Breaking bad news is one of the most difficult types of conversations for healthcare providers to have with their patients. Paula McAvoy and Maura Ellis at Staten Island University Hospital (SIUH) got to collaborate with fellow SIUH peers to do something about it. Recently, the training team completed an extensive program for all medical residents and hospitalists at the Patient Safety Institute, SIUH’s state-of-the-art simulation lab. The training focused on addressing two issues:
The training team was interdisciplinary and included physicians, nurses, and social workers with backgrounds in internal medicine, hospice, palliative care, and emergency medicine. The program was unique in that the participants interacted with a live “patient” or “family member” who were role-played by fellow healthcare professionals (many of them hospice and palliative care team members). The case studies provided opportunities for the residents and hospitalists to practice the communication skills taught in real time with the standardized patient in the simulation lab.
A large focus of the training was to shift the doctors from focusing on the delivery of purely clinical information, and change that focus to providing empathetic and emotional responses as a way of ensuring that patients will feel heard and understood. They were given tools from an evidence-based research method called SPIKES (Setting, Perception, Invitation, Knowledge, Explore Emotions and Empathy, and Strategize and Summarize). During the simulations, they were able to practice new skills like rephrasing for clarification of emotions and understanding, utilizing ‘pauses’ to allow patients to process information, and using body language to convey empathy.
A content expert in palliative care and simulation training observed the interaction through a one-way mirror and would then debrief the residents and hospitalists. It was interesting for participants to receive feedback on some of the exact words they used or emotions that they did not respond to, but were not aware of, during the simulation lab. They then got a chance to repeat those parts of the interaction. This was a great learning experience and SIUH is currently looking to expand the program to the pediatric residents in early 2020.