concept of a postgraduate course for physicians on breaking bad news and the results of the course evaluation.
Methods: The course takes place on two days and comprises 11,5 hours. Participants work in small groups in the presence of an experienced facilitator. Key methods include role plays and conversations with simulated patients as well as feedback from the group and group discussions, following the principle of peer group learning. For evaluation purposes, a questionnaire using closed-ended questions and likert-scales is distributed before and immediately after the course.
Results: Between October 2003 and November 2004 six courses had taken place. 37 physicians (response rate: 84,1%) from seven specialities returned the questionnaire. 28 respondents had broken bad news more than 5 times per month. Disclosing the news that there was no other option of curative treatment was rated as one of the most difficult communication situations by half of the respondents (N=18; 48,7%). With one exception all physicians denied the existence of guidelines on breaking bad news in their institutions. The respondents rated their communication skills better at the conclusion of the course, the difference being significant. The course’s relevance for clinical practice, the teaching methods and the organisation of the course were rated positively.
Conclusions: The interest in this optional postgraduate course and the feedback of the participants indicate the necessity of professional training on difficult communication situations such as breaking bad news. The improved self-rating of communication skills may be interpreted as a positive effect of the course. Observational studies are required to confirm the effects of the training on the communication of the participating physicians.
