ASSESSING BAD NEWS DELIVERY SKILLS TO A PATIENT: ADAPTATION AND VALIDATION OF THE BREAKING “BAD NEWS ASSESSMENT SCHEDULE (BAS)” METHODOLOGY

• Elena Yu. Vasil`eva
• Lyudmila N. Kuzmina
• Elena V. Dyachenko

Abstract

Introduction. Assessment of bad news reporting skills to the patient is an integral component of physician training in professional communication, performing diagnostic, control, developmental, and stimulating control functions, provided that the assessment tools are standardized, i. e., valid and reliable. However, in Russian medical educational practice such a tool is absent.

The aim of the study is to translate and adapt the standardized “Breaking bad news Assessment Schedule (BAS)” (Miller S.J.) methodology to a sample of residents.

Material and methods. A description of the validated technique itself, the sample on which the study was conducted, is given. In the validation process, a forward and backward translation of the technique was performed, a cognitive interview was conducted, and 22 residents were evaluated and interviewed. The reliability-coherence of the five sections of the questionnaire was assessed. Criterion validity of the questionnaire was assessed using the contrast-group method, where sex differences were the validation criterion. To assess the retest reliability of the questionnaire, residents were questioned again six months after training in the bad news reporting technique.

Results. The reliability of the BAS questionnaire was found to be excellent (α=0.95). The proportion of respondents who had no difficulty in understanding the questions of the questionnaire was very high – ​98%. The results of comparing the structures of the integral marks given by the expert to the respondents and the respondents are statistically significantly different: the expert assessed the communication skills of the respondents more strictly compared to the self-assessments of the respondents. The results of the comparative analysis of the structures of marks in the primary and repeated questionnaires of the residents show that, in general, they are statistically significantly different. A study of the retest reliability of the questionnaire showed that the questionnaire is reliable as a tool for assessing bad news reporting.

Conclusion. The Russian-language version of the BAS technique is reliable, valid, and allows us to assess and examine the level of bad news reporting skills and residents’ and physicians’ readiness to have a difficult conversation with a patient in many training programs during residency training.

Keywords:communication skills; bad news; methodology; reliability and validity of the questionnaire; assessment; self-assessment; resident; patient

References

1. Vasilieva E. Yu., Ovodova G.F., Kuzmina L.N. Bad news and medical error: the tactics of reporting to the patient; textbook. Moscow: RUSAJNS, 2020. 107 p. (in Russian)
2. Buckman R. Breaking bad news: why is it still so difficult? Br Med J (Clin Res Ed). 1984; 288 (6430): 1597–9. DOI: https://doi.org/10.1136/bmj.288.6430.1597. PMID: 6426658; PMCID: PMC 1441225.
3. Mack J.W., Smith T.J. Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol. 2012; 30 (22): 2715–7. DOI: https://doi.org/10.1200/JCO.2012.42.4564. Epub 2012 Jul 2. PMID: 22753911.
4. Ptacek J.T., Eberhardt T.L. Breaking bad news. A review of the literature. JAMA. 1996; 276 (6): 496–502. PMID: 8691562.
5. Rabow M.W., McPhee S.J. Beyond breaking bad news: how to help patients who suffer. West J Med. 1999; 171 (4): 260–3. PMID: 10578682; PMCID: PMC 1305864.
6. Baile W.F., Buckman R., Lenzi R., et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000; 5 (4): 302–11. DOI: https://doi.org/10.1634/theoncologist.5-4-302. PMID: 10964998.
7. Girgis A., Sanson-Fisher R.W. Breaking bad news. 1: Current best advice for clinicians. Behav Med. 1998; 24 (2): 53–9. DOI: https://doi.org/10.1080/08964289809596381. PMID: 9695896.
8. Girgis A., Sanson-Fisher R.W. Breaking bad news: consensus guidelines for medical practitioners. J Clin Oncol. 1995; 13 (9): 2449–56. DOI: https://doi.org/10.1200/JCO.1995.13.9.2449. PMID: 7666105.
9. Narayanan V., Bista B., Koshy C. «BREAKS» Protocol for Breaking Bad News. Indian J Palliat Care. 2010; 16 (2): 61–5. DOI: https://doi.org/10.4103/0973-1075.68401. PMID: 21811349; PMCID: PMC 3144432.
10. Parker P.A., Baile W.F., de Moor C., et al. Breaking bad news about cancer: patients’ preferences for communication. J Clin Oncol. 2001; 19 (7): 2049–56. DOI: https://doi.org/10.1200/JCO.2001.19.7.2049. PMID: 11283138.
11. Pereira C.R., Calônego M.A., Lemonica L., et al. The P-A-C-I-E-N-T-E Protocol: An instrument for breaking bad news adapted to the Brazilian medical reality. Rev Assoc Med Bras (1992). 2017; 63 (1): 43–9. DOI: https://doi.org/10.1590/1806-9282.63.01.43. PMID: 28225878.
12. Wolfe A.D., Frierdich S.A., Wish J., et al. Sharing life-altering information: development of pediatric hospital guidelines and team training. J Palliat Med. 2014; 17 (9): 1011–8. DOI: https://doi.org/10.1089/jpm.2013.0620. Epub 2014 Jun 27. PMID: 24971650; PMCID: PMC 4158952.
13. Calhoun A.W., Rider E.A., Peterson E., et al. Multi-rater feedback with gap analysis: an innovative means to assess communication skill and self-insight. Patient Educ Couns. 2010; 80 (3): 321–6. DOI: https://doi.org/10.1016/j.pec.2010.06.027. Epub 2010 Jul 17. PMID: 20638814.
14. Joyce B.L., Scher E., Steenbergh T., et al. Development of an institutional resident curriculum in communication skills. J Grad Med Educ. 2011; 3 (4): 524–8. DOI: https://doi.org/10.4300/JGME-D-10-00233.1. PMID: 23205202; PMCID: PMC 3244319.
15. Kiluk J.V., Dessureault S., Quinn G. Teaching medical students how to break bad news with standardized patients. J Cancer Educ. 2012; 27 (2): 277–80. DOI: https://doi.org/10.1007/s13187-012-0312-9. PMID: 22314793; PMCID: PMC 4504018.
16. Brann M., Bute J.J., Scott S.F. Qualitative assessment of bad news delivery practices during miscarriage diagnosis. Qual Health Res. 2020; 30 (2): 258–67. DOI: https://doi.org/10.1177/1049732319874038. Epub 2019 Sep 19. PMID: 31535938
17. Hilkert S.M., Cebulla C.M., Jain S.G., et al. Breaking bad news: A communication competency for ophthalmology training programs. Surv Ophthalmol. 2016; 61 (6): 791–8. DOI: https://doi.org/10.1016/j.survophthal.2016.04.005. Epub 2016 Apr 29. PMID: 27134009; PMCID: PMC 5086298.
18. Lenkiewicz J., Lenkiewicz O., Trzciński M., et al. Delivering bad news: self-assessment and educational preferences of medical students. Int J Environ Res Public Health. 2022; 19 (5): 2622. DOI: https://doi.org/10.3390/ijerph19052622. PMID: 35270311; PMCID: PMC 8910051.
19. Miller S.J., Hope T., Talbot D.C. The development of a structured rating schedule (the BAS) to assess skills in breaking bad news. Br J Cancer. 1999; 80 (5-6): 792–800. DOI: https://doi.org/10.1038/sj.bjc.6690423. PMID: 10360657; PMCID: PMC 2362267.
20. Federal Law of 21.11.2011 N 323-FZ (ed. from 29.05.2019) «On the basis of health protection of citizens in the Russian Federation». URL: URL: http://www.consultant.ru/cons/cgi/ (in Russian)
21. Gaidyshev I.P. Modeling of stochastic and deterministic systems: attestat user’s manual. Kurgan, 2013. 491 p. (in Russian)
22. Zaks L. Statistical assessment. Moscow : Statistics, 1976. 600 p. (in Russian)
23. Beaton D.E., Bombardier C., Guillemin F., et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000. Vol. 25, N 24. P. 3186–91. DOI: https://doi.org/10.1097/00007632-200012150-00014. PMID: 11124735
24. Serikova D.D., Mikhalets I.V. Psychological characteristics of men and women. Naukosfera. 2020; 11-1: 103–6. URL: https://elibrary.ru/download/elibrary_44468515_43435189.pdf (in Russian)

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