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Release: Oct. 30, 2002

UI researcher studies how to teach delivering bad news to patients

Delivering bad news to a patient is a difficult task that many physicians face almost every day. One University of Iowa researcher's work, however, suggests that addressing the topic in medical education is effective in making the situation more comfortable for both patients and physicians.

Marcy E. Rosenbaum, Ph.D., UI assistant professor in family medicine, conducted a study on the impact of hands-on education on medical students' comfort with delivering difficult news.

"It's an important topic to study because until recently, most practicing physicians did not have training in delivering bad news," Rosenbaum said. "There is a way to make it less distressing for both patient and physician."

In small groups, third-year medical students practiced presenting bad news in five different scenarios to simulated patients, paid volunteers who are trained to play real patients. Each patient presented a different response to bad news, including shock, denial, anger and sadness. If the student effectively showed empathy, the actor/patient's distress decreased.

The five scenarios included having to tell a patient that they have cancer, that they have contracted a sexually transmitted disease, that a loved one has died, that cancer has returned to a young patient and discussing hospice care with a family member.

After going through a scenario, the student discussed it with other students, who watched the sessions through closed-circuit television.

"We want students to learn through doing," Rosenbaum said.

Surveys were administered to 341 students before, four weeks after and one year after the program. Students rated their comfort levels in discussing bad news, terminal illness, hospice care and dying with patients.

Results of the surveys showed that students became more comfortable with discussing bad news with patients after the educational program. Students rated highly the encounters with standardized patients and observation of others.

Rosenbaum, along with Jeffrey Lobas, M.D., UI professor (clinical) of pediatrics, and Raymond Tannous, M.D., UI associate professor of pediatrics, teaches the skills of delivering bad news to third-year medical students at the UI during clinical skills week.

"This is an essential skill that physicians must develop over time, which means the earlier we start, the better," said Mustafa Shadi Bashir, a third-year UI medical student who participated in the class. "Giving people bad news is difficult, and the first time it counts should not be the first time you try. Getting a chance to practice is very important."

Tracy Reittinger, M.D., a first-year resident in internal medicine at the University of Michigan, took Rosenbaum's class while a UI medical student. Already, she has used the experience in her residency. One situation required having to tell a patient that he likely had only weeks to live due to stomach cancer that had spread throughout his body.

"I am very grateful that my first experience with delivering bad news was not with a real patient, but was rather a very positive experience with a simulated patient during Dr. Rosenbaum's class," Reittinger said. "While I don't like delivering bad news to families, I feel confident that I can do it well and that families are satisfied with the experience."

The study results were published in the summer 2002 issue of Teaching and Learning in Medicine. Clarence Kreiter, Ph.D., UI assistant professor in family medicine, co-authored the article.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.