Comunicação de más notícias na formação médica: aprimoramento desta habilidade a partir de um protocolo adaptado para casos de demência

Abstract

BACKGROUND: Dementia is a life threatening, incurable and stigmatized condition, with devastating impacts on patient’s personal identity and their caregivers. It is currently one of the most fearsome diseases. There are many barriers to an effective diagnosis disclosure to dementia patients, including fear of causing distress, uncertainty of the diagnosis, caregivers objection and lack of training on communication skills in undergraduate medical school. Therefore, it is crucial to implement strategies to help medical students to build up multiple skills for an appropriate relationship between doctor, patient and family, including the ability of disclosing the diagnosis. The SPIKES protocol is a didactic approach to deliver bad news and it has been used in a variety of clinical settings. The cognitive impairment on Alzheimer disease and other dementias require a few adaptations on this model, which were made after reviewing the current literature on dementia diagnosis disclosure. OBJECTIVE: To develop an educational intervention based on the suggested protocol and evaluate if it could help to improve medical students’ communication skills. METHODS: Interventional, cross-sectional, randomized study with third year medical students from Universidade Federal do Rio Grande do Norte, along the 2nd semester 2016 and the first semester 2017. The sample consisted of 86 students, divided into three groups: GI (trained protocol in the beginning of the Geriatrics clerkship), GII (trained protocol after lectures about dementias) and GIII (did not join the protocol). Students on GI and GII were analysed by two similar OSCEs (Objective Structured Clinical Examination); students on GIII only took part at the second OSCE. RESULTS: Groups GI and GII showed better results on the second OSCE comparing to GIII (GI:7,56±1,22, GII: 7,47±1,09, GIII: 6,42±1,68, p<0,001). Students on GI performed better on this assessment than students on GII (p<0,001). Groups GI and GII exhibited increasing scores along the two OSCEs (GI OSCE1: 6,38±1,34, GI OSCE2: 7,56±1,22, p<0,001; GII OSCE1: 5,31± 1,36, GII OSCE2: 7,47± 1,09, p<0,001). The results show an improvement on the communication skills of the medical students who joined the training, which was independent of previous theoretical lectures about dementia. The more the students practiced these skills on a simulation, the better were the scores on OSCEs. The training was well accepted by the medical students and most of them (98%) agreed that a training on communicating the diagnosis of dementia is important for their career development. CONCLUSION: Suggested adaptations to SPIKES protocol seem to encompass current guidelines about communication of the diagnosis of dementia, keeping its didactic approach. This model of training, as well as the adapted protocol, may represent replicable strategies for other curriculum elements in a way of improving communication abilities on medical schools.