Doctors' experience of stress during simulated bad news consultations

Patient Educ Couns. 2013 Nov;93(2):203-8. doi: 10.1016/j.pec.2013.06.009. Epub 2013 Jul 12.

Abstract

Objective: Breaking bad news (BBN) is a core component of medicine. Psychophysiological studies confirm the subjective reports of doctors that BBN is a stressful experience. This study investigated doctors' physiological stress responses prior to and during two simulated bad news consultations.

Methods: Thirty-one doctors participated in a speech-interaction task and two simulated BBN consultations. Heart rate (HR) and skin conductance (SC) were recorded using consecutive 30-s epochs during each of the interactions. The simulations were video recorded.

Results: Most doctors showed an early anticipatory increase in HR and SC that peaked during the reading of the case history prior to the BBN consultations. Most doctors then experienced a brief and relatively small stress response. However, about one-third of the doctors showed a significant and sustained stress response.

Conclusions: The results suggest that most doctors were cognitively engaged with the BBN tasks, however, a small proportion of doctors might have focused more on their own internal feelings and less on these contextual features.

Practice implications: In regards to training medical students and doctors, these results suggest that there is a need to focus more on the impact of these encounters on the doctors, not just their performance during these encounters.

Keywords: Breaking bad news; Health communication; Physiological stress.

MeSH terms

  • Adult
  • Female
  • Galvanic Skin Response / physiology
  • Heart Rate / physiology
  • Humans
  • Male
  • Monitoring, Physiologic / instrumentation
  • Patient Simulation
  • Physician-Patient Relations*
  • Physicians / psychology*
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Truth Disclosure*
  • Video Recording