Subject(s)
Infant, Premature , Patient Comfort , Humans , Infant , Infant, Newborn , Palliative CareABSTRACT
PURPOSE: To teach medical students how to deliver a diagnosis of cancer using role-play with a cancer survivor volunteer. METHOD: Medical students participated in a curricular module on "breaking bad news." Its novel aspect was the inclusion of role-playing exercises during which the student communicated the initial diagnosis of cancer to a cancer survivor volunteer. The clinical scenario was based on the volunteer's own history of cancer. The exercise required the student to become knowledgeable about the volunteer's cancer and its mode of presentation, deliver the diagnosis using previously demonstrated methods, and then receive verbal feedback from the volunteer. A panel discussion with the cancer survivor volunteers concluded the module. The efficacy of this curricular module was assessed by the students' performance during the role-playing exercise, gain in confidence in communicating bad news, and overall rating of the learning experience. RESULTS: The interaction of the students with the cancer survivors was the strength of this curriculum, providing the students with an important perspective on physician-patient relationships and coping with cancer. The students demonstrated a high level of adherence to preferred communication techniques, gained significant confidence with the task of "breaking bad news," and were very satisfied with the module. Participation in these role-playing exercises by the cancer survivor volunteers was viewed as emotionally demanding but also rewarding. Recruitment and retention of the volunteers were not obstacles to this activity. CONCLUSION: Role-playing with cancer survivor volunteers can be an effective method of teaching medical students how to communicate bad news.
Subject(s)
Education, Medical, Undergraduate/methods , Neoplasms/psychology , Role Playing , Terminally Ill/psychology , Truth Disclosure , Adult , Aged , Clinical Competence , Female , Humans , Male , Middle Aged , Patient Simulation , Physician-Patient Relations , Research Subjects , Students, Medical , SurvivorsABSTRACT
BACKGROUND: There is a growing awareness of the need for discussion of advance directives (ADs) in the ambulatory setting, but rates of completion remain low. Clarification of patients' perceptions and knowledge would help in designing future strategies. METHODS: This is a prospective study of adult ambulatory patients at four academic internal medicine clinical sites at the University at Buffalo during a 6-week period in 2004. We obtained data using a standard instrument administered by a research assistant. The data included demographic variables, patients' awareness of and familiarity with specific ADs, and whether the patient had any ADs. Patients also were asked about attitudes concerning the appropriateness of ADs. We performed multivariate logistic regression on the variables. RESULTS: Of 508 patients, 86.2% were unfamiliar with the term "advance directives," but 93.5% were familiar with one or more specific kinds of ADs. Some 43.1% of patients claimed to have completed an AD, but of those who said they had, only 25% thought their provider had a copy. Multivariate logistic regression demonstrated significant correlation between having completed an AD and age, reading ability, and educational level (all P < .001). CONCLUSIONS: A large number of patients in an ambulatory internal medicine practice knew about ADs and believed they had completed such documents, but these documents were often not in the chart. Many patients believe discussions of ADs are not appropriate for them. A better understanding of this phenomenon will help in promoting effective advance care planning.
