Effectiveness of Integrating Simulation with Art-Based Teaching Strategies on Oncology Fellows’ Performance Regarding Breaking Bad News

  • Afsaneh Yakhforoshha
  • Seyed Amir Hossein Emami
  • Farhad Shahi
  • Saeed Shahsavari
  • Mohammadali Cheraghi
  • Rita Mojtahedzadeh
  • Behrooz Mahmoodi-Bakhtiari
  • Mandana Shirazi
Article
  • 58 Downloads

Abstract

The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows’ performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows’ performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows’ performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p < 0.05). Similarly, the significant level change in fellows’ score rated by faculty members in post-training was B = 1.091, F = 3.273, G = 1.724; p < 0.05. There was no significant change in trend of fellows’ performance after the intervention. Our results showed that using an integrating simulation with art-based teaching strategies may help oncology fellows to improve their communication skills in different facets of BBN performance. Iranian Registry of Clinical Trials ID: IRCT2016011626039N1

Keywords

Simulation Education Breaking bad news Interrupted time series 

Notes

Acknowledgments

The authors would like to express their deep gratitude to Dr. Mehrzad Mirzania, Dr. Hazhir Saberi, Dr. Alireza Abdollahi, and Dr. Mohsen Esfandbod for their kind contribution in the study and also would like to thank all the oncology fellows and employers and SPs who participated in this study.

Compliance with Ethical Standards

The study was approved by Ethics Committee at TUMS, and it was registered in the Iranian Registry of Clinical Trials (ID: IRCT2016011626039N1). Informed consent is obtained from fellows and SPs.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

13187_2018_1324_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)

References

  1. 1.
    Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (2000) SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5(4):302–311CrossRefPubMedGoogle Scholar
  2. 2.
    Bays AM, Engelberg RA, Back AL, Ford DW, Downey L, Shannon SE, Doorenbos AZ, Edlund B, Christianson P, Arnold RW (2014) Interprofessional communication skills training for serious illness: evaluation of a small-group, simulated patient intervention. J Palliat Med 17(2):159–166CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bowyer MW, Hanson JL, Pimentel EA, Flanagan AK, Rawn LM, Rizzo AG, Matthew Ritter E, Lopreiato JO (2010) Teaching breaking bad news using mixed reality simulation. J Surg Res 159(1):462–467CrossRefPubMedGoogle Scholar
  4. 4.
    Brown J (2010) Transferring clinical communication skills from the classroom to the clinical environment: perceptions of a group of medical students in the United Kingdom. Acad Med 85(6):1052–1059CrossRefPubMedGoogle Scholar
  5. 5.
    Brown RF, Bylund CL (2008) Communication skills training: describing a new conceptual model. Acad Med 83(1):37–44CrossRefPubMedGoogle Scholar
  6. 6.
    Bryson EO, Levine AI (2008) The simulation theater: a theoretical discussion of concepts and constructs that enhance learning. J Crit Care 23(2):185–187CrossRefPubMedGoogle Scholar
  7. 7.
    Chen RP (2011) Moral imagination in simulation-based communication skills training. Nurs Ethics 18(1):102–111CrossRefPubMedGoogle Scholar
  8. 8.
    Eggly S, Penner L, Albrecht TL, Cline RJW, Foster T, Naughton M, Peterson A, Ruckdeschel JC (2006) Discussing bad news in the outpatient oncology clinic: rethinking current communication guidelines. J Clin Oncol 24(4):716–719CrossRefPubMedGoogle Scholar
  9. 9.
    Eisenberg A, Rosenthal S, Schlussel YR (2015) Medicine as a performing art: what we can learn about empathic communication from theater arts. Acad Med 90(3):272–276CrossRefPubMedGoogle Scholar
  10. 10.
    Fallowfield L, Jenkins V (2004) Communicating sad, bad, and difficult news in medicine. Lancet 363(9405):312–319CrossRefPubMedGoogle Scholar
  11. 11.
    Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet 359(9307):650–656CrossRefPubMedGoogle Scholar
  12. 12.
    Farber NJ, Urban SY, Collier VU, Weiner J, Polite RG, Davis EB, Boyer EG (2002) The good news about giving bad news to patients. J Gen Intern Med 17(12):914–922CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Farokhyar N, Shirazi M, Bahador H, Jahanshir A (2014) Assessing the validity and reliability of spikes questionnaires regard in of medical residents awareness breaking bad news in TUMS 2012. Razi J Med Sci 21(122):29–36Google Scholar
  14. 14.
    Fieschi L, Burlon B, De Marinis MG (2015) Teaching midwife students how to break bad news using the cinema: an Italian qualitative study. Nurse Educ Pract 15(2):141–147CrossRefPubMedGoogle Scholar
  15. 15.
    Fujimori M, Uchitomi Y (2009) Preferences of cancer patients regarding communication of bad news: a systematic literature review. Jpn J Clin Oncol 39(4):201–216CrossRefPubMedGoogle Scholar
  16. 16.
    Girgis A, Sanson-Fisher RW (1995) Breaking bad news: consensus guidelines for medical practitioners. J Clin Oncol 13(9):2449–2456.  https://doi.org/10.1200/jco.1995.13.9.2449 CrossRefPubMedGoogle Scholar
  17. 17.
    Helitzer DL, LaNoue M, Wilson B, de Hernandez BU, Warner T, Roter D (2011) A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns 82(1):21–29CrossRefPubMedGoogle Scholar
  18. 18.
    Hopewell S, Ravaud P, Baron G, Boutron I (2012) Effect of editors’ implementation of CONSORT guidelines on the reporting of abstracts in high impact medical journals: interrupted time series analysis. BMJ 344:e4178CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hulsman RL (2009) Shifting goals in medical communication. Determinants of goal detection and response formation. Patient Educ Couns 74(3):302–308CrossRefPubMedGoogle Scholar
  20. 20.
    Mafinejad MK, Rastegarpanah M, Moosavi F, Shirazi M (2017) Training and validation of standardized patients for assessing communication and counseling skills of pharmacy students: a pilot study. J Res Pharm Pract 6(2):83CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD (2009) Difficult conversations: improving communication skills and relational abilities in health care. Pediatr Crit Care Med 10(3):352–359CrossRefPubMedGoogle Scholar
  22. 22.
    Ptacek JT, Eberhardt TL (1996) Breaking bad news: a review of the literature. JAMA 276(6):496–502CrossRefPubMedGoogle Scholar
  23. 23.
    Reed S, Kassis K, Nagel R, Verbeck N, Mahan JD, Shell R (2015) Breaking bad news is a teachable skill in pediatric residents: a feasibility study of an educational intervention. Patient Educ Couns 98(6):748–752CrossRefPubMedGoogle Scholar
  24. 24.
    Rimondini M, Del Piccolo L, Goss C, Mazzi M, Paccaloni M, Zimmermann C (2010) The evaluation of training in patient-centred interviewing skills for psychiatric residents. Psychol Med 40(03):467–476CrossRefPubMedGoogle Scholar
  25. 25.
    Schildmann J, Kupfer S, Burchardi N, Vollmann J (2012) Teaching and evaluating breaking bad news: a pre–post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters. Patient Educ Couns 86(2):210–219CrossRefPubMedGoogle Scholar
  26. 26.
    Shirazi M, Majid S, Emami A, Sabouri Kashani A, Sagar P, Alaeddini F, Arbabi M, Wahlstrom R (2011) Training and validation of standardized patients for unannounced assessment of physicians’ management of depression. Acad Psychiatry 35(6):382–387CrossRefPubMedGoogle Scholar
  27. 27.
    Skye EP, Wagenschutz H, Steiger JA, Kumagai AK (2014) Use of interactive theater and role play to develop medical students’ skills in breaking bad news. J Cancer Educ 29(4):704–708CrossRefPubMedGoogle Scholar
  28. 28.
    Suchman AL, Markakis K, Beckman HB, Frankel R (1997) A model of empathic communication in the medical interview. JAMA 277(8):678–682CrossRefPubMedGoogle Scholar
  29. 29.
    Tavakol M, Murphy R, Torabi S (2008) Educating doctors about breaking bad news: an Iranian perspective. J Cancer Educ 23(4):260–263CrossRefPubMedGoogle Scholar
  30. 30.
    Taylor S, Harley C, Campbell LJ, Bingham L, Podmore EJ, Newsham AC, Selby PJ, Brown JM, Velikova G (2011) Discussion of emotional and social impact of cancer during outpatient oncology consultations. Psycho-Oncology 20(3):242–251CrossRefPubMedGoogle Scholar
  31. 31.
    Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D (2002) Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 27(4):299–309CrossRefPubMedGoogle Scholar
  32. 32.
    Yakhforoshha A, Emami A H, Mohammadi N, Cheraghi M A, Mojtahedzadeh R, Mahmoodi-Bakhtiari B, and Shirazi M. 2017. Developing an integrated educational simulation model by considering art approach: teaching empathic communication skills. Eur J Person Centered Healthcare AccessedGoogle Scholar

Copyright information

© American Association for Cancer Education 2018

Authors and Affiliations

  • Afsaneh Yakhforoshha
    • 1
  • Seyed Amir Hossein Emami
    • 2
  • Farhad Shahi
    • 3
  • Saeed Shahsavari
    • 4
  • Mohammadali Cheraghi
    • 5
  • Rita Mojtahedzadeh
    • 6
  • Behrooz Mahmoodi-Bakhtiari
    • 7
  • Mandana Shirazi
    • 8
    • 9
    • 10
  1. 1.Medical SchoolTehran University of Medical SciencesTehranIran
  2. 2.Department of Medical Education, Faculty of MedicineTehran University of Medical SciencesTehranIran
  3. 3.Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
  4. 4.School of HealthQazvin University of Medical SciencesQazvinIran
  5. 5.School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
  6. 6.Virtual SchoolTehran University of Medical SciencesTehranIran
  7. 7.Department of Performing ArtsUniversity of TehranTehranIran
  8. 8.Educational Development Centre (EDC), Faculty of MedicineTehran University of Medical SciencesTehranIran
  9. 9.LIME DepartmentKarolinska InstitutetSolnaSweden
  10. 10.Department of Medical EducationTehran University of Medical SciencesTehranIran

Personalised recommendations