Reviewers
Authors
Adult Medical Oncology, King Abdulaziz Medical City, National Guard Health Affair, Saudi Arabia
Abstract
In recent years, medical guidelines for communicating bad news to patients have been
published. Training for this task was included in the curricula of undergraduate medical
courses, specialization, and continuing medical education. The objective of this review is
to evaluate the existing evidence in the literature on the effectiveness of such training. Only
seven controlled trials were found, four of which were randomized, and these four indicate
an improvement in the trainees. These findings suggest that training undergraduate and
postgraduate doctors in skills for communicating bad news may be beneficial but there are
important limitations to reach a definitive conclusion. These limitations are discussed in this
article.
Keywords
1. Barnett MM, Fisher JD, Cooke H, James PR, Dale J. Breaking bad
news: Consultants’ experien ce, previous education and views on
educational format and timing. Med Educ 2007;41:947‑56.
2. Lino AC, Augusto KL, Oliveira RA, Feitosa LB, Caprara A. Using the
Spikes protocol to teach skills in breaking bad news. Rev Bras Med
Educ 2011;35:52‑7.
3. Reiser SJ. Words those Scalpels: Words as scalpels: Transmitting
evidence in the clinical dialogue. Ann Intern Med 1980;92:837‑42.
4. Charlton RC. Breaking bad news. Med J Aust 1992;157:615‑21.
5. Maguire P. Breaking bad news. Eur J Surg Oncol 1998;24:188‑91.
6. Eggly S, Afonso N, Rojas G, Baker M, Cardozo L, Robertson RS. An
assessment of residents’ competence in the delivery of bad news
to patients. Acad Med 1997;72:397‑9.
7. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young
doctors: II‑Most young doctors are bad at giving information. Br
Med J (Clin Res Ed) 1986;292:1576‑8.
8. Dosanjh S, Barnes J, Bhandari M. Barriers to breaking bad news
among medical and surgical residents. Med Educ 2001;35:197‑205.
9. Dickinson GE, Tournier RE. A decade beyond medical school:
A longitudinal study of physicians’ attitudes Toward death and
terminally‑ill patients. Soc Med Sci 1994;38:1397‑400.
10. Orgel E, McCarter R, Jacobs S. A failing medical educational
model: A self‑assessment by physicians at all levels of training
of ability and comfort to deliver bad news. Palliat Med J
2010;13:677‑83.
11. Costantini A, Baile WF, Lenzi R, Costantini M, Ziparo V, Marchetti P,
et al. Overcoming cultural barriers to giving bad news: Feasibility
of training to promote truth‑telling to cancer patients. J Cancer
Educ 2009;24:180‑5.
12. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news
in medicine. Lancet 2004;363:312‑9.
13. Girgis A, Sanson‑Fisher RW. Breaking bad news: Consensus
guidelines for medical practitioners. J Clin Oncol 1995;13:2449‑56.
14. Baile WF, 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;5:302‑11.
15. Rossi L, Lima CC, Queiroz IN, Froes SS, Caldeira AP. The perception
of patients about non‑verbal communication in healthcare. Rev Bras
Med Ed 2010;34:363‑70.
16. Turini B, Martins ND, Tavares MS, Nunes SO, Silva VL,
Thomson Z. Communication in medical education: Experience,
structuring and new challenges in medical curricula. R Rev Bras
Med Ed 2008;32:264‑70.
17. Rosenbaum ME, Ferguson KJ, Wolves JG. Teaching medical
students and residents skills for delivering bad news: A review of
strategies. Acad Med 2004;79:107‑17.
18. Hebert HD, Butera JN, Castillo J, Mega AE. Are we training our
fellows adequately in delivering bad news to patients? A survey
of hematology/oncology program directors. Palliat Med J
2009;12:1119‑24.
19. Wittenberg‑Lyles EM, Goldsmith J, Sanchez‑Reilly S,
Ragan SL. Communicating a terminal prognosis in a palliative
care setting: Deficiencies in current communication training
protocols. Soc Sci Med 2008;66:2356‑65.
20. Colletti L, Gruppen L, Barclay M, Stern D. Teaching students to
break bad news. Am J Surg 2001;182:20‑3.
21. Amiel GE, Ungar L, Alperin M, Baharier Z, Cohen R, Reis S. Ability
of primary care physician’s to break bad news: A performance
based assessment of an educational intervention. Patient Educ
Couns 2006;60:10‑5.
22. Lienard A, Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J,
et al. Factors That Influence cancer patients’ anxiety Following the
medical consultation: Impact of a communication skills training
program for physicians. Ann Oncol 2006;17:1450‑8.
23. Alexander SC, Keitz SA, Sloane R, Tulsky JA. A controlled trial of a
short course to Improve residents’ communication with pacientes
at the end of life. Acad Med 2006;81:1008‑12.
24. Szmuilowicz E, el‑Jawahri A, Chiappetta L, Kamdar M,
Block S. Improving residents’ end‑of‑life communication skills
with a short retreat: A randomized controlled trial. Palliat Med J
2010;13:439‑52.
25. Daetwyler CJ, Cohen DG, Gracely E, Novack DH. eLearning
to Enhance physician patient communication: A pilot test of
“doc.com” and “WebEncounter” in teaching bad news delivery. Med
Teach 2010;32:e381‑90.26. Liénard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM,
et al. Is it Possible to Improve residents breaking bad news skills?
A randomized study Assessing the efficacy of a communication
skills training program. Br J Cancer 2010;103:171‑7.
27. Cushing AM, Jones A. Evaluation of a breaking bad news course
for medical students. Educ Med 1995;29:430‑5.
28. Garg A, Buckman R, Kason Y. Teaching medical students to break
bad news. CMAJ 1997;156:1159‑64.
29. Baile WF, Kudelka AP, Beale EA, Glober GA, Myers EG, Greisinger AJ,
et al. Communication skills training in oncology. Description and
preliminary outcomes of work‑shops on breaking bad news and
managing patient reactions to illness. Cancer 1999;86:887‑97.
30. Moore PM, Wilkinson SS, Rivera Mercado S. Communication skills
training for health care professionals working with cancer patients,
Their families and/or carers. Cochrane Database of Systematic
Reviews. In: The Cochrane Library, Issue 10, Article No. CD003751.
news: Consultants’ experien ce, previous education and views on
educational format and timing. Med Educ 2007;41:947‑56.
2. Lino AC, Augusto KL, Oliveira RA, Feitosa LB, Caprara A. Using the
Spikes protocol to teach skills in breaking bad news. Rev Bras Med
Educ 2011;35:52‑7.
3. Reiser SJ. Words those Scalpels: Words as scalpels: Transmitting
evidence in the clinical dialogue. Ann Intern Med 1980;92:837‑42.
4. Charlton RC. Breaking bad news. Med J Aust 1992;157:615‑21.
5. Maguire P. Breaking bad news. Eur J Surg Oncol 1998;24:188‑91.
6. Eggly S, Afonso N, Rojas G, Baker M, Cardozo L, Robertson RS. An
assessment of residents’ competence in the delivery of bad news
to patients. Acad Med 1997;72:397‑9.
7. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young
doctors: II‑Most young doctors are bad at giving information. Br
Med J (Clin Res Ed) 1986;292:1576‑8.
8. Dosanjh S, Barnes J, Bhandari M. Barriers to breaking bad news
among medical and surgical residents. Med Educ 2001;35:197‑205.
9. Dickinson GE, Tournier RE. A decade beyond medical school:
A longitudinal study of physicians’ attitudes Toward death and
terminally‑ill patients. Soc Med Sci 1994;38:1397‑400.
10. Orgel E, McCarter R, Jacobs S. A failing medical educational
model: A self‑assessment by physicians at all levels of training
of ability and comfort to deliver bad news. Palliat Med J
2010;13:677‑83.
11. Costantini A, Baile WF, Lenzi R, Costantini M, Ziparo V, Marchetti P,
et al. Overcoming cultural barriers to giving bad news: Feasibility
of training to promote truth‑telling to cancer patients. J Cancer
Educ 2009;24:180‑5.
12. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news
in medicine. Lancet 2004;363:312‑9.
13. Girgis A, Sanson‑Fisher RW. Breaking bad news: Consensus
guidelines for medical practitioners. J Clin Oncol 1995;13:2449‑56.
14. Baile WF, 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;5:302‑11.
15. Rossi L, Lima CC, Queiroz IN, Froes SS, Caldeira AP. The perception
of patients about non‑verbal communication in healthcare. Rev Bras
Med Ed 2010;34:363‑70.
16. Turini B, Martins ND, Tavares MS, Nunes SO, Silva VL,
Thomson Z. Communication in medical education: Experience,
structuring and new challenges in medical curricula. R Rev Bras
Med Ed 2008;32:264‑70.
17. Rosenbaum ME, Ferguson KJ, Wolves JG. Teaching medical
students and residents skills for delivering bad news: A review of
strategies. Acad Med 2004;79:107‑17.
18. Hebert HD, Butera JN, Castillo J, Mega AE. Are we training our
fellows adequately in delivering bad news to patients? A survey
of hematology/oncology program directors. Palliat Med J
2009;12:1119‑24.
19. Wittenberg‑Lyles EM, Goldsmith J, Sanchez‑Reilly S,
Ragan SL. Communicating a terminal prognosis in a palliative
care setting: Deficiencies in current communication training
protocols. Soc Sci Med 2008;66:2356‑65.
20. Colletti L, Gruppen L, Barclay M, Stern D. Teaching students to
break bad news. Am J Surg 2001;182:20‑3.
21. Amiel GE, Ungar L, Alperin M, Baharier Z, Cohen R, Reis S. Ability
of primary care physician’s to break bad news: A performance
based assessment of an educational intervention. Patient Educ
Couns 2006;60:10‑5.
22. Lienard A, Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J,
et al. Factors That Influence cancer patients’ anxiety Following the
medical consultation: Impact of a communication skills training
program for physicians. Ann Oncol 2006;17:1450‑8.
23. Alexander SC, Keitz SA, Sloane R, Tulsky JA. A controlled trial of a
short course to Improve residents’ communication with pacientes
at the end of life. Acad Med 2006;81:1008‑12.
24. Szmuilowicz E, el‑Jawahri A, Chiappetta L, Kamdar M,
Block S. Improving residents’ end‑of‑life communication skills
with a short retreat: A randomized controlled trial. Palliat Med J
2010;13:439‑52.
25. Daetwyler CJ, Cohen DG, Gracely E, Novack DH. eLearning
to Enhance physician patient communication: A pilot test of
“doc.com” and “WebEncounter” in teaching bad news delivery. Med
Teach 2010;32:e381‑90.26. Liénard A, Merckaert I, Libert Y, Bragard I, Delvaux N, Etienne AM,
et al. Is it Possible to Improve residents breaking bad news skills?
A randomized study Assessing the efficacy of a communication
skills training program. Br J Cancer 2010;103:171‑7.
27. Cushing AM, Jones A. Evaluation of a breaking bad news course
for medical students. Educ Med 1995;29:430‑5.
28. Garg A, Buckman R, Kason Y. Teaching medical students to break
bad news. CMAJ 1997;156:1159‑64.
29. Baile WF, Kudelka AP, Beale EA, Glober GA, Myers EG, Greisinger AJ,
et al. Communication skills training in oncology. Description and
preliminary outcomes of work‑shops on breaking bad news and
managing patient reactions to illness. Cancer 1999;86:887‑97.
30. Moore PM, Wilkinson SS, Rivera Mercado S. Communication skills
training for health care professionals working with cancer patients,
Their families and/or carers. Cochrane Database of Systematic
Reviews. In: The Cochrane Library, Issue 10, Article No. CD003751.
)