Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
Patient Educ Couns. 2013 Nov;93(2):203-8. doi: 10.1016/j.pec.2013.06.009. Epub 2013 Jul 12.
Breaking bad news (BBN) is a core component of medicine. Psychophysiological studies confirm the subjective reports of doctors that BBN is a stressful experience. This study investigated doctors' physiological stress responses prior to and during two simulated bad news consultations.
Thirty-one doctors participated in a speech-interaction task and two simulated BBN consultations. Heart rate (HR) and skin conductance (SC) were recorded using consecutive 30-s epochs during each of the interactions. The simulations were video recorded.
Most doctors showed an early anticipatory increase in HR and SC that peaked during the reading of the case history prior to the BBN consultations. Most doctors then experienced a brief and relatively small stress response. However, about one-third of the doctors showed a significant and sustained stress response.
The results suggest that most doctors were cognitively engaged with the BBN tasks, however, a small proportion of doctors might have focused more on their own internal feelings and less on these contextual features.
In regards to training medical students and doctors, these results suggest that there is a need to focus more on the impact of these encounters on the doctors, not just their performance during these encounters.
传达坏消息（BBN）是医学的核心内容。心理生理学研究证实了医生的主观报告，即 BBN 是一种有压力的体验。本研究调查了医生在两次模拟坏消息咨询之前和期间的生理压力反应。
31 名医生参与了一项演讲互动任务和两次模拟 BBN 咨询。在每次互动中，使用连续的 30 秒时程记录心率（HR）和皮肤电导（SC）。模拟过程被视频记录下来。
大多数医生在进行 BBN 咨询之前阅读病历时，表现出 HR 和 SC 的早期预期性增加，峰值出现在早期。大多数医生随后经历了短暂而相对较小的压力反应。然而，约三分之一的医生表现出显著且持续的压力反应。
结果表明，大多数医生在认知上都参与了 BBN 任务，但一小部分医生可能更关注自己的内心感受，而较少关注这些背景特征。
在培训医学生和医生方面，这些结果表明，需要更加关注这些遭遇对医生的影响，而不仅仅是他们在这些遭遇中的表现。
