Breaking Bad News: Jordanian Doctors’ Training Needs & Applicability of Training Frameworks
DOI:
https://doi.org/10.35516/jmj.v59i1.1213Keywords:
Breaking bad news, communication skills, medical education, Middle East, physiciansAbstract
Background: Sharing bad news is a complex and challenging task for doctors, requiring knowledge and skills development.
Aims: To identify Jordanian doctors’ training needs for breaking bad news, comparing two different populations of doctors, and to investigate the applicability of different training frameworks.
Methods: This questionnaire based cross-sectional study targeted doctors working at hospitals in Amman, Jordan. Data was analyzed using SPSS v25 and MedCalc v20. Comparisons were made using chi-square test. Free text responses were analyzed thematically.
Results: 161 doctors participated of whom 33.8% had received breaking bad news training. 45.5% of doctors were confident/very confident at breaking bad news. However, there was no significant association between confidence and training status. The greatest challenge reported by 64.1% of doctors was that “relatives do not want the patient to know the diagnosis” and a free-text challenge was ”managing aggressive reactions of patients and/or relatives”. The highest interest in training for specific skills was 59% for ”answering difficult questions”. Comparison between doctors working at a specialized cancer hospital and those working at government hospital revealed statistically significant differences in the frequency of breaking bad news (p = .031), attendance of training (p = .010), and helpfulness of training (p = .001).
Conclusions: Combining elements of different international communication skills models and taking into account specific cultural considerations may provide the most culturally responsive curriculum framework for developing the skills of current and future Middle Eastern doctors.
References
Baile W, 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(4): 302-31.
Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press; 1992.
Hanratty B, Lowson E, Holmes L, Grande G, Jacoby A, Payne S, et al. Breaking bad news sensitively: what is important to patients in their last year of life? BMJ Support Palliat Care 2012; 2(1): 24-8.
Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. Oxford: Radcliffe Medical Press; 1998.
Burt J, Abel G, Elmore N, Campbell J, Roland M, Benson J, et al. Assessing communication quality of consultations in primary care: initial reliability of the global consultation rating scale, based on the Calgary-Cambridge guide to the medical interview. BMJ Open 2014; 4(3): e004339.
Grant J. Principles of Curriculum Design. In: Swanwick T, editor. Understanding Medical Education: Evidence, Theory and Practice, Oxford: Wiley-Blackwell; 2014, p.31-46.
Salem A, Salem AF. Breaking bad news: current prospective and practical guideline for Muslim countries. J Cancer Educ 2013; 28(4): 790-4.
Obeidat R, Khrais HI. Jordanian physicians’ attitudes toward disclosure of cancer information and patient participation in treatment decision-making. Asia-Pac J Oncol Nurs 2016; 3(3): 281-8.
Borgan S, Amarin J, Othman A, Suradi H, Qwaider Y. Truth disclosure practices of physicians in Jordan. J Bioeth Inq 2018; 15(1): 81-7.
Borgan S, Amarin J, Othman A, Suradi H, Qwaider Y. Attitudes of Physicians in Jordan Towards Non-Disclosure of Health Information. Sultan Qaboos Univ Med J 2021; 21(3): 4237.
Boynton P, Greenhalgh T. Selecting, designing and developing your questionnaire. BMJ 2004;
(7451): 1312-5.
Cohen L, Manion L, Morrison K. Research Methods in Education. London and New York: Routledge; 2011.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
Kitto S, Chesters J, Grbich, C. Quality in qualitative research. Med J Aust 2008; 188(4): 243-6. 15. Karnieli-Miller O, Pelles S, Meitar D. Position paper: Teaching breaking bad news (BBN) to undergraduate medical students. Patient Educ Couns 2022; 105(9): 2899-2904. 16. Alanazi A, Nicholson N, Thomas S. The use of simulation training to improve knowledge, skills, and confidence among healthcare students: a systematic review. Internet J. Allied Health Sci Pract 2017; 15(3): 2. 17. Cushing A, Jones A. Evaluation of a breaking bad news course for medical students. Med Educ 1995; 29(6): 430-5. 18. Zekri JM, Karim SM, Bassi S, Bin Sadiq BM, Fawzy EE, Nauf YI. Breaking bad news: Comparison of perspectives of Middle Eastern cancer patients and their relatives. J Clin Oncol 2013; 31: S9568. 19. Al Amri A. Cancer patients' desire for information: a study in a teaching hospital in Saudi Arabia. East Mediterr Health J 2009; 15(1): 19-24.
General Medical Council. Good Medical Practice: Explanatory Guidance, http://www.gmc-uk.org/guidance/ethical_guidance.asp [accessed 31 July 2022]. 21. Buda R, Elsayed-Elkhouly SM. Cultural differences between Arabs and Americans: Individualism-collectivism revisited. J Cross-Cultural Psychol 1998; 29(3): 487-492. 22. Aein F, Delaram M. Giving bad news: a qualitative research exploration. Iran Red Crescent Med J 2014; 16(6): e8197. 23. Alrukban MO, Albadr BO, Almansour M, Sami W,Alshuil M, Aldebaib A, et al. Preferences and attitudes of the Saudi population toward receiving medical bad news: A primary study from Riyadh city. J Fam Community Med 2014; 21(2): 85.
Patai R. The Arab Mind. New York: Hatherleigh Press; 2007.
Roya News. Doctor assaulted by patient’s brother in Amman,
https://en.royanews.tv/news/36251/2022-06-25 [accessed 10 August 2022].
The Guardian. ‘The family will kill you if the patient dies’: the doctors facing attack in Iraq’s hospitals, https://www.theguardian.com/global-development/2022/aug/09/the-doctors-facing-attack-in-iraq-hospitals?CMP=Share_AndroidApp_Other[accessed 10 August 2022].
Roland D, Matheson D, Coats T, Martin G. A qualitative study of self-evaluation of junior doctor performance: is perceived ‘safeness’ a more useful metric than confidence and competence? BMJ Open 2015; 5(11): e008521.
Barnsley L, Lyon PM, Ralston SJ, Hibbert EJ, Cunningham I, Gordon FC, Field MJ. Clinical skills in junior medical officers: a comparison of self‐reported confidence and observed competence. Med Educ 2004; 38(4): 358-367.
Davis D, Mazmanian P, Fordis M, Van Harrison R, Thorpe K, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 2006; 296(9): 1094-1102.
