Breaking bad news in amyotrophic lateral sclerosis: The need for medical education

Abstract

The manner in which physicians deliver difficult diagnoses is an area of discontent for patients with amyotrophic lateral sclerosis (ALS). The American Academy of Neurology's Practice Parameter for care of the ALS Patient recommended teaching and evaluating strategies for disclosing the diagnosis (10). Our objective was to examine residents’ ability in and perceptions of communicating the diagnosis of ALS. Twenty-two resident physicians were videotaped and rated by two ALS neurologists as they delivered an ALS diagnosis to a standardized patient (SP) during an objective structured clinical examination (OSCE). Residents self-rated immediately after the OSCE, again after viewing their videotape, and completed a survey regarding the OSCE and delivering difficult diagnoses. OSCE performance was suboptimal, particularly for communication skills and empathy. The two examiners’ scores correlated except for the empathy subscore. Residents’ self-assessments did not align with the examiners’ scores either before or after watching their videotape. The survey uncovered residents’ apprehension and dissatisfaction with their training in diagnosis delivery. The results highlight a need for resident education in delivering an ALS diagnosis. The lack of correlation between residents’ and examiners’ scoring requires further study. Evaluation of empathy is particularly challenging. Residents agreed that OSCE participation was worthwhile.

Key words::

• Methods of education
• amyotrophic lateral sclerosis
• palliative care
• professional conduct and ethics

Acknowledgements

The authors thank Ted Roberts for his work in checklist development, Penny Smyth for facilitating the OSCE.

Declaration of interest: Kerri L. Schellenberg was the recipient of the Betty Norman research fellowship of the ALS Society of Canada. Wendy S.W. Johnston receives research support from the Canadian Institutes of Health Research. The authors alone are responsible for the content and writing of the paper.