As doctor appointments have shifted from in-person encounters to video visits during the COVID-19 pandemic, some physicians have little choice but to break bad news to patients over Zoom.
Telling a patient that she has cancer or that a family member faces a terminal illness is a stressful moment for physicians even when the patient is sitting a few feet away. Delivering that news remotely brings a whole new set of communication challenges.
"I have two personal friends who both lost parents to COVID-19 and the doctors told them over telehealth. There is a need to effectively and compassionately break bad news and it's even harder to do that through a computer screen or an iPad," Anthony Orsini, M.D., a practicing neonatologist, told Fierce Healthcare.
In turns out, most physicians, nurses, and first responders receive very little training on how to effectively communicate and convey compassion when telling patients tragic news.
Less than 10% of senior physicians (PDF) receive any training on how to deliver bad news during medical school, according to Orsini, and the limited training typically involves one-hour lectures.
Delivering difficult news to patients and their families is a challenging yet impactful skill to master for medical professionals, Orsini said.
According to research, 71% of patients have reported experiencing a lack of compassion when speaking with a physician. With increased virtual consultations brought on by the pandemic, these conversations can be even more unnatural and uncomfortable for doctors.
Recognizing the void in communications training in medicine, Orsini founded a healthcare communications training company 10 years ago. Called The Orsini Way, the company works with hospitals and healthcare professionals to create culture change and help improve patient satisfaction scores through innovative communications training. The program consists of in-person workshops, simulations, and an interactive digital learning experience to help physicians built better relationships with patients.
In response to the virtual care boom during the pandemic, Orsini's company launched a new telehealth communications training program that pairs doctors with professional actors to roleplay patient scenarios—remotely.
Immediately following the medical improv session, the physicians and nurses review their recorded video and receive play-by-play coaching from certified instructors, Orsini said.
“Medical school doesn’t prepare you to tell someone over telehealth that their loved one is dying,” he said. “Our program simulates the emotions these conversations invoke and allows doctors to receive critical feedback to improve interactions with patients and their families. The pandemic is changing the vehicle medical professionals use to communicate with patients, so we developed a training program to make sure physicians and nurses are effectively prepared.”
Englewood Health, a leading hospital and health care system in New Jersey, is the first health system to participate in the new training program and turned to the program after the pandemic forced the health system to rely heavily on virtual communication platforms.
“The pandemic changed so much for so many. We had to quickly pivot to telehealth consultations at a time where our team was beyond overwhelmed,” said Tanganyika Barnes, M.D., program director of the internal medicine residency program at Englewood Health.
“The training we received from The Orsini Way is like none other. Our residents now have greater confidence and skills to lead conversations with patients and their families, whether in person or virtually," Barnes said.
It's all in the delivery
There are common mistakes that physicians and nurses make when delivering bad news to patients, whether it's in-person or over telehealth, Orsini said.
"It's human nature when you are uncomfortable doing a task and are not feeling confident, you rush through it and you just want to get it over with. You can see that through your tone and cadence and your body language," he said.
In two different training videos, Orsini provides a good example and a bad example of delivering bad news as he is paired with an improvisational actor playing a patient during a telehealth visit.
In the bad example, Orsini abruptly tells the patient that she might have lung cancer and he often uses medical jargon that increases the patient's confusion and stress over the diagnosis.
"Another mistake we make is not understanding verbal and non-verbal cues. Most physicians and healthcare workers are compassionate people, but it’s conveying compassion that we struggle with," he said.
During a telehealth visit, most non-verbal cues will come from the physicians' facial expressions and tone of voice. Orsini's telehealth training program focuses on coaching physicians to understand how their tone of voice, cadence, and inflection can best convey compassion.
"Healthcare professionals need to understand that facial expressions are extremely important when you give bad news via telehealth. You need to prepare the patient that difficult news is coming using very specific tones of voice, a specific cadence, and the inflection of your voice," he said.
"Through your tone and cadence, you can convey the sense that I'm giving this news reluctantly, I understand the seriousness of what I’m doing and that I'm here to help. You want the patient to truly feel that compassion from you," he said.
In the training video that shows a good example of delivering bad news, Orsini takes the time to ask the patient how she is feeling and how she is coping during the pandemic. He patiently explains that the results of her CT scan indicate a potentially cancerous legion in her lung and he uses simple, straightforward language.
"Physicians and healthcare workers have an incredible responsibility to deliver tragic news to patients and they need to be trained correctly. It's a skill that is very sought-after and one to be very proud of if you can master it," he said.
With the rapid shift to virtual meetings across every industry, Orsini said he is seeing increased interest in the training program from companies outside of healthcare.
"Companies have asked us to help them train their human resources professionals on how to give bad news over the phone or video conference. Some businesses are finding themselves calling people to tell them that a co-worker died of COVID last week. Other companies are interested in getting training for how to give a performance review over a Zoom call," he said.