Comunicação de más notícias na formação médica: aprimoramento desta habilidade a partir de um protocolo adaptado para casos de demência
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, incl...
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| Formato: | Dissertação |
| Idioma: | por |
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/26367 |
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| Resumo: | 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. |
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