Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, UNISIMES (UNIté de SIMulation Européenne en Santé), Strasbourg, France; Inserm U1114 - Neuropsychologie cognitive et Physiopathologie de la Schizophrénie, Strasbourg, France; FMTS, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, Strasbourg, France.
J Surg Educ. 2021 Jul-Aug;78(4):1357-1365. doi: 10.1016/j.jsurg.2020.11.009. Epub 2020 Nov 19.
Delivering bad news is a stressful moment for both patient and clinician. As poor bad-news consultation quality may lead to misunderstandings, lack of treatment adherence, acute or even post-traumatic stress in patients, training interventions to improve communication skills and stress-management are necessary. Mindfulness is a recognised stress-management strategy that has shown its efficacy in reducing stress in both health professionals and students. We then supposed that a short mindfulness meditation session performed just before a simulated breaking bad-news consultation to patients with laryngeal cancer may help ear, nose and throat (ENT) residents to master their stress and improve their management of this consultation. This study aims at showing how a short mindfulness meditation performed before a simulated bad-news consultation may improve performance in its realisation by ENT residents.
We enrolled 53 ENT residents, randomised in 2 groups. The first group completed a 5-minute mindfulness session while the other group listened to a control track. Thereafter, every resident completed an 8-minute simulated bad-news consultation with a standardised patient. Two blinded expert assessors evaluated their performance on a 25-point grid (BNC-OSAS). Residents self-assessed their stress before and after the intervention and simulated patients rated their perception of physician's empathy.
The performance was significantly better in the mindfulness group than in the control group (m = 19.8, sd = 3.2 and m = 17.4, sd = 3.7 respectively, F(1,45)=5.27, p = 0.026, d = 0.67), especially in the communication and knowledge subdomains. There was no significant difference in perceived stress between the 2 groups. Empathy perceived by simulated patients was positively correlated to residents' performance.
A short mindfulness meditation is effective for improving ENT residents' performance in a simulated bad-news consultation. These results encourage further assessments of this method with objective measures of physiological stress. More research is required concerning the feasibility and efficacy of mindfulness before daily clinical activities such as stressing bad-news consultation.
向患者传达坏消息对医患双方来说都是一个压力时刻。由于不良的不良消息咨询质量可能导致误解、治疗依从性差、患者急性甚至创伤后应激，因此需要培训干预措施来提高沟通技巧和压力管理。正念是一种公认的压力管理策略，已证明其在减轻卫生专业人员和学生的压力方面的有效性。因此，我们假设在对喉癌患者进行模拟不良消息咨询之前，进行短暂的正念冥想练习，可以帮助耳鼻喉科住院医师控制压力并改善对这种咨询的管理。本研究旨在展示在模拟不良消息咨询之前进行短暂的正念冥想如何帮助耳鼻喉科住院医师提高咨询的实施效果。
我们招募了 53 名耳鼻喉科住院医师，将他们随机分为两组。第一组完成 5 分钟的正念练习，而另一组则听对照曲目。之后，每位住院医师都与一名标准化患者进行了 8 分钟的模拟不良消息咨询。两名盲评专家根据 25 分制网格（BNC-OSAS）对他们的表现进行评估。住院医师在干预前后自我评估压力，模拟患者评估医生的同理心感知。
正念组的表现明显优于对照组（正念组的平均得分为 19.8，标准差为 3.2；对照组的平均得分为 17.4，标准差为 3.7，F（1,45）=5.27，p=0.026，d=0.67），尤其是在沟通和知识子领域。两组之间的感知压力没有显著差异。模拟患者感知到的同理心与住院医师的表现呈正相关。
短暂的正念冥想有助于提高耳鼻喉科住院医师在模拟不良消息咨询中的表现。这些结果鼓励进一步使用生理压力的客观测量方法来评估这种方法。需要进一步研究在日常临床活动（如压力大的不良消息咨询）之前进行正念的可行性和效果。
