Assessment of perceived competence in breaking bad news tasks among RESIDENT doctors at Moi Teaching and Referral Hospital

Abstract

Background: Breaking bad news refers to a medical procedure of passing unfavorable medical information to patients about their illnesses. Competence in this skill is required in medical practice and medical education curriculum was designed to equip doctors in this important issue. Globally, standardized specific guidelines in delivering bad news have been developed to assist doctors to fully disclose life threatening diagnosis, including cancer. It is against this backdrop of increasing burden of life-threatening diseases and the need for safe verbal procedures in Sub Saharan Africa that necessitated relooking at the training of breaking bad news skills among doctors. Objectives: The objectives of this study were: to determine residents’ perception of their competence in performing Breaking Bad News tasks, to determine the relationship between residents’ perception of their competence and their sociodemographic characteristics, to determine the adequacy of the medical training curriculum content and methodologies utilized in training doctors in breaking bad news tasks and to determine residents perception of constraints they encounter at MTRH/MUSOM while performing breaking bad news tasks Methods: A mixed methods approach used to collect data. Qualitative data on curriculum content methodologies and constraining factors; checklist and focus group discussions and in-depth interviews; quantitative data; perceived competence, additional training, level of training and gender in breaking bad news; surveys and causal-comparative research designs. Study population constituted postgraduate doctors from whom a sample of 80 out of 240 selected, purposeful sampling used to sample 7 residents doctors and 3 lecturers. Data was collected using questionnaires in-depth interviews and focus group discussion. Quantitative data was cleaned and entered and analyzed in SPSS version 10, descriptive statistics used to describe, and inferential statistics used in comparing data. Qualitative data was analyzed and presented thematically. A p-value of <_ 0.5 was set as significant for all tests. Results: Competence in breaking bad news varied on three aspects: self-efficacy 134% ,however this was found to be overrated during the focus group discussion, empathy 74% of normed value, physicians beliefs scores 160% of the normed value, (N=80) 45% and 55% of the participants were female and male respectively 46% were in part 1 54% in part 2. Gender did not significantly influence competence self-efficacy t(78)=0.152 p= 0,876, empathy t(78)=0.015 p= 0.897 physician belief score t(78) =0.121 p=0.736 while level of training significantly influenced with part 2 residents being better in all aspects of competence; self-efficacy t(73)=0.427, p= 0.004., empathy t(73) 0.331 p =0.023, physician belief Score t(73) =0.213 p= 0.018. Curriculum structure (competence levels and helical approach) 12.5%, theoretical basis covered 42.5% task approach to training 20.2%, challenging situations addressed 36.3% and reflective approach 0% (N=80). Feeling uncomfortable, being stressed, workload and lack of formal training were identified as major constraints in breaking bad news. Conclusions: Perceived competence varied according to the three aspects; self-efficacy was very good, less caring behaviour towards psychosocial aspects in life threatening disease care. Additional training and level of training significantly influences all aspects of competence in breaking bad news, Doctors’ curriculum content and methodologies breaking bad news is inadequate, Personal and workplace factors were the main constraints identified. Recommendations: Curriculum need structuring to include competency levels, content and methodologies in breaking bad news. Breaking bad news training should be given during the clinical years. Training in breaking bad news at postgraduate level needed. Breaking bad news teaching and clinical teaching should be consistent and complementary to reduce the constraints associated with it.