Delivering bad news to patients is one of the many challenges physicians face. The exchange can be emotionally taxing for both the physician and patient, and if communicated poorly, can lead to misunderstanding, emotional devastation, and low treatment compliance. Cultivating a mindful state before delivering bad news may potentially help physicians communicate bad news more skillfully.
Mengin et al. [Journal of Surgical Education] conducted a pilot study to test if a brief guided mindfulness meditation could improve bad news communication skills in medical residents.
The researchers randomized 53 French ear, nose, and throat (ENT) residents to a brief mindfulness meditation and a control condition. Participants in both conditions attended a 45-minute lecture on how to communicate bad news to patients. After the lecture they completed self-report measures of anxiety, fear of evaluation, and mindfulness (Mindful Attention Awareness Scale, MAAS).
The residents completed a bad news consultation training session that consisted of preparation, simulation, and post-simulation phases. The preparation phase included having residents self-rate their stress and self-confidence and then listen to either a 5-minute guided mindfulness meditation audio track or an information-only control audio track on the definition of atoms.
After listening to the audio tracks, residents again rated their stress and self-confidence. In the simulation phase, residents engaged in an 8-minute simulated consultation in which they disclosed a diagnosis of laryngeal cancer to a person acting as a patient.
A psychiatrist and ENT specialist blind to the resident’s study group rated each resident on skill performance. Ratings were made for respect, efficacy, knowledge, communication, and overall impression.
The evaluators also passed or failed each resident based on their belief that the resident was now ready to perform bad news consultations independently. In the post-simulation phase residents again rated their stress, self-confidence, and empathy. The patient actors also rated resident empathy.
The results showed that the mindfulness group performed significantly better overall in the simulated bad news consultation (Cohen’s d=0.67) compared to controls, and this effect was driven, in part, by significantly higher scores on knowledge and communication skills.
Only 4% of residents in the mindfulness group failed their simulated consultation, while 30% of the controls failed. There were no between-group differences in either self-rated empathy or empathy as perceived by the patient actor. In addition, there were no differences in perceived stress before and after the mindfulness meditation.
The study shows that a brief mindfulness meditation immediately prior to a simulated bad news consultation significantly improves resident bad news communication. Based on medical specialist evaluator reports, residents who briefly meditate communicate better, appear more knowledgeable, and are less likely to fail a communication task.
The meditation proved effective even though it did not affect residents’ perceived stress or empathy. The fact that the meditation enhanced performance in the absence of prior extensive training suggests that physicians could use mindfulness as a stand-alone technique prior to engaging in bad news delivery to patients. The study is limited by use of a simulation performance rating scale not previously validated.
Mengin, A. C., Kayser, C., Tuzin, N., Perruisseau-Carrier, J., Charpiot, A., Berna, F., Lilot, M., & Vidailhet, P. (2020). Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study. Journal of Surgical Education.