502 - DOES THE STRESS ASSOCIATED WITH BREAKING BAD NEWS HAVE AN EFFECT ON PHYSICIAN COMMUNICATION AND THE PATIENT’S SATISFACTION WITH THE ENCOUNTER? – A SIMULATION STUDY

Poster Number: 502
Publication Number: 502.2857

Background: Breaking bad news is an important skill in medicine and is associated with anxiety and stress before, during and after the encounter. Stress is known to affect our concentration, memory and decision-making ability.

Objective: To explore the effect of stress experienced by physicians when communicating adverse news to patients, and whether this stress influences the effectiveness of communication during simulated patient encounters.

Design/Methods: We used a mixed analysis repeated-measure design in two different randomized simulated medical scenarios—one involving the delivery of bad news and the other neutral news. Participants were pediatric residents from all training levels. Measures such as the State-Trait Anxiety Inventory (STAI), cognitive appraisal measures, heart rate variability (HRV), and salivary cortisol levels were utilized to evaluate subjective and physiological stress. Performance was assessed using the Communication Assessment Tool (CAT) and modified Kalamazoo Essential Element Communication Checklist scores, through reviews of video-recorded participant performances.

Results: Thirty residents participated in the study. Residents experienced more subjective stress while delivering bad news compared to neutral news (F (1,28) = 22.70, MSE=82.84, p<.001, Eta2=.45). There were no significant differences in subjective stress perception based on the order of scenarios (p = .41).
Cortisol responses varied depending on the encounter order, with higher levels observed for the scenario encountered first (F (1, 28) = 25.13, MSE = 24.13, p < .001, Eta2 = .998). Delivering bad news induced a stress response as measured with heart rate variability, while delivering neutral news did not (F(4, 108) = 15.63, MSE = 111.33, p < .001, eta2 = .37). Performance evaluations by physicians showed no significant differences in global rating scale scores by independent raters (p=.17). However, ratings by standardized actors using the CAT yielded slightly higher scores for delivering good news (t(29) =1.87, p= .036.).

Conclusion(s): Residents exhibit increased subjective and physiological stress levels when tasked with communicating adverse news. While the study observed no marked difference in professional evaluation scores, there was a mild improvement in communication scores for delivering good news, as per standardized actors. Future investigations should focus on real-life patient interactions, studying the influence of physician stress on communication, and its subsequent impact on patient perceptions and outcomes.