Institute for Medical Education, University of Bern, Bern, Switzerland.
Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.
BMC Psychol. 2023 May 10;11(1):153. doi: 10.1186/s40359-023-01167-6.
Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition.
In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances.
Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition.
ClinicalTrials.gov (NCT05037318), September 8, 2021.
传递坏消息（例如，告知癌症诊断）被认为是医疗领域中最具挑战性的沟通任务之一，并且与高度的压力相关。医生在传递坏消息时的压力增加会对他们的沟通表现产生负面影响，并在长期内影响患者的健康结果。尽管越来越多的文献承认传递坏消息的压力性质，但在解决这个问题方面做得还不够。因此，需要有适当的工具来帮助医生应对压力反应，以便他们能够发挥最佳的传递坏消息能力。在本研究中，我们将采用挑战与威胁的心理社会模型作为理论框架。根据该模型，感知到的情境需求和感知到的应对资源之间的平衡决定了一个有压力的表现情境，如传递坏消息，是否被体验为挑战（资源 > 需求）或威胁（资源 < 需求）。我们使用两种干预措施，旨在支持医学生向以挑战为导向的压力反应和改善沟通表现转变：（1）应激唤醒再评价（SAR），引导个体重新解释他们的应激唤醒，将其视为对任务表现有益的适应性反应；（2）示例练习（WE），逐步演示如何进行传递坏消息，提供结构并促进技能获取。
在一项随机对照试验中，采用 2（SAR 与对照组）x 2（WE 与对照组）的被试间设计，我们将确定这两种干预措施对 N = 200 名三年级医学生在模拟传递坏消息情境中压力反应和传递坏消息技能表现的影响。为了确定学生的压力反应，我们将评估他们的感知应对资源和任务需求，记录他们的心血管活动，并在传递坏消息前后测量唾液参数。三名经过培训的评估员将独立评估学生的传递坏消息技能表现。
研究结果将为面临传递坏消息任务的医学生的心理生理学提供独特的见解。从挑战和威胁的角度可以更全面地理解参数，并将其与表现结果联系起来。如果被证明有效，评估过的干预措施可以纳入医学生的课程中，促进传递坏消息技能的获取。
ClinicalTrials.gov（NCT05037318），2021 年 9 月 8 日。
