Protocol Based Breaking Bad News: Awarness and Practice among Resident Physicians Working in Tikur Anbessa Specialized Hospital, College of Health Science, Addis Ababa University
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Date
2023-08-19
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Addis Ababa University
Abstract
Background :Effective communication is at ‘the heart of the art of medicine, and it is recognized that in developing countries, with inefficient health care systems, the emphasis to foster better communication is lacking. Skillful delivery of bad news can provide comfort for the patient and family. There is a widespread problem with physicians’ and students’ skills and knowledge on standardized ways of Breaking Bad News (BBN). Improvements are needed on knowledge, attitude, skill and practice of protocol-based BBN such as the Setting, Perception, Innovation, Knowledge, Emotion, Summary and strategy (SPIKES) protocol. Data regarding practicing such protocols is little in Ethiopia and in developing countries as a whole. This study will determine resident physician’s awareness and practice of protocol-based BBN in the different specialty fields of Tikur Anbessa Specialized Hospital (TASH), and serve as an evidence-based input to improve medical curriculum design.
Objective :The overall objective of the study is to assess the awareness and practice of protocol-based BBNs among resident physicians working in TASH in Addis Ababa, Ethiopia.
Methods: An institutional based cross-sectional survey was conducted among resident physicians working in 9 major departments of TASH: Internal Medicine, Surgery, Pediatrics, Orthopedics, Oncology, Obstetrics and Gynecology, Anesthesiology, Emergency Medicine and Family Medicine from April 28, 2023 to July 10, 2023-. Study subjects from each department were allocated based on their number of total residents. The study subjects from each department were selected using simple random sampling technique. Data was collected using both online and selfadministered semi-structured questionnaire, and presented in frequency distribution tables & figures. To identify the determinants correlating with the protocol-based BBNs, chi square test was done, and bivariable & multivariable logistic regression analysis were performed to cfor their association. Adjusted odds ratios (AOR) with 95% CI were estimated to assess the strength of associations and statistical significance was declared at a p-value < 0.05.
Results: In this study 284 resident physicians were included making a response rate of 100%. Two-third (65%) of the study participants were in the age group of ≤30 years. Male constituted 69 % and 73.2% were single. Twenty percent of the participants were obstetrics and gynecology residents followed by internal medicine (17.3%). Majority (72.9%) of the participants had ≤5 years of experience in medical practice, and only 23.6% had received BBN training. More than one-third (39%) of them were year two residents followed by year three (36%) and year one residents (19%). Ninety-one percent of the study participants had involved in delivering bad news to patients/family, and majority (81.5%) didn’t use any protocol during BBNs. Eighty three percent of the study participants feel stressful during BBNs and 58.8% had bad experience after BBNs. Overall 59% and 48% of resident physicians had good knowledge on protocol-based BBNs and SPIKES protocol adherence/Practice respectively. Field of specialization, experience in medical practice (AOR=2.6, 95%; CI=1.39, 4.86), and having training on BBNs (AOR=3.7, 95%; CI=1.84, 7.6) had an association with the adherence on SPIKES protocol based BBNs. The present study also showed that having bad experience (AOR=5.0, 95%; CI=1.95, 7.09) and feeling stressful during BBNs (AOR=3.9, 95%; CI=1.99, 8.00) had a statistically significant relationship with level of training on BBN. Conclusion & Recommendation Awareness and SPIKES protocol adherence is generally poor among resident physician.
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PROTOCOL BASED BREAKING BAD NEWS