Doctors' stress responses and poor communication performance in simulated bad-news consultations.
OBJECTIVE
No studies have previously evaluated factors associated with high stress levels and poor communication performance in breaking bad news (BBN) consultations. This study determined factors that were most strongly related to doctors' stress responses and poor communication performance during a simulated BBN task.


METHODS
In 2007, the authors recruited 24 doctors comprising 12 novices (i.e., interns/residents with 1-3 years' experience) and 12 experts (i.e., registrars, medical/radiation oncologists, or cancer surgeons, with more than 4 years' experience). Doctors participated in simulated BBN consultations and a number of control tasks. Five-minute-epoch heart rate (HR), HR variability, and communication performance were assessed in all participants. Subjects also completed a short questionnaire asking about their prior experience BBN, perceived stress, psychological distress (i.e., anxiety, depression), fatigue, and burnout.


RESULTS
High stress responses were related to inexperience with BBN, fatigue, and giving bad versus good news. Poor communication performance in the consultation was related to high burnout and fatigue scores.


CONCLUSIONS
These results suggest that BBN was a stressful experience for doctors even in a simulated encounter, especially for those who were inexperienced and/or fatigued. Poor communication performance was related to burnout and fatigue, but not inexperience with BBN. These results likely indicate that burnout and fatigue contributed to stress and poor work performance in some doctors during the simulated BBN task.
Brown
Rhonda
R
School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, Australia.
Dunn
Stewart
S
Byrnes
Karen
K
Morris
Richard
R
Heinrich
Paul
P
Shaw
Joanne
J
D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety; D003142:Communication; D003863:Depression; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians; D011594:Psychometrics; D012017:Referral and Consultation; D012044:Regression Analysis; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014342:Truth Disclosure