ABSTRACT
Introduction: The COVID-19 pandemic increased the volume of critically ill patients in hospital. Healthcare professionals (HCPs), many of whom had limited experience of communicating bad news to relatives, needed to be able to do this and often by telephone. Aim: To design, deliver and evaluate a simulation based course to help HCPs communicate about death and dying by telephone during the pandemic. Methods: In March 2020 a multi-professional group of clinicians and educators developed a 2-hour, socially distanced communication skills course for HCPs in our Trust. Courses ran through March-June 2020, each course facilitated by 3-5 faculty. The course taught the 'SPIKES' structure for breaking bad news (BBN), using it to critique a pre-recorded conversation and role play of simulated scenarios, with faculty feedback. Participant confidence (using 1-5 scale) was assessed by pre and post course questionnaire, and analysed by descriptive statistics. Qualitative feedback was from participant questionnaires and thematic analysis of a faculty focus group. Ethical approval was gained. Results: 79 HCPs attended a course;55 gave feedback: nurses (24), doctors (21), allied health professionals (10). There was significant improvement in participant confidence in having a communication structure for BBN (mean change 1.69 (CI 1.94,1.44), p=0.03);applying SPIKES to BBN by telephone (mean change 1.82 (CI 2.05,1.59), p=0.005);giving and seeking feedback to improve communication (mean change 1.55 (CI 1.79,1.3), p=0.012). Qualitative data indicated excellent engagement and relevance beyond the pandemic. A faculty focus group identified key themes: applicability post COVID-19, greater openness to communication challenges, and awareness of emotionality in practice. Conclusion: An innovative course developed during the COVID-19 pandemic demonstrated improved HCP confidence in communicating bad news. Skills taught are applicable post pandemic and will inform further course development.