Renee Cholyway, MD; Susan Haynes, MSW, MEd; and Emily Rivet, MD, MBA
December 1, 2020
The COVID-19 pandemic caused an abrupt change in communication practices for physicians and health care providers. Prior to the pandemic, the consensus surrounding the delivery of bad news could be summarized in the statement, “The first rule of breaking bad news is: do not do it over the phone." 2
Beginning in March 2020, social distancing forced the adoption of virtual communication strategies with a rapid revision of HIPAA privacy policies and a $200 million fund for telemedicine approved by Congress, allowing wider access for family and care providers to discuss medical management.5, 6, 4, 7, 8
After the pandemic, pilot training programs were initiated at our institution with the objective of creating an educational model to fill an urgent gap in training, to emphasize the relevance of telehealth skills, and to provide strategies for quality and compassionate communication via virtual modalities. The programs included 38 medical students and 33 surgery residents and faculty. An overwhelmingly positive response from participants supported coaching telehealth communication skills as a highly relevant strategy for improving clinical care delivery at this time and into the future. The program built upon the SPIKES protocol for breaking bad news, a well-established paradigm developed in oncology.
We see that preparation is critical for breaking bad news remotely: minimizing interruptions, being conscious of lighting and camera angles, and preparing for technology failures and disconnections. Empathy is expressed during virtual discussions through key variations of customary practices used in face-to-face encounters. The conclusion of the discussion should include follow-up communication, describing resources, and insuring a support system for patients during a challenging time.
The authors would like to thank Sally Santen, MD, PhD, Senior Associate Dean of Evaluation, Assessment, and Scholarship, Virginia Commonwealth University School of Medicine, and Moshe Feldman, PhD, Associate Professor and Assistant Director for Research and Evaluation, Center for Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine.
Renee Cholyway, MD, is a general surgery resident in the department of surgery at Virginia Commonwealth University.
Susan Haynes, MSW, Med, is a surgical simulation administrator at the VCU Center for Human Simulation and Patient Safety, Virginia Commonwealth University.
Emily Rivet, MD, MBA, is an assistant professor of surgery and internal medicine in the division of colon and rectal surgery and the division of hospice and palliative medicine, Virginia Commonwealth University.