Date of Award

2020

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Sayed Karar

Second Supervisor/Advisor

Dr. Jasmit Shah

Department

Internal Medicine (East Africa)

Abstract

Background: Effective delivery of difficult news to patients and family has been shown to improve the physician-patient relationship, quality of care, and overall patient satisfaction. However, delivery of difficult news (DDN) remains a challenging task for even the most experienced providers. Little has been studied about delivery of difficult news by resident physicians in the sub-Saharan setting. We developed a 4-minute, easily accessible, graphic video using the mnemonic UNMASKES to help improve delivery of difficult news by resident physicians at our institution and their patients.

Objective: To determine the impact of a short training video called UNMASKES in helping resident physicians deliver difficult news to their patients.

Methods: We conducted a prospective consensus study amongst all residents currently doing their Masters in Medicine program at the Aga Khan University hospital in Nairobi, Kenya and Dar Es Salaam, Tanzania. After completing a pretest survey, all residents received comprehensive training on the use of the UNMASKES video to help improve effective communication in their clinical practice. A link to the UNMASKES video was provided to the residents for easy reference. Posttest surveys were anonymously completed at 4 and 12 weeks.

Results: 102 (68%) residents completed the surveys. Prior to UNMASKES, residents did not feel confident delivering difficult news to their patients. Furthermore, 83% of the residents reported significant anxiety prior to having such conversation. At the end 12 weeks, we found that residents notified their patient before delivering difficult news (p value < 0.001), ensured a private and quiet room to foster difficult conversations (p value < 0.001), were better trained to provide information in small amounts to patients and family members (p value < 0.001), provided a summary after delivery of difficult news (p value < 0.001), followed up with patients at 24-48hours after delivering difficult news (p value < 0.001), and felt better prepared to deal with patient and family emotions when delivering difficult news (p value < 0.001).

Conclusion and recommendation: Effective delivery of difficult news to patients and family remains key to better patient care and improved patient satisfaction. Yet, opportunities to train physicians to deliver difficult news remain scarce, especially in sub-Saharan Africa. UNMASKES, a 4 minute, easily accessible, colorful, and graphic video showed a significant improvement in confidence and capacity to deliver difficult news to patients and families. Long term applicability of this video in improving the delivery of difficult news remains under investigation.

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