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would you tell a father that his toddler will never walk again?
A mother that her little girl’s cancer has spread beyond the reach
of chemotherapy? Or a couple that their baby did not make it through
emergency surgery? Delivering bad news is one of the most difficult
parts of a clinician’s job, yet most receive little or no formal
training in how to do it.
Looking to fill this void, Children’s has developed the unique
Program to Enhance Relational and Communication Skills (PERCS),
which helps practitioners learn the delicate art of delivering bad
news.
“We spend a lot of time working on improving our procedures,” says
Robert Truog, MD, chief of Critical Care Medicine,
“but often what families remember is what physicians said to them
and how they said it. Until now, that’s not anything we’ve practiced.”
PERCS is a daylong training session that includes lectures, short
films, and most important, a simulation experience where professional
actors portray patients and family members dealing with critical
care or end-of-life situations. Session trainees must deliver the
difficult news while facilitators and peers watch from another room.
“Simulation in general is widely recognized as a way to improve
skills in medicine,” Truog says. “We wanted to extend the simulation
methodology into the realm of communication skills.”
The simulations are designed to integrate the medical aspects of
each scenario with issues such as parental guilt, family conflicts
and disagreement about care. “We don’t just present straight medical
cases,” says PERCS Director Elaine Meyer, PhD.
“We include the psychosocial issues that clinicians deal with every
day.”
For medical trainees, being pushed like this is difficult, but
ultimately it pays off. “PERCS is a long, very emotionally exhausting
day,” says participant Robert
Graham, MD, a clinical fellow in Anesthesia. Graham
says he found the day productive despite his years of experience.
“Everyone gained something from going through it, no matter how
long they’ve been in medicine.”
Following each simulation, participants reflect on the experience
with input from the PERCS team, families who have experienced similar
tragedies in real life and the actors from the simulation. The feedback
offers participants a rare glimpse of how real-life parents may
perceive them in a tough situation.
It’s not just physicians who benefit from the training. Each session
also includes nurses, social workers, psychologists and even chaplains.
Eighty Children’s staff members, with medical experience ranging
from one to 30 years, have been trained so far.
“New hires often tell me that talking to families in difficult
situations is one of their biggest fears,” says intensive care nurse
Christine Roe, RN. According to a survey of PERCS
participants, the program has helped most of them reduce that anxiety.
The PERCS philosophy isn’t about teaching a specific way to deliver
a message, but about how to build relationships with families. “We
know that when clinicians express their humanity, families realize
that they’re not walking this path alone,” says Meyer.—BD
For more info about the program, e-mail elaine.meyer@childrens.harvard.edu.
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