Breaking Bad News: the TAKE five program

Introduction For years, bad news delivery’s impact on patients or their relatives, as well as physicians’ stress has been a major concern. Based on studies claiming the efficacy of training courses to help physicians delivering such news, many protocols, like SPIKES, BREAKS or SHARE, have emerged worldwide. However, training to such protocol might be time-consuming and not suitable with junior doctors or trainees’ turnover. We hypothesised that a standardized 5-hours training program could improve bad news delivery practice. Participants and methods This preliminary study was conducted in the ED of a tertiary care academic hospital accounting for 90000 ED census per year, 16 attending physicians, 10 junior residents, and 5 trainees per month. Data were collected between November 2015 and April 2016. The study included 3 phases over 4 weeks. Video recorded single role-playing sessions happened the 1st (T1) and the 4th (T3) weeks. A 3-hour theory lesson happened the second week (T2), introducing the basics of therapeutic communication and delivering bad news. Each role-playing session lasted almost 1 hour (10 minutes briefing and medical case reading, 10 minutes role-plays and 40 minutes group debriefing). Bad news delivery performance was evaluated by a 14-points retrospective assessment tool (1). We collected data about the status and impact of a stressful event at 3-days using the French version of the IES-R scale (2). We applied Student t-tests for statistical analysis. Results 14 volunteers (10 trainees and 4 junior emergency physicians) were included in the study. On average, bad-news delivery process took 9’45’’ at T1 and 10’20’’ at T3. From T1 to T3, bad-news delivery performance increased significantly for both junior emergency physicians and trainees (p=0.0003 and p=0.0006, respectively). Further analysis revealed that most relevant increases involved the “situation” (p<0.001), “presentation” (p=0.009), “knowledge” (p=0.037), “emotions” (p=0.01) and “summary” (p=0.001) steps. We also found a significant decrease of the impact of bad-news delivery on trainee physicians’ stress (p=0.006). Discussion and conclusion These preliminary results indicate some potential for this new standardized course of bad news delivery. Apart from allowing physicians increase their communications skills, we believe that this simple 5-hour simulation-training program could alleviate physicians’ stress when they happen to break bad news. References 1. Brunet, A. et al. (2003). Validation of a French version of the Impact of Event Scale-Revised. Can J Psychiatry, 48(1), 56-61. 2. Park, I. et al. (2010). Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol. J Emerg Trauma Shock, 3(4), 385-388

Evolutions sociales, innovations et poliques. Nouvelles questions et nouveaux enjeux pour la psychologie de la santé

Le 8e Congrès de l’Association francophone de psychologie de la santé s’est déroulé à l’Université de Liège, du 15 au 17 décembre 2014. Trois grands thèmes y ont été développés : les évolutions sociales, les innovations et les politiques, dans le domaine de la psychologie de la santé. Ce congrès a également permis la production de cet ouvrage qui se subdivise en sept parties : « Enfant, famille et santé » ; « Psycho-oncologie » ; « Santé au travail » ; « Vieillissement et santé » ; « Maladies chroniques » ; « Risques en santé et éducation thérapeutique » ; « Émotion et santé ». Les différents articles présentés rendent compte de la diversité des approches conceptuelles et méthodologiques qui constituent l’identité de la psychologie de la santé francophone

Soutenir le développement professionnel des enseignants en haute école par la recherche : analyse d’un dispositif d’appel à projets interne

Le décret de 2013 définissant les missions des institutions d’enseignement supérieur en Fédération Wallonie-Bruxelles de Belgique a identifié la recherche appliquée comme étant une mission à part entière des hautes écoles. Or, le projet professionnel des enseignants qui évoluent dans ces établissements est initialement guidé par l’enseignement. Afin d’affilier son corps enseignants à cette nouvelle mission, une hautes écoles a mis en place un appel à projets interne. L’étude présentée dans cet article prend pour objet le développement professionnel inédit des enseignants impliqués dans des projets de recherche. Dans une perspective d’amélioration continue de la démarche d’appel, sa visée compréhensive et exploratoire est de documenter le processus de construction identitaire dans lequel sont engagés ces enseignants-chercheurs, d’identifier les apprentissages réalisés ainsi que les facilitateurs et obstacles perçus. Ce sont 51 enseignants ont été interrogés par le biais d’un questionnaire individuel proposé en ligne. Les données ont fait l’objet d’une analyse de contenu qualitative. Les résultats indiquent notamment que le souhait de faire de la recherche s’articule à celui d’améliorer et d’alimenter ses pratiques d’enseignement. A cet égard, l’approche du Scholaship of Teaching and learning (Brew, 2010) pourrait apporter un éclairage sur la spécificité du processus de développement professionnel en HE. Le principal frein reste le temps dévolu au projet de recherche, à la fois trop court et difficile à articuler avec le temps dévolu à l’enseignement. Des leviers sont identifiés dans la dynamique collective au sein et entre équipes de projet ainsi que dans l’accompagnement institutionnel qui s’avère nécessaire.The 2013 decree defining the missions of higher education institutions in the Wallonia-Brussels Federation of Belgium identified applied research as a full-fledged mission of the university college. However, the professional project of teachers who evolve in university college is initially guided by teaching. In order to align its teaching staff with this new mission, one university of applied sciences has set up a call for internal projects. The study presented in this article takes as its object the novel professional development of teachers involved in research projects. With a view to the continuous improvement of the call process, its comprehensive and exploratory aim is to document the process of identity construction in which these teacher-researchers are involved, to identify the learning achieved as well as the facilitators and obstacles perceived. Finally, 51 teachers were interviewed by means of an individual online questionnaire. The data were analysed with a qualitative method. The results indicate, among other things, that the desire to do research is linked to the desire to improve and inform one's teaching practices. In this respect, the Scholaship of Teaching and learning approach (Brew, 2010) could shed light on the specificity of the professional development process in HE. The main obstacle remains the time allocated to the research project, which is both too short and difficult to combine with the time allocated to teaching. Levers are identified in the collective dynamics within and between project teams as well as in the institutional support that is necessary

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P &lt; 0.001), the BBN process (P &lt; 0.001), and communication skills (P &lt; 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P &lt; 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills

Transfer of Communication Skills to the Workplace during Clinical Rounds : Impact of a Program for Residents

peer reviewe

Intérêt et utilisation de l’hypnose pour améliorer le bien-être physique et psychologique en oncologie

Le cancer et ses traitements ont de nombreux effets secondaires : douleurs, fatigue, difficultés de sommeil, nausées, vomissements, bouffées de chaleur, détresse émotionnelle. Ces symptômes impactent négativement la qualité de vie des patients et perdurent souvent pendant des années après les traitements. Malgré la difficulté à traiter ces effets secondaires au moyen d’approches pharmacologiques, l’hypnose a souvent été laissée de côté en oncologie. L’hypnose est définie comme un état de conscience modifié au cours duquel des processus d’attention et de concentration focalisées permettent au sujet une absorption dans son monde intérieur associée à une relative mise en suspens de la conscience de l’environnement. Durant cette procédure, un professionnel suggère au patient des changements dans ses sensations, perceptions, pensées ou comportements. Plusieurs études ont mis en évidence l’efficacité de l’hypnose pour diminuer la douleur provoquée par les traitements et procédures oncologiques. ’hypnose est également utile dans le cadre de la gestion de la fatigue liée au cancer. Des interventions combinant hypnose et thérapie cognitivocomportementale ou auto-bienveillance ont montré des effets positifs à ce niveau. Par ailleurs, l’hypnose permet une amélioration de la détresse émotionnelle liée aux procédures médicales et du bien-être psychologique général, ainsi qu’une diminution de certains symptômes physiques comme les nausées et les bouffées de chaleur. Les techniques de neuro-imagerie mettent en évidence des processus cérébraux spécifiques à l’état d’hypnose. Nous pouvons ainsi mieux comprendre les mécanismes sous-jacents aux modifications comportementales rapportées par les patients qui bénéficient de l’hypnose dans leur prise en charge.Cancer and its treatments have several consequences: pain, fatigue, sleep disturbances, nausea, vomiting, hot flashes, and emotional distress. These symptoms negatively affect patients’ quality of life and can persist for years after treatment completion. Despite the difficulty to improve them with pharmacological approaches, hypnosis has often been ignored in oncology settings. Hypnosis can be defined as a particular state of consciousness during which focalized attention and concentration processes allows the person to be absorbed in their inner world, associated with a suspension of the awareness of the environment. During this procedure, a therapist will suggest to the patient some changes in their sensations, perceptions, thoughts or behaviors. Studies have shown the efficacy of hypnosis to decrease treatment and procedure-related pain in oncology. Hypnosis is also useful to deal with cancer-related fatigue. Interventions combining hypnosis and cognitive-behavioral therapy or self-care techniques have shown positive effects on fatigue. Hypnosis also helps to improve procedure-related emotional distress and psychological well-being, as well as some physical symptoms such as nausea and hot flashes. Neuroimaging studies highlighted specific neural mechanisms of hypnotic state, allowing to better understand behavioral modifications reported by patients, after hypnosis

Analyse qualitative thématique de la phénoménologie des expériences de mort imminente

peer reviewedNear-death experiences (NDEs) refer to profound psychological events that can have an important impact on the experiencers’ (NDErs) lives. Previous studies have shown that NDEs memories are phenomenologically rich. In the present study, we therefore aimed to extract the common themes (referred to as “features” in the NDE literature) reported by NDErs by analyzing all the concepts stored in the narratives of their experiences. A qualitative thematic analysis has been carried out on 34 cardiac arrest survivors’ NDE narratives. Our results shed the light on the structure of the narratives by identifying 10 “time-bounded” themes which refer to isolated events encountered during the NDE and 1 “transversal” theme which characterizes the whole narrative and generally appears as a retrospective comment of self-reflection on the experience. The division of narratives into themes provides us with detailed information about the vocabulary used by NDErs to describe their experience. This established thematic method enables a rigorous description of the phenomenon, ensuring the inclusion of all self-reported manifestations of themes in narratives

Some novel applications of VR in the domain of health

Recent progress in virtual reality (VR) technologies make immersion more accessible to everyone, and, in particular, developments aimed at the entertainment industry are being brought into to the domain of health. The main uses of VR in health are of two forms. First, it is a new method to diagnose and to treat patients; second, it is a new method to train and/or teach healthcare and emergency-response professionals. There are several reasons for using VR in healthcare. First, virtual environments (VE) are fully under control, so that the user (patient or professional) is then safe from any harm and the session can be interrupted if necessary. Second, there are many instances where placing the user in a real environment would be very hard to do and/or very costly. A major advantage of VR is that this user can instead be immerged in an equivalent artificial/virtual environment through the use of immersive technologies. Third, with regard to teaching, a significant advantage of VR is that it allows one “to bring the body to learning”, thereby effectively embedding new knowledge into the muscles. Below, we describe several uses of VR at our university in the domain of health. © Springer Nature Switzerland AG 2019