Delivering bad news to patients from the perspective of medical students

Freiberger, Miguel Henrique; Carvalho, Diego de; Bonamigo, Elcio Luiz

doi:10.1590/1983-80422019272316

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Research • Rev. Bioét. 27 (2) • Apr-Jun 2019 • https://doi.org/10.1590/1983-80422019272316 linkcopy

Delivering bad news to patients from the perspective of medical students

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study is to verify if medical students acquired knowledge about delivering bad news to patients during their undergraduate clinical courses. A questionnaire was applied to two groups: Group 1, which had not studied the theme and Group 2, which had already studied it. 29.41% of Group 1 knew about the Spikes Protocol and 100% of Group 2 (p=0.0001) knew about it. 25.88% of Group 1 and 81.01% of Group 2 (p=0.0001) were partially prepared for communication. 17.65% of Group 1 and 83.54% of Group 2 (p=0.0001) felt more secure after the study. 90.59% of Group 1 attributed a maximum grade to the importance of learning and 87.34% of Group 2 (p=0.8166) did the same. It was concluded that all students recognized the importance of learning about delivering bad news and the wide difference of knowledge in favor of Group 2 highlights the effectiveness of its approach during undergraduation.

Health communication; Truth disclosure; Physician-patient relations; Learning; Bioethics

Specific data	Group 1		Group 2		p
Specific data	n	%	n	%	p
Witnessed a doctor breaking bad news to a patient
Yes
Cancer diagnosis	10	12	56	71	<0.0001
Diagnosis of another disease	5	6	5	6
Patient’s death	3	3	9	11.5
No	67	79	9	11.5
Total	85	100	79	100
The physician’s communication was satisfactory
Yes	16	19	63	80	<0.0001
No	3	3.5	8	10
Non-applicable	66	77.5	8	10
Total	85	100	79	100
Has communicated some bad news to a patient
No	85	100	54	68	–
Yes. Which news?
HIV diagnosis	0	0	1	1.5
Has communicated some bad news to a patient
Worsening of disease	0	0	4	5	–
Cancer diagnosis	0	0	16	20
Patient’s death	0	0	1	1.5
Diagnosis of non-cancer / HIV	0	0	3	4
Total	85	100	79	100
Who asked you to do the communication?
Physician	1	1	20	25	–
Nurse	0	0	0	0
Patient	1	1	2	2.5
No one	83	98	55	69.5
Relative	0	0	1	1
Other. Who?	0	0	1	1
Total	85	100	79	100
Broke bad news to a patient regarding his/hers health
No or non-applicable	83	97.64	9	11.39	<0.0001
Yes. Which?	–	–	52	65.82
Explained the risks of high blood pressure	1	1.18	0	0.00
Showed the result of an altered exam	1	1.18	0	0.00
HIV diagnosis	0	0	2	2.53
Worsening of disease	0	0	1	1.27
Cancer diagnosis	0	0	7	8.86
Diagnosis of non-cancer / HIV	0	0	5	6.33
Did not mention what news	0	0	3	3.80
Total	85	100.00	79	100.00
At what phase of the course did you break bad news?
Did not communicate	83	98	49	62	<0.0001
1^st	1	1	0	0
2^nd	0	0	1	1
3^rd	1	1	0	0
4^th to 7^th	0	0	7	9
8^th to 10^th	0	0	22	28
Total	85	100.00	79	100.00

Specific data	Group 1		Group 2		p
Specific data	n	%	n	%	p
Participated in some breaking bad news event
No	4	5	8	10	0.1829
Academic week of medicine	81	95	65	82.5
Bioethics congress	0	0	2	2.5
Round table	0	0	2	2.5
Participated in some breaking bad news event
Course	0	0	2	2.5	0.1829
Total	85	100	79	100	0.1829
Teaching strategy used for your learning
Film	22	26	53	67	<0.0001
Role-playing (simulation)	5	6	40	51
Educational video	26	31	39	50
SPIKES protocol	21	25	77	97.5
Theory class	50	59	59	75
Had no strategy	15	18	2	2.5
Other strategy
Lecture	7	8	0	0
Case report	2	2.5	0	0
Real situation	0	0	1	1
Feels more confident to break bad news to patients after studying the discipline
Yes	15	17.65	66	83.54	<0.0001
No	6	7.06	13	16.46
Have not yet studied the discipline	64	75.29	0	0.00
Total	85	100	79	100
Do you know any communication protocol?
Yes	23	27	79	100	<0.0001
No	62	73	0	0
Total	85	100	79	100
Knows the SPIKES protocol
Yes	25	30	79	100	<0.0001
No	60	70	0	0.00
Total	85	100	79	100
How well do you think you are prepared to break bad news to a patient?
Totally prepared	4	5	0	0	<0.0001
Partially prepared	18	21	64	81
Partially unprepared	29	34	15	19
Totally unprepared	34	40	0	0
Total	85	100	79	100

Degree of importance of learning how to communicate	Group 1		Group 2		p
Degree of importance of learning how to communicate	n	%	n	%	p
0	1	1	0	0	0.4330
1	1	1	0	0
2	0	0	0	0
3	2	2.5	2	2.5
4	4	5	8	10
5	77	90.5	69	87.5
Total	85	100.00	79	100.00

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