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Medline ® Abstract for Reference 39

of 'Discussing serious news'

Doctors' experience of stress during simulated bad news consultations.
Shaw J, Brown R, Heinrich P, Dunn S
Patient Educ Couns. 2013 Nov;93(2):203-8. Epub 2013 Jul 12.
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.
Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. Electronic address: joanne.shaw@sydney.edu.au.