Jameel Abid, Noor Sahibzada Mahmood, Ayub Shahid
Department of Medical Oncology, Postgraduate Medical Institute, Peshawar.
J Pak Med Assoc. 2012 Jun;62(6):585-9.
To assess the perception, skills and comfort level of postgraduate residents with respect to breaking bad news.
Five workshops were conducted on communication skills, including the task of breaking bad news, at three teaching hospitals of Peshawar, Pakistan. Teaching methods included interactive lectures, video presentations, role play and small group discussions. Pre- and post-workshop data was collected from all the 97 participants to assess their previous training, comfort level and perceptions regarding the subject and any improvement after attending the workshop.
Of the total participants, 92 (95%) residents had not received any training in communication skills at the undergraduate level. Only 64 (66%) residents had witnessed bad news being broken by a consultant. Before the workshop, 83 (85%) residents felt either not comfortable or somewhat comfortable while breaking bad news compared to 36% post-workshop (p < 0.0000). Besides, 64 (66%) residents reported breaking bad news to be extremely stressful or very stressful before the workshop versus 25% post-workshop (p < 0.0000). Before the workshop, 18 (19%) residents said they would withhold the information from the patient on family's insistence despite the patient's wish to be informed, compared to 6% post-workshop (p < 0.007). Regarding the utility of the workshop, 91 (94%) residents said it had changed their perceptions to a major extent, while 92 (95%) residents rated the workshop as extremely useful or very useful.
Formal structured training in breaking bad news is lacking both at undergraduate and postgraduate levels in Pakistan. Structured training programmes for residents can do the task effectively.
评估研究生住院医师在传达坏消息方面的认知、技能和舒适度。
在巴基斯坦白沙瓦的三家教学医院举办了五期关于沟通技巧的讲习班，其中包括传达坏消息的任务。教学方法包括互动讲座、视频展示、角色扮演和小组讨论。从所有97名参与者那里收集了讲习班前和后的资料，以评估他们以前接受的培训、对该主题的舒适度和认知，以及参加讲习班后的任何改进。
在所有参与者中，92名（95%）住院医师在本科阶段未接受过任何沟通技巧培训。只有64名（66%）住院医师目睹过顾问传达坏消息的情况。在讲习班前，83名（85%）住院医师在传达坏消息时感觉不舒服或有点舒服，而在讲习班后这一比例为36%（p<0.0000）。此外，64名（66%）住院医师报告在讲习班前传达坏消息时压力极大或非常大，而在讲习班后这一比例为25%（p<0.0000）。在讲习班前，18名（19%）住院医师表示，尽管患者希望了解情况，但在家人的坚持下他们会向患者隐瞒信息，而在讲习班后这一比例为6%（p<0.007）。关于讲习班的效用，91名（94%）住院医师表示它在很大程度上改变了他们的认知，而92名（95%）住院医师将讲习班评为极其有用或非常有用。
在巴基斯坦，本科和研究生阶段都缺乏关于传达坏消息的正规结构化培训。为住院医师制定的结构化培训计划可以有效地完成这项任务。
