PG110 Challenging conversations: simulation based education for breaking bad news

Difficult conversations are an everyday reality for most healthcare professionals. Breaking bad news requires sophisticated communication skills and comes with added challenges in the context of COVID-19. These conversations are widely acknowledged to be an important part of medical practice but have historically been ignored in the undergraduate curriculum.1 In recent years, there has been advances in breaking bad news education such as the development of the ‘SPIKES’ framework.2 However, ongoing debate remains as to whether didactic teaching is adequate or even appropriate to address this topic.3 Simulated patient-based scenarios were designed with input from the palliative care team at University Hospitals Bristol and Weston Foundation Trust (UHBW). Content for the scenarios was tailored to individual learner groups and varied from informing a patient’s relative of a delayed discharge date to communicating a new diagnosis of cancer. These scenarios were run as part of several small group simulation sessions at different sites across the trust, some face-to-face and others over the telephone to reflect the COVID-19 visitor policy at the time. Teams from different specialities participated in the simulations including doctors, nurses, health care assistants, physiotherapists and occupational therapists (n = 56). Feedback was collected anonymously following each session via an online google form. 94% participants either strongly agreed or agreed that the scenarios were relevant to their clinical practice. 82% felt that simulation had improved their confidence in breaking bad news. The feedbacks shows that simulation is a useful tool in breaking bad news education. Simulated-patient based scenarios can be employed alongside other teaching methods to achieve the ‘high level of empathy and information quality’ that patients expect from their healthcare team, no matter what the news.4 These sessions allow learners to share experiences in a safe, non-judgemental environment and discuss communication strategies for challenging conversations amongst their peers. Simulation also provides an opportunity for staff to reflect on the emotional impact that breaking bad news may have on patients, relatives and themselves which is pertinent to their own wellbeing. Reference Barnett, M., Fisher, J., Cooke, H., James, P. and Dale, J., 2007. Breaking bad news: consultants’ experience, previous education and views on educational format and timing. Medical Education, 41(10), pp.947–956. Kaplan, M., 2010. SPIKES: A Framework for Breaking Bad News to Patients With Cancer. Clinical Journal of Oncology Nursing, 14(4), pp.514–516. Coutinho, F. and Ramessur, A., 2016. An Overview of Teaching Communication of Bad News in Medical School: Should a Lecture be Adequate to Address the Topic?. Acta Medica Portuguesa, 29(12), p.826. Munoz Sastre, M., Sorum, P. and Mullet, E., 2011. Breaking Bad News: The Patient’s Viewpoint. Health Communication, 26(7), pp.649–655.