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Interviewing families about Organ and Tissue Donation
Interviewing families about Donation over the Phone
Our Clients
Hixson Engineering, Cincinnati
Engersoll Rand
Lean Enterprise Institute, Cambridge, MA
Breaking Bad News
U.K. Transplant Bulletin, Summer 2005
Purpose:
The breaking of bad news is one of the most stressful aspects of a physician’s practice. How it is done is often remembered for decades and colors many peoples’ impression of the care they or their loved ones received in the hospital. This workshop teaches skills that can be applied across the board in bad news situations, and many participants say they will use them in all aspects of their practice that involve communication. However, the workshop was designed to educate clinicians on communication skills related to increasing consent for organ donations, as the research in that field points to a very specific need to improve practice to significantly increase consent rates. This workshop trains physicians to talk to families about brain death and futility and to transition the coordinator into the conversation to talk about organ donation. It was designed for physicians in the U.K., as historically the culture there has been for the doctor to request donation, and consent rates, when compared to other countries that use donation specialists, has been low.
Description and Success:
Breaking Bad News is a one-day workshop designed for physicians who work with patients who may be pronounced by either neurological or cardiac criteria. It is based on our three decades of teaching donation coordinators how to talk to families, on the research on consent and on the research on breaking bad news to patients and their families.
The workshop has been taught in the U.K. for the past five years and has also been taught in Australia. Data collected in December of 2007 from hospitals in London and the south of England where physicians attended the workshop shows coordinator presence in the brain stem death conversation rose by 19.5%. Year-long data collected in 2007-2008 from hospitals in Newcastle and Edinburgh shows that when the model taught was implemented consent rates were 93% and 83% respectively.
The workshop is interpersonal and enrollment is limited to 18 physicians. Instructional methods include presentation, large and small group discussion, modeling and role-playing. In a round of 3 workshops presented in the spring of 2009, physician participants thought the following:
▪ 73 % The workshop provided me new skills.
▪ 70 % It stimulated me to examine my current practice.
▪ 78 % It was worthwhile.
▪ 70 % I would recommend it to colleagues.
▪ 70 % I will change my pattern of non-verbal behavior
when talking to families as a result of the
workshop.
▪ 68% I will give information in small doses and check
for understanding.
▪ 63 % I will ensure the donation specialist is notified
early.
▪ 60 % I will be more likely to involve the donation
specialist in the brain stem death conversation.
▪ 63% I will partner with the donation specialist.
Workshop Objectives:
1. Acquire familiarity with best practice research in breaking bad news.
2. Exhibit an understanding of the relationship between skillfully breaking bad news, families’ understanding of death and consent for donation.
3. Practice verbal and non-verbal skills consistent with skillfully breaking bad news, including:
A. Structuring a coherent narrative of events that educates, supports your decision-making, and creates meaning out of confusion;
B. Assessing understanding;
C. Empathetically accepting responses;
D. Probing concerns.
4. Complete at least two breaking bad news role-plays, one as a physician and one as a family member, and participate in group debriefs.
Workshop Support:
Large group instruction will require a computer and projector, screen, two flip chart stands with pads, name tents and markers, and chairs and table space for 18 participants. Lunch should be served buffet-style in a room close to the workshop, and morning and afternoon break food should be available. The afternoon will require two smaller rooms set with couches and chairs for role-playing. At least two donor coordinators should be present and will be in the role-plays. Detailed instructions for putting on the workshop and room arrangement diagrams will be sent upon booking and handout masters and instructions will be sent one month in advance.
Advanced Preparation:
The most difficult part of this workshop is getting the doctors to attend. Arrangements must be made well in advance, commitments secured and personally followed up. In the U.K., pharmaceutical companies have provided financial support to secure sites attractive to physicians.
Personnel Costs:
Fee- $3,600.00 US, plus reasonable travel expenses
Customization costs at $150 an hour for objective #2