Delivering bad
news
Program trains professionals in delicate situations
How would you tell a father that his toddler will never walk
again? A mother that her little girl’s cancer has spread beyond
the reach of chemotherapy? Or a couple in a waiting room that
their baby did not make it through emergency surgery? Delivering
bad news is one of the most difficult parts of a clinician’s job.
But unfortunately, most receive little or no formal training communicating
with families in critical situations.
Looking to fill this void, Children’s Hospital Boston has developed
the unique Program to Enhance Relational and Communication Skills
(PERCS), which provides practitioners with hands-on training in
the delicate art of delivering devastating news.
“We spend a lot of time working on improving our clinical procedures,”
says Robert
Truog, MD, chief of Critical Care Medicine, “but
often what families remember is not the details of the procedure,
but what physicians said to them and how they said it. Until now,
that’s not anything we’ve practiced.”
PERCS is a daylong training session that includes lectures, short
films, and most important, a simulation experience where professional
actors portray patients and family members dealing with critical
care or end-of-life situations. Session trainees must deliver
the difficult news while facilitators and peers watch from another
room.
“Simulation in general is widely recognized as a way to improve
skills in medicine,” Truog says. “We wanted to extend the simulation
methodology into the realm of communication skills.”
Trainees typically forget about the observers very quickly as
each scenario becomes emotionally authentic, says PERCS Director
Elaine Meyer, PhD. “Although you are role playing,
you feel very ‘in the moment.’ The situations really pull you
in.”
The simulations are designed to integrate the medical aspects
of each scenario with issues such as parental guilt, family conflicts
and disagreement about care. “We don’t just present straight medical
cases,” says Meyer. ”We include the psychosocial issues that clinicians
deal with every day.”
For medical trainees, being pushed like this is difficult, but
it pays off ultimately. “PERCS is a long, very emotionally exhausting
day,” says participant Robert
Graham, MD, a clinical fellow in the department of
Anesthesia. Graham says he found the day productive despite his
years of experience. “Everyone gained something from going through
it, no matter how long they’ve been in medicine.”
Following each simulation, participants reflect on the experience
with input from the PERCS team, families who have experienced
similar tragedies in real life and the actors from the simulation.
The feedback offers participants a rare glimpse of how real-life
parents may perceive them in a tough situation.
And it’s not just physicians who benefit from the training. Each
session also includes nurses, social workers, psychologists and
even chaplains. Eighty Children’s staff members, with medical
experience ranging from one to 30 years, have been trained so
far.
“New hires often tell me that talking to families in difficult
situations is one of their biggest fears coming into the job,”
says intensive care nurse Christine
Roe, RN. According to a survey of PERCS participants,
the program has helped most of them reduce that anxiety.
The PERCS philosophy isn’t about teaching a communication technique
or a specific way to deliver a message, but about how to build
relationships with families. “We know that when clinicians express
their humanity,” says Meyer. “Families realize that they’re not
walking this path alone.”
A videotape highlighting the teaching
philosophy of PERCS has been produced by the Initiative for
Pediatric Palliative Care and has been presented at the American
Academy of Pediatrics, and the American Academy of Hospice
and Palliative Medicine. It will be distributed to children’s
hospitals throughout the nation as part of the IPPC’s educational
program.
