Improving Perinatology Residents' Skills in Breaking Bad News: A Randomized Intervention Study

Objective Breaking bad news (BBN) is particularly difficult in perinatology. Previous research has shown that BBN skills can be learned and improved when taught and practiced. This project evaluated whether a structured training session would enhance perinatology residents' skills in BBN. Methods This was a randomized controlled intervention study with year 1 to 4 Perinatology residents from a medical school in Brazil, during the 2014/15 school year. A total of 61 out of 100 (61%) eligible residents volunteered to a structured training program involving communicating a perinatal loss to a simulated patient (SP) portraying the mother followed by the SP's immediate feedback, both video recorded. Later, residents were randomly assigned to BBN training based on a setting, perception, invitation, knowledge, emotion and summary (SPIKES) strategy with video reviews (intervention) or no training (control group). All residents returned for a second simulation with the same SP blinded to the intervention and portraying a similar case. Residents' performances were then evaluated by the SP with a checklist. The statistical analysis included a repeated measures analysis of covariance (RM-ANCOVA). Complementarily, the residents provided their perceptions about the simulation with feedback activities. Results Fifty-eight residents completed the program. The simulations lasted on average 12 minutes, feedback 5 minutes and SPIKES training between 1h and 2h30m. There was no significant difference in the residents' performances according to the SPs' evaluations (p = 0.55). The participants rated the simulation with feedback exercises highly. These educational activities might have offset SPIKES training impact. Conclusion The SPIKES training did not significantly impact the residents' performance. The residents endorsed the simulation with feedback as a useful training modality. Further research is needed to determine which modality is more effective.

Download Full-text

Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0484 ◽

2019 ◽

Vol 32 (9) ◽

pp. 1005-1011 ◽

Cited By ~ 1

Author(s):

Ali Heidarianpour ◽

Elnaz Shokri ◽

Tayebe Baghian ◽

Behnaz Shokri

Keyword(s):

Precocious Puberty ◽

Repeated Measures ◽

Aerobic Training ◽

Training Session ◽

Training Group ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Significant Difference ◽

Cortisol Levels ◽

Serum Crp

Abstract Background The aim of this study was to investigate the effect of 12 weeks of aerobic training, 4 weeks of detraining and use gonadotropin-releasing hormone agonist (GnRHa) on serum C-reactive protein (CRP) and cortisol levels in girls with central precocious puberty (CPP). Methods Forty-five girls (aged 6–8 years) with precocious puberty were randomly divided into three groups (medication, training and medicine + training groups). Fifteen healthy girls (without precocious puberty) were also included as the control group. Serum CRP and cortisol levels were measured at baseline by the enzyme-linked immunosorbent assay (ELISA) technique. Then, the experimental groups performed an aerobic training program for 3 days/week 20–75 min per day at 45–75% maximum heart rate for 12 weeks. The medication groups also received GnRHa during the study, once a month (1 mL every 4 weeks) by intramuscular injection. Serum CRP and cortisol levels were measured again 48 h after the last training session and also after 4 weeks of detraining. Results Analysis of variance (ANOVA) with repeated measures showed a significant decrease in CRP (p = 0.02) and cortisol levels (p = 0.01) in the training group and the medicine + training group. Detraining led to return of CRP and cortisol levels to the pre-training levels (p = 0.001). No significant difference in serum CRP (p = 0.43) and cortisol levels (p = 0.06) was observed in the medication group. Further, no significant difference was observed between groups in CRP and cortisol. Conclusions Long-term regular moderate training decreases inflammation indices, and detraining eliminates the benefits of training in girls with precocious puberty.

Download Full-text

Breaking bad news of cancer diagnosis – Perception of the cancer patients in a rural community in Malaysia

South Asian Journal of Cancer ◽

10.4103/2278-330x.130447 ◽

2014 ◽

Vol 03 (02) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

Mathew Gabriel Bain ◽

Cheah Whye Lian ◽

Chang Ching Thon

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Current Method ◽

Bad News ◽

Breaking Bad News ◽

Language Management ◽

Cross Sectional ◽

Breaking Bad ◽

Information Giving ◽

Significant Difference

Abstract Context: Breaking of bad news is an important component in the management of cancer patients. Aims: This study aimed to assess the perceptions of breaking bad news of cancer diagnosis. Settings and Design: It was a cross-sectional study using Breaking Bad News Assessment Schedule (BAS) questionnaire on cancer patients in Serian district. Materials and Methods: Using snowballing sampling method, a total of 134 patients were interviewed face-to-face after the consent was obtained from each of the respondents. Statistical Analysis Used: Data was entered and analyzed using SPSS version 19.0. Results: Majority were comfortable with the current method of breaking bad news. The main aspects found to be the areas of concern were the importance of the usage of body language, management of time and identifying patients′ key area of concerns. There were significant difference between sex and "information giving" (P = 0.028) and "general consideration" (P = 0.016) and also between "the age and setting the scene" (P = 0.042). Significant difference was also found between the types of cancer and "the setting of scene" (P = 0.018), "breaking bad news technique" (P = 0.010), "eliciting concerns" (P = 0.003) and "information giving" (P = 0.004). Conclusion: Good and effective communication skill of breaking bad news is vital in the management of cancer patients. As the incidence of new cases of cancer increase every year, breaking of bad news has become a pertinent to the medical professionals′ role. Specific aspects of communication skills based on local characteristics should be more emphasized in the formulation of training for doctors.

Download Full-text

Comparison of the Effectiveness of Metacognitive Therapy and Behavioral Activation on Depression in Elderly with Type 2 Diabetes

10.32592/ajnpp.2020.7.1.101 ◽

2019 ◽

pp. 9-14

Keyword(s):

Type 2 Diabetes ◽

Repeated Measures ◽

Behavioral Activation ◽

The Elderly ◽

Analysis Of Covariance ◽

Control Group ◽

Metacognitive Therapy ◽

Significant Difference ◽

And Control

Background and Aims: Generalized anxiety and depression are prevalent in patients with type 2 diabetes. Type 2 diabetes is one of the most common chronic diseases leading to many complications. This study aimed to compare the effectiveness of metacognitive therapy and behavioral activation on depression in the elderly with type 2 diabetes. Materials and Methods: This quasi-experimental study was conducted based on a pretest-posttest design using a follow-up and control group. The study population consisted of elderly with type 2 diabetes who referred to five endocrine and metabolism clinics in region 11 of Tehran, Iran, during 2017. A total of 45 males and females were selected by purposive sampling method based on the inclusion criteria. Then they were assigned randomly to one control and two case groups. The Beck Depression Inventory (Second Edition) was utilized to measure the depression scale. In total, eight 90-min group intervention sessions were held weekly. The data were analyzed in SPSS software (version 25) through analysis of covariance and repeated measures ANOVA. Results: The results showed that metacognitive therapy (F=15.07, P<0.001) and behavioral activation (F=7.09, P<0.008) were significantly effective on depression in the elderly with type 2 diabetes, and there was a significant difference between the experimental and control groups in this regard (P<0.001). Conclusions: This study was conducted to compare the effectiveness of metacognitive therapy and behavioral activation on depression in the elderly with type 2 diabetes. The results showed that metacognitive therapy and behavioral activation were significantly effective on depression in this population with type 2 diabetes. Moreover, behavioral activation was more effective than metacognitive therapy on depression reduction.

Download Full-text

Positive effect of combined exercise on adipokines levels and pubertal signs in overweight and obese girls with central precocious puberty

Lipids in Health and Disease ◽

10.1186/s12944-021-01588-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Elnaz Shokri ◽

Ali Heidarianpour ◽

Zahra Razavi

Keyword(s):

Precocious Puberty ◽

Repeated Measures ◽

Training Session ◽

User Profile ◽

Exercise Group ◽

Control Group ◽

Ovarian Volume ◽

Combined Exercise ◽

Tnf Α ◽

Significant Difference

Abstract Background The prevalence of precocious puberty is increasing. Obesity has been demonstrated to be associated with changes in the adipokine profile and incidence of early puberty in girls. This study assessed the pubertal signs, the levels of adiponectin, resistin, and tumor necrosis factor-alpha (TNF-α) after 12 weeks of combined exercise and 4 weeks of detraining in overweight and obese girls with precocious puberty. Methods Thirty overweight and obese girls (aged 7–9) with precocious puberty, who had received Triptorelin, were randomly divided into two groups (15 exercise and 15 control). Initially, serum levels of adiponectin, resistin, TNF-α, luteinising hormone (LH), and follicle-stimulating hormone (FSH) and the signs of puberty progression (bone age, uterine length, and ovarian volume) were measured. The exercise group performed 60 min of combined (aerobic and resistance) exercise three times/week for 12 weeks. The control group did not receive any exercise. 48 h after the last training session and after 4 weeks of detraining, all research variables were measured (also in the control group). The statistical method used for data analysis was repeated measures ANOVA. Results In the exercise group, adiponectin significantly increased and resistin significantly decreased after 12 weeks. After 4 weeks of detraining, adiponectin significantly decreased, but resistin significantly increased. TNF-α levels did not change significantly during the study. There was no significant difference in all of the factors in the control group. Throughout the 16-week study period, the rate of puberty and LH significantly decreased in both exercise and control groups, but FSH, LH/FSH and ovarian volume significantly decreased in the exercise group alone (P<0.05). Conclusions Combined exercise increased adiponectin and decreased resistin and the rate of puberty. However, after 4 weeks of detraining, these effects diminished but did not disappear. Trial registration IRCT, IRCT56471. Registered 25 may 2021 - Retrospectively registered, https://fa.irct.ir/user/profile

Download Full-text

Breaking Bad News Training Program Based on Video Reviews and SPIKES Strategy: What do Perinatology Residents Think about It?

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1604490 ◽

2017 ◽

Vol 39 (10) ◽

pp. 552-559 ◽

Cited By ~ 6

Author(s):

Maria Setubal ◽

Andrea Gonçalves ◽

Sheyla Rocha ◽

Eliana Amaral

Keyword(s):

Training Program ◽

Medical Training ◽

Bad News ◽

Control Group ◽

Breaking Bad News ◽

Emotional Needs ◽

Residency Programs ◽

Breaking Bad ◽

Education Activity ◽

The Impact

Objective Resident doctors usually face the task to communicate bad news in perinatology without any formal training. The impact on parents can be disastrous. The objective of this paper is to analyze the perception of residents regarding a training program in communicating bad news in perinatology based on video reviews and setting, perception, invitation, knowledge, emotion, and summary (SPIKES) strategy. Methods We performed the analysis of complementary data collected from participants in a randomized controlled intervention study to evaluate the efficacy of a training program on improving residents' skills to communicate bad news. Data were collected using a Likert scale. Through a thematic content analysis we tried to to apprehend the meanings, feelings and experiences expressed by resident doctors in their comments as a response to an open-ended question. Half of the group received training, consisting of discussions of video reviews of participants' simulated encounters communicating a perinatal loss to a “mother” based on the SPIKES strategy. We also offered training sessions to the control group after they completed participation. Twenty-eight residents who were randomized to intervention and 16 from the control group received training. Twenty written comments were analyzed. Results The majority of the residents evaluated training highly as an education activity to help increase knowledge, ability and understanding about breaking bad news in perinatology. Three big categories emerged from residents' comments: SPIKES training effects; bad news communication in medical training; and doctors' feelings and relationship with patients. Conclusions Residents took SPIKES training as a guide to systematize the communication of bad news and to amplify perceptions of the emotional needs of the patients. They suggested the insertion of a similar training in their residency programs curricula.

Download Full-text

Effect of a simulation-based workshop on breaking bad news for anesthesiology residents: an intervention study

BMC Anesthesiology ◽

10.1186/s12871-017-0374-7 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 11

Author(s):

Vanda Yazbeck Karam ◽

Hanane Barakat ◽

Marie Aouad ◽

Ilene Harris ◽

Yoon Soo Park ◽

...

Keyword(s):

Intervention Study ◽

Bad News ◽

Breaking Bad News ◽

Breaking Bad ◽

Simulation Based

Download Full-text

Study of Binaural Auditory Cortical Response in Children with History of Recurrent Otitis

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1718527 ◽

2020 ◽

Author(s):

Leticia Sampaio Oliveira ◽

Anna Caroline Silva de Oliveira ◽

Yara Bagali Alcântara ◽

Carolina Almeida Vieira ◽

Dayse Mayara de Oliveira Ferreira ◽

...

Keyword(s):

Repeated Measures ◽

Statistical Tests ◽

Sensory Deprivation ◽

Group Versus ◽

Cortical Potential ◽

Analysis Of Covariance ◽

Control Group ◽

Negative Consequences ◽

Significant Difference ◽

History Of

Abstract Introduction Any type of sensory deprivation in childhood resulting from conductive hearing loss may impair the development of peripheral and central auditory pathway structures with negative consequences for binaural processing. Objective To characterize and compare monoaural and binaural auditory responses in neonates and children without and with a history of recurrent otitis. Methods The study included participants from 0 to 8 years and 11 months old, in good general health conditions, of both genders, divided into a control group, with no history of otitis, and a study group, with history of recurrent otitis. Cortical potential with speech stimulus /ba/-/da/ was used as collection procedure. The arithmetic calculation of the 512 points of the wave was performed to obtain the grand average of the waves of the subjects in both groups. The Shapiro-Wilk and mixed repeated measures analysis of covariance (ANCOVA) statistical tests were performed to analyze the group effect, the condition, and the interaction (group versus condition) controlling the effect of the age-sex covariable. Results There was a statistically significant difference between the groups for all latency values; and for the P1, N1, P2, and N2 latencies, the differences between the groups occurred in the three analyzed conditions (right and left ears and binaural), revealing the influence of sensory deprivation. There were no significant differences in relation to wave amplitudes. Conclusion There are differences in the cortical potential with speech stimuli and in the binaural interaction component of children with and without history of recurrent otitis.

Download Full-text

A long-term evaluation of a training program on breaking bad news in pediatric neurosurgery: a pilot study

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.12.peds19554 ◽

2020 ◽

Vol 25 (6) ◽

pp. 670-678

Author(s):

Marc Zanello ◽

Thomas Baugnon ◽

Alexandre Roux ◽

Federico Di Rocco

Keyword(s):

Training Program ◽

Positive Impact ◽

Training Session ◽

Pediatric Neurosurgery ◽

Bad News ◽

Long Term Results ◽

Breaking Bad News ◽

Immediate Feedback ◽

Breaking Bad

OBJECTIVEBreaking bad news is a difficult task in medical practice. Several breaking-bad-news training programs have been proposed. However, long-term results of such training have rarely been investigated. The aim of this study was to compare the short- and long-term evaluations by young neurosurgeons of a training program for breaking bad news to patients and their parents.METHODSBetween 2012 and 2015, pediatric neurosurgery residents participated in a training day on breaking bad news in pediatric neurosurgery with professional actors. A personal debriefing, followed by a theoretical session, completed the training. Immediate feedback was evaluated through a survey administered at the end of the day. Long-term results were explored via an online form sent at least 3 years after the training completion.RESULTSSeventeen participants from 9 different countries were interviewed. Their immediate feedback confirmed their interest. For 71% of them, the program was very interesting, and 77% were extremely satisfied or very satisfied. All trainees wanted more training sessions. At a mean of 4.5 years of follow-up (range 3–6 years), 71% of the trainees fully remembered the session. Most of them (86%) reported a positive impact of the training on their career. Only 21% had another training session on breaking bad news during their residency. At long-term analysis, fewer trainees considered the duration of the training to have been sufficient (p = 0.044).CONCLUSIONSBreaking-bad-news training has a positive long-term educational impact even several years later. Such a training program should be implemented into pediatric neurosurgery residency.

Download Full-text