Learning to deliver difficult news with sensitivity

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We have all been there. Not all medical procedures go as intended and it is often left to physicians to deliver distressing news. Communicating unexpected medical outcomes is daunting. It can create fear and anxiety for everyone involved. It is important to know how to convey unanticipated results in a sensitive manner, but few physicians receive communication training.

As part of a provincial quality improvement initiative, VPSA is working with Vancouver Coastal Health to address this issue. VPSA is funding physician time to act as peer facilitators in delivering Communications in Unanticipated Outcomes in Healthcare training. Since spring 2021, 80 VCH frontline health-care workers have taken the course, which consists of two two-hour sessions delivered via Zoom.

VGH Hospitalist Dr. Rod Tukker is one of the accredited facilitators.

“The course provides communication tools specifically around disclosure,” he said. “There’s training on understanding when disclosure conversations need to happen—the thresholds for disclosure in clinical practice. It gives you a framework on how to have the conversations to meet patient needs. The course was designed by CMPA’s Saegis branch and meets the guidelines set out by the Canadian Patient Safety Institute.”

Feedback from participants has been positive. Health-care workers appreciate the focus the course puts on taking a team approach to disclosure. The course also gives participants a clearer understanding that it is difficult for both patients and staff when things go wrong.

“The anxiety, the stress it puts upon staff when things don’t go as anticipated is something we often don’t talk about, but in this course, it’s front and centre,” added Dr. Tukker. “Disclosure can heal or help deal with the stress and anxiety that come along with unexpected outcomes for health-care providers. Course participants learn to see these situations through a different lens. Having a framework and approach takes the anxiety level down.”

Participants say some of the most valuable lessons from the workshop are understanding patients’ clinical, emotional, and information needs when receiving distressing news as well as the importance of providing ongoing support. They appreciate the focus on making this type of communication a team effort and recognize that disclosure creates an avenue for improving the quality of care and mutual trust.

“As we work towards a cohesive approach to communicating with patients and families, we hope to see improved experiences for everyone,” said VCH Regional Director, Patient Experience Elizabeth Baron. “The impact of improved disclosure conversations—in addition to it being the right thing to do—has been shown to build trust in the organization, reduce fear of blame, decrease litigation against providers and the organization, and also shed light on organizational opportunities for improvement.”

“If there’s one area of focus for improving quality and patient and provider experience, improving our communication skills can really make an impact,” concluded Dr. Tukker. “If we can improve these skills, we ourselves will have a better experience of our work, and certainly we know our patients will have a better experience. That will go a long way to improving quality.”

VPSA members interested in taking the training are encouraged to connect with Elizabeth Baron at elizabeth.baron@vch.ca.

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