Digital learning for breaking bad news in clinical training and practice

Introduction Good communication and the ability to break bad news are essential skills for clinicians but are underemphasised in training programmes. In recent years, digital learning has come to the forefront in healthcare education. However, the evidence for its use in breaking bad new (BBN) training is limited. This thesis explores clinicians’ digital learning needs, highlights pre-existing curricular requirements for BBN training, and examines how this translates into clinical practice. Methods Digital learning needs and curricular requirements for BBN training were established through (i) a systematic review and narrative synthesis of the literature, (ii) a thematic analysis of semi-structured interviews exploring clinicians’ perceptions, and (iii) a content analysis of UK postgraduate medical and nursing curricula. From this, a novel digital learning framework for BBN training was presented and used to evaluate pre-existing digital learning resources (DLRs). The acceptability of one DLR and its impact on confidence in BBN was tested with clinicians in a pre-post mixed-methods pilot study. Results Three digital learning needs were identified from the narrative synthesis of a heterogenous group of 26 studies, including positioning the learner as an active participant in a safe digital environment. Five learning needs were extracted from interviews with doctors (n=16) and nurses (n=16), including accessibility and catering to learning preferences. Thirty-one pre-existing curriculum requirements were identified from the content analysis of curricula. The learning needs and curriculum requirements were collated to form a digital learning framework. In the pilot study, a mobile learning application (VitalTips) proved to enable skills acquisition and improve confidence in BBN, as it was user-friendly, emulated clinical practice, and highlighted challenges for learning in the workplace. Conclusions The research presented in this thesis showcases the requirements for and effectiveness of digital learning for BBN training. Though it may not replace learning through clinical practice, digital learning can be a powerful adjunct. As digital learning develops, there will be exciting future advancements in this field of education.Open Acces

Unconventional Methods for a Traditional Setting: The Use of Virtual Reality to Reduce Implicit Racial Bias in the Courtroom

The presumption of innocence and the right to a fair trial lie at the core of the United States justice system. While existing rules and practices serve to uphold these principles, the administration of justice is significantly compromised by a covert but influential factor: namely, implicit racial biases. These biases can lead to automatic associations between race and guilt, as well as impact the way in which judges and jurors interpret information throughout a trial. Despite the well-documented presence of implicit racial biases, few steps have been taken to ameliorate the problem in the courtroom setting. This Article discusses the potential of virtual reality to reduce these biases among judges and jurors. Through analyzing the various ethical and legal considerations, this Article contends that implementing virtual reality training with judges and jurors would be justifiable and advisable should effective means become available. Given that implicit racial biases can seriously undermine the fairness of the justice system, this Article ultimately asserts that unconventional de-biasing methods warrant legitimate attention and consideration

Level Up: The Use of Video Games in Healthcare

Video games have been primarily used for recreational purposes, however over the last few years the healthcare field has taken an interest in them. Traditionally, video games were primarily used for recreational purposes but as technology has evolved, video games are now being used to improve patient health outcomes and improve the way physicians and medical professionals practice medicine. While there may be some adverse effects associated with gaming, the benefits outweigh them. This paper discusses the positive impact video games have had in healthcare including, medical training, anxiety management, and physical therapy

Initial Construct Validity Evidence of a Virtual Human Application for Competency Assessment in Breaking Bad News to a Cancer Patient

Background: Despite interest in using virtual humans (VHs) for assessing health care communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN) to a VH patient. Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15) completed the VH simulation before and after the seminar, and Group B (n=12) completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre-and postseminar differences for Group A were analyzed with a paired t-test, and comparisons between Groups A and B were analyzed with an independent t-test. Results: Compared to the preseminar result, Group A\u27s postseminar scores improved significantly, indicating that the VH program was sensitive to differences in assessing performance-based competence in BBN. Postseminar scores of Group A and Group B were not significantly different, indicating that both groups performed similarly on the VH program. Conclusion: Improved pre-post scores demonstrate acquisition of skills in BBN to a VH patient. Pretest sensitization did not appear to influence posttest assessment. These results provide initial construct validity evidence that the VH program is effective for assessing BBN performance-based communication competence

Telephone communication with patients’ relatives: A meta-synthesis

La relació metge-pacient ha canviat al llarg de la història i, en l’actualitat, s’ha abandonat progressivament el tipus paternalista que s’ha mantingut durant centenars d’anys fins a arribar a la medicina centrada en el pacient. En aquesta, la comunicació té un paper principal. La pandèmia de la covid-19 ha suposat importants reptes en aquesta matèria.Aquesta recerca pretén revisar la literatura científica sobre el tema, des de 2015 fins a finals del 2021. La metodologia emprada ha estat una metasíntesi, que ha permès revisar i analitzar diferents estudis qualitatius. S’han trobat diferències entre els períodes pre- i postcovid-19, a més d’una manca de cos teòric. La telemedicina creixerà en els pròxims anys i també la comunicació a distància, per la qual cosa és necessari considerar tots els possibles inconvenients i riscs que puguin presentar-se i mitigar-los abans que es converteixin en problemes greus, com podrienser qüestions relacionades amb la seguretat dels pacients, la confidencialitat, la seguretat física, els costos ocults, la falta de formació del personal o la bretxa digital. The relationship between doctor and patient has evolved over time and the paternalistic attitudes that were held for centuries have been progressively superseded by patientcentred medicine, in which communication plays a key role. The COVID-19 pandemic has introduced serious challenges in this field. This investigation aims to review the scientific literature dealing with this issue, from 2015 to the end of 2021. The methodology employed has been a meta-synthesis,allowing the review and analysis of different qualitative studies. Some differences have been found between the pre- and post-pandemic periods, together with a lack of theoretical corpus. Telehealth will grow in the years to come and so will distance communication, so it is necessary to consider all possible drawbacks and risks and mitigate them before they may turn into serious problems, such as issues related to patient safety, security, and confidentiality; hidden costs; lack of training; or the digital breach.&nbsp

Social Skills Training Tool in Virtual Reality, Intended for Managers and Sales Representatives

International audienceSocial skills training courses for managers and sales representatives are mainly realized today through role-playing sessions, which show several limits: realism, contextualization, evaluation objectivity. This paper describes a prototype of a Virtual Reality tool intended to answer these issues. This tool allows living role-playing sessions with virtual characters. We present the results of the first user tests we carried out. Users felt spatially present, involved, and socially present. Results also underline areas of improvement, such as non-verbal behaviors, scenario content and environment realism

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Breaking bad news about cancer : the experiences of patients, patients' family/whānau members and healthcare professionals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand

Breaking bad news is a reality of medical practice in oncology, and can be a challenging task for those receiving and delivering the news. For patients and their family members, ‘bad news’ is understandably accompanied by strong emotions and ongoing implications for their lives as they adjust to the news. For healthcare professionals (HCPs), there are numerous variables to consider and balance when having these difficult conversations, as well as managing the personal impact. The current study aims to explore the subjective experiences of patients, patients’ family/whānau members, and HCPs when bad news was delivered to patients about their cancer within the surgical departments of MidCentral District Health Board. The study is designed to allow multiple perspectives to be gathered and compared, and recommendations for practice to be made that align with the goals of those involved in the project’s inception, as well as attend to the underrepresentation of family members’ perspectives and New Zealand-based data in the literature. To achieve this, the current study utilised a qualitative approach with the epistemological and methodological basis informed by interpretative phenomenological analysis. The study also included a consumer perspective with the involvement of the Otaki advisory group to guide how the study was conducted and provide feedback on the study outcomes. Data was collected through semi-structured interviews with 10 patients, 6 family/whānau members, 5 surgeons, and 6 nurses. Interviews were analysed in two ways: by participant group (i.e., patients, family members, and HCPs) and by ‘linked case’ (i.e., direct comparisons of the perspectives of all those involved in the same patient’s case of breaking bad news). The findings are presented as a series of superordinate and subordinate themes. The group-based analysis highlighted that patients understood their bad news experiences through the lens of their health beliefs and expectations of care, the relational and support needs they, and others, had during and following the encounter, and the ongoing shifts in perspective and priorities they experienced. Family members identified the patient as the focus of care, but also acknowledged their need for support in order to cope. HCPs recognised that breaking bad news was challenging based on the variation between instances of breaking bad news and patients’ needs, organisational constraints they had to work under, and the personal toll this task could take. The linked case-based analysis demonstrated that the receivers of bad news have a range of emotional and informational needs and that HCPs and family members fulfil important roles in accurately meeting patients’ needs. Four conclusions can be drawn from the study as a whole about the process of breaking bad news. Firstly, there is variability in the situations, delivery approaches and needs of those involved in breaking bad news, requiring a flexible and tailored approach. Secondly, establishing an interpersonal connection between the deliverer and receiver of bad news is a central part of the process. Thirdly, breaking bad news is a challenge for all and receiving support in order to cope, is paramount. Lastly, there is a shared responsibility across healthcare organisations, training providers, HCP teams, and individual HCPs to make this process go as well as possible for all those involved. The current research makes an important contribution to understanding that, without doubt, breaking bad news is a complex process for those delivering and receiving the news, and improvements in this area require careful consideration, prioritising and resourcing as part of delivering effective cancer care

New Economic Analysis of Law: Beyond Technocracy and Market Design

This special issue on New Economic Analysis of Law features illuminating syntheses of social science and law. What would law and economics look like if macroeconomics were a concern of scholars now focused entirely on microeconomics? Do emerging online phenomena, such as algorithmic pricing and platform capitalism, promise to perfect economic theories of market equilibrium, or challenge their foundations? How did simplified economic models gain ideological power in policy circles, and how can they be improved or replaced? This issue highlights scholars whose work has made the legal academy more than an “importer” of ideas from other disciplines—and who have, instead, shown that rigorous legal analysis is fundamental to understanding economic affairs.The essays in this issue should help ensure that policymakers’ turn to new economic thinking promotes inclusive prosperity. Listokin, Bayern, and Kwak have identified major aporias in popular applications of law and economics methods. Ranchordás, Stucke, and Ezrachi have demonstrated that technological fixes, ranging from digital ranking and rating systems to artificial intelligence-driven personal assistants, are unlikely to improve matters unless they are wisely regulated. McCluskey and Rahman offer a blueprint for democratic regulation, which shapes the economy in productive ways and alleviates structural inequalities. Taken as a whole, this issue of Critical Analysis of Law shows that legal thinkers are not merely importers of ideas and models from economics, but also active participants, with a great deal to contribute to social science research