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New training tool aims to help doctors better deliver hard news

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Doctors often don't have any formal training in how to deliver a difficult diagnosis to their patients. A new training tool aims to help physicians and allied health professionals be better prepared and provides ways to better interact with patients.

Having to deliver life-changing news is a difficult task — especially in a medical setting, such as letting a patient know that they have an incurable illness.

UW-Milwaukee professor of social work Melinda Kavanaugh used to work as a medical social worker in neurology units, and she saw firsthand how unprepared many physicians are to deliver a devastating diagnosis.

"I can't count the number of times that I was called into the room because the patient really struggled with that diagnosis, or the caregiver had so many questions, or there was a huge emotional response — as to be expected," Kavanaugh recalls. "And more often than not, the physicians really needed that support. They needed someone to come in there and help guide that patient and that caregiver."

In her clinical experience, Kavanaugh says physicians and medical students typically don't go through any training on how to best interact with a patient when delivering a life-changing diagnosis. Often, doctors are trained to be knowledgeable, give a diagnosis and maybe bring in others to help out in the aftermath of that diagnosis.

Kavanaugh notes the need to recognize how difficult it is for physicians to deliver hard news — the emotional impact it can have on them and the self-preservation tools they may be consciously or unconsciously using to protect themselves.

In order to better prepare doctors and ultimately help patients in how they can face the challenges to come, Kavanaugh got involved in developing a new training toolfor health professionals, called “How to Break the News in ALS/MND: A Primer for Physicians and Allied Health Professionals."

Kavanaugh helped to develop this program with Dr. Angela Genge and Dr. Colleen O’Connell, both of whom who practice in Canada and have been doing work in the ALS community for years.

This project was grounded in their own clinical work experience, which helped them to brainstorm "what would it look like if we did a program and we targeted the ALS community, knowing it could be adapted well beyond ALS and what protocol can we use?," explains Kavanaugh.

"How to Break the News" covers topics such as what physicians and allied health professionals need to know in advance before a patient encounter, location and setting, patient's perceptions, emotions, empathy and strategies.

"This is really something we want to be inclusive across healthcare and allied health professionals," notes Kavanaugh. "In social work as a profession, we always say, 'Check your bias at the door.' Well it's incredibly hard to do ... unless you give yourself that space to really teach yourself how to do that."

Kavanaugh worked specifically on how to help physicians "know thyself," which helps to identify any personal perceptions and/or biases that they may have toward death and dying that could impact their delivery of news to people living with ALS/MND and their caregivers.

"It's a really critical piece of this training that helps all of the professionals understand where they're coming from and how that might influence how they do or don't give a good diagnosis, or do or don't give a good follow up," she notes.

Another simple, but crucial tool the training highlights is letting the patients set the pace and control the conversation.

"Ask them where they're at, what do they know, what's been happening, so that you're not only understanding where you need to move from but you're privileging that person, their information and their perspective," says Kavanaugh.

The "How to Break the News" training is relatively new and in the process of being presented around the world, she shares. Kavanaugh says this 90-minute program can be done as a group, individually, or can be presented in person.

Audrey Nowakowski is a WUWM host and producer for Lake Effect.
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