title: Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study.
abstract: BACKGROUND
  Although patients with cancer are often accompanied by a relative during breaking bad news (BBN) consultations, little is known regarding the efficacy of training programmes designed to teach residents the communication skills needed to break bad news in a triadic consultation.
  
  
  METHODS
  Residents were randomly assigned to a 40-h dyadic and triadic communication skills training programme (n=48) or a waiting list (n=47). A simulated BBN triadic consultation was audiotaped at baseline, and after training for the training group, and 8 months after baseline for the waiting list group. Transcripts were analysed using content analysis software (LaComm). A coder determined the moment of bad news delivery and the relative's first turn of speech regarding the bad news. A generalised estimating equation was used to evaluate residents' communication skills, BBN timing, and the relative's inclusion in the consultation.
  
  
  RESULTS
  Ninety-five residents were included. After training, the duration of the pre-delivery phase was found to be longer for the trained residents (relative risk (RR)=3.04; P<0.001). The simulated relative's first turn of speech about the bad news came more often during the pre-delivery phase (RR=6.68; P=0.008), and was more often initiated by the trained residents (RR=19.17; P<0.001). Trained residents also used more assessment (RR=1.83; P<0.001) and supportive utterances (RR=1.58; P<0.001).
  
  
  CONCLUSIONS
  This study demonstrates that a training programme that focuses on the practice of dyadic and triadic communication skills can improve the communication skills of the participating residents in a BBN triadic consultation. Such a training should be included in resident curriculum.
authors.affiliation: 1] Clinique de Psycho-oncologie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium [2] Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50-CP 191, B-1050 Brussels, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Merckaert
authors.forename: A
authors.initials: A
authors.lastname: Liénard
authors.forename: Y
authors.initials: Y
authors.lastname: Libert
authors.forename: I
authors.initials: I
authors.lastname: Bragard
authors.forename: N
authors.initials: N
authors.lastname: Delvaux
authors.forename: A-M
authors.initials: AM
authors.lastname: Etienne
authors.forename: S
authors.initials: S
authors.lastname: Marchal
authors.forename: J
authors.initials: J
authors.lastname: Meunier
authors.forename: C
authors.initials: C
authors.lastname: Reynaert
authors.forename: J-L
authors.initials: JL
authors.lastname: Slachmuylder
authors.forename: D
authors.initials: D
authors.lastname: Razavi
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D004493:Education; D004501:Education, Medical / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards; D008297:Male; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology / Q000592:standards; D058996:Quality Improvement; D014342:Truth Disclosure; D055815:Young Adult