RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0038-1667051
Breaking Bad: An Assessment of Ophthalmologists' Interpersonal Skills and Training on Delivering Bad News
Funding This work was supported by the National Eye Institute, Bethesda, MD (Grant no. 1RO1EY023557–01 [J.M.O.] and Award no. P30 EY001583 [G.S.Y.]) and the Department of Ophthalmology at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Funds also come from the F.M. Kirby Foundation, Research to Prevent Blindness, the UPenn Hospital Board of Women Visitors, the Paul and Evanina Bell Mackall Foundation Trust, and the National Eye Institute, National Institutes of Health, Department of Health and Human Services, under eyeGENETM and contract nos. HHSN260220700001C and HHSN263201200001C. The sponsor or funding organization had no role in the design or conduct of this research.Publikationsverlauf
19. Februar 2018
04. Juni 2018
Publikationsdatum:
12. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00033285/201801/lookinside/thumbnails/10-1055-s-0038-1667051_81ra-1.jpg)
Abstract
Purpose This article aims to assess ophthalmologists' practice patterns, experiences, and self-perceived skills when delivering bad news to patients and to compare this to patients' experience and preferences in receiving bad news from ophthalmologists.
Design/Methods This is a prospective cross-sectional survey study of two populations: (1) Attending ophthalmologists and current ophthalmologists-in-training (N = 202) at accredited ophthalmology residency programs in the United States and Canada. (2) Patients (N = 151) 18 years of age and older at a single academic center who had received bad news from their ophthalmologist. An e-mail was sent to ophthalmology department chairs and resident program directors requesting that they distribute an online survey to their faculty, fellows, and residents. Patients were recruited from the clinics at an academic center and completed a self-administered survey before their scheduled appointments. Both populations were surveyed on their experience in breaking and receiving bad news, respectively. Questions were rated on a standard five-point Likert scale, and mean score was calculated for statistical comparison. The primary outcome variable was the quantitative rating (Likert scale 1–5) of physicians' communication skills when delivering bad news from physicians and patients' responses.
Results Patients rated their physicians higher than physicians rated themselves with regard to ability to deliver bad news (mean score of 4.23 vs. 3.48, p < 0.01). Multivariate analysis showed frequent delivery of bad news (mean score of 3.66 for once per day, 3.53 for per week, 3.40 for once per month, and 3.22 for once per year, linear trend; p = 0.004) and years of practice were associated with better self-perceived ability to deliver bad news (mean score of 3.75 for ≥15 years, 3.48 for <15 years, and 3.30 for residents/fellows, linear trend; p < 0.001). Having received formal training in breaking bad news was associated with better perceived ability score, yet not statistically significant (3.51 vs. 3.39, p = 0.31). Most patients (97.5%) and physicians (92.1%) believe delivering bad news can be taught.
Conclusion Physicians and patients agree that skills of delivering bad news can be learned. Patients are less critical of their physicians' ability to deliver bad news than physicians are themselves. Further study of best methods to deliver bad news is clearly indicated for the field of ophthalmology.
Ethical Approval
Ethical approval has been granted for this study.
Previous Presentations
Association of University Professors of Ophthalmology, Annual Meeting, San Diego, CA, 2017.
-
References
- 1 National Alliance for Eye and Vision Research Fact Sheet. Available at: http://www.eyeresearch.org/resources/NEI_Factsheet.html . Accessed January 23, 2017
- 2 Alelwani SM, Ahmed YA. Medical training for communication of bad news: a literature review. J Educ Health Promot 2014; 3: 51
- 3 Maguire P. Breaking bad news. Eur J Surg Oncol 1998; 24 (03) 188-191
- 4 Schofield PE, Butow PN, Thompson JF, Tattersall MH, Beeney LJ, Dunn SM. Psychological responses of patients receiving a diagnosis of cancer. Ann Oncol 2003; 14 (01) 48-56
- 5 Hebert HD, Butera JN, Castillo J, Mega AE. Are we training our fellows adequately in delivering bad news to patients? A survey of hematology/oncology program directors. J Palliat Med 2009; 12 (12) 1119-1124
- 6 Supiot S, Bonnaud-Antignac A. Using simulated interviews to teach junior medical students to disclose the diagnosis of cancer. J Cancer Educ 2008; 23 (02) 102-107
- 7 Zhou Q, Shen JC, Liu YZ, Lin GZ, Dong H, Li K. Effects of doctor-patient communication on quality of life among breast cancer patients in southern China. Asian Pac J Cancer Prev 2014; 15 (14) 5639-5644
- 8 Zakrzewski PA, Ho AL, Braga-Mele R. Should ophthalmologists receive communication skills training in breaking bad news?. Can J Ophthalmol 2008; 43 (04) 419-424
- 9 Hilkert SM, Cebulla CM, Jain SG, Pfeil SA, Benes SC, Robbins SL. Breaking bad news: A communication competency for ophthalmology training programs. Surv Ophthalmol 2016; 61 (06) 791-798
- 10 Mack JW, Hilden JM, Watterson J. , et al. Parent and physician perspectives on quality of care at the end of life in children with cancer. J Clin Oncol 2005; 23 (36) 9155-9161
- 11 Lee AG, Arnold AC. The next accreditation system in ophthalmology. Surv Ophthalmol 2015; 60 (01) 82-85
- 12 Morse AR. Talking to patients about vision loss and rehabilitation. Arch Ophthalmol 2012; 130 (02) 235-237
- 13 Orgel E, McCarter R, Jacobs S. A failing medical educational model: a self-assessment by physicians at all levels of training of ability and comfort to deliver bad news. J Palliat Med 2010; 13 (06) 677-683
- 14 Buckman R. Breaking bad news: why is it still so difficult?. Br Med J (Clin Res Ed) 1984; 288 (6430): 1597-1599
- 15 Ptacek JT, Fries EA, Eberhardt TL, Ptacek JJ. Breaking bad news to patients: physicians' perceptions of the process. Support Care Cancer 1999; 7 (03) 113-120
- 16 Ptacek JT, Eberhardt TL. Breaking bad news. A review of the literature. JAMA 1996; 276 (06) 496-502
- 17 Dosanjh S, Barnes J, Bhandari M. Barriers to breaking bad news among medical and surgical residents. Med Educ 2001; 35 (03) 197-205
- 18 Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: II--Most young doctors are bad at giving information. Br Med J (Clin Res Ed) 1986; 292 (6535): 1576-1578
- 19 Randall TC, Wearn AM. Receiving bad news: patients with haematological cancer reflect upon their experience. Palliat Med 2005; 19 (08) 594-601
- 20 Fujimori M, Akechi T, Morita T. , et al. Preferences of cancer patients regarding the disclosure of bad news. Psychooncology 2007; 16 (06) 573-581
- 21 Kim MK, Alvi A. Breaking the bad news of cancer: the patient's perspective. Laryngoscope 1999; 109 (7, Pt 1): 1064-1067
- 22 Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L. Breaking bad news about cancer: patients' preferences for communication. J Clin Oncol 2001; 19 (07) 2049-2056
- 23 Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 2000; 5 (04) 302-311