Isabelle Bragard

Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum

BackgroundIneffective physicians’ communication skills have detrimental consequences for patients and their relatives, such as insufficient detection of psychological disturbances, dissatisfaction with care, poor compliance, and increased risks of litigation for malpractice. These ineffective communication skills also contribute to everyday stress, lack of job satisfaction, and burnout among physicians. Literature shows that communication skills training programs may significantly improve physicians’ key communication skills, contributing to improvements in patients’ satisfaction with care and physicians’ professional satisfaction. This paper describes a Belgian Interuniversity Curriculum (BIC) theoretical roots, principles, and techniques developed for junior physicians specializing in various disciplines dealing with cancer patients.Curriculum descriptionThe 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and affective approach. The cognitive approach aims to improve physicians’ knowledge and skills on the two domains cited. The behavioral approach offers learners the opportunity to practice these appropriate skills through practical exercises and role plays. The affective approach allows participants to express attitudes and feelings that communicating about difficult issues evoke. Such an intensive course seems to be necessary to facilitate the transfer of learned skills in clinical practice.ConclusionsThe BIC is the first attempt to bring together a stress management training course and a communication training course that could lead not only to communication skills improvements but also to burnout prevention.

Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout: A randomized controlled study

This is a longitudinal randomized controlled study investigating the efficacy of a communication and stress management skills training programme on medical residents’ self-efficacy to communicate and to manage stress in interviews, stress to communicate in interviews, and burnout. Ninety-six medical residents participated. Results showed a statistically significant increase in self-efficacy and decrease in stress to communicate. No changes were noted in burnout. Results of this training may encourage its compulsory organization in the medical curriculum. Further research is required to examine whether a programme associating person-directed and organization-directed interventions could have an impact on residents’ burnout.

Quality of Work Life, Burnout, and Stress in Emergency Department Physicians: A Qualitative Review

A 2006 literature review reported that emergency department (ED) physicians showed elevated burnout levels and highlighted several environment and personal issues contributing toward burnout. Research on burnout in EDs is limited. We propose an updated qualitative review on the relationships between work stress, burnout, and quality of work life in ED physicians. We searched MEDLINE, PsycInfo, and Science Direct for studies published since 2005. Of 491 papers, 10 papers were retained, using validated measures and having a minimum of 75 participants. Data extraction was performed manually by the first author and was reviewed by the second author. The majority of the studies used large samples, cross-sectional designs, random, and/or stratified assignment. ED physicians showed moderate to high levels of burnout with difficult work conditions including significant psychological demands, lack of resources, and poor support. Nonetheless, physicians reported high job satisfaction. Further studies should focus on the implementation of measures designed to prevent burnout.

Is it possible to improve the breaking bad news skills of residents when a relative is present? A randomised study

Background:Although patients with cancer are often accompanied by a relative during breaking bad news (BBN) consultations, little is known regarding the efficacy of training programmes designed to teach residents the communication skills needed to break bad news in a triadic consultation.Methods:Residents were randomly assigned to a 40-h dyadic and triadic communication skills training programme (n=48) or a waiting list (n=47). A simulated BBN triadic consultation was audiotaped at baseline, and after training for the training group, and 8 months after baseline for the waiting list group. Transcripts were analysed using content analysis software (LaComm). A coder determined the moment of bad news delivery and the relative’s first turn of speech regarding the bad news. A generalised estimating equation was used to evaluate residents’ communication skills, BBN timing, and the relative’s inclusion in the consultation.Results:Ninety-five residents were included. After training, the duration of the pre-delivery phase was found to be longer for the trained residents (relative risk (RR)=3.04; P<0.001). The simulated relative’s first turn of speech about the bad news came more often during the pre-delivery phase (RR=6.68; P=0.008), and was more often initiated by the trained residents (RR=19.17; P<0.001). Trained residents also used more assessment (RR=1.83; P<0.001) and supportive utterances (RR=1.58; P<0.001).Conclusion:This study demonstrates that a training programme that focuses on the practice of dyadic and triadic communication skills can improve the communication skills of the participating residents in a BBN triadic consultation. Such a training should be included in resident curriculum.

A non-randomized comparison study of self-hypnosis, yoga and cognitive behavioral therapy to reduce emotional distress in breast cancer patients

Abstract The authors asked breast cancer (BC) patients to participate in 1 of 3 mind-body interventions (cognitive-behavioral therapy (CBT), yoga, or self-hypnosis) to explore their feasibility, ease of compliance, and impact on the participants’ distress, quality of life (QoL), sleep, and mental adjustment. Ninety-nine patients completed an intervention (CBT: n = 10; yoga: n = 21; and self-hypnosis: n = 68). Results showed high feasibility and high compliance. After the interventions, there was no significant effect in the CBT group but significant positive effects on distress in the yoga and self-hypnosis groups, and, also, on QoL, sleep, and mental adjustment in the self-hypnosis group. In conclusion, mind–body interventions can decrease distress in BC patients, but RCTs are needed to confirm these findings.

Impact de l’utilisation de la Luminette® sur le bien-être au travail dans un service de radiothérapie

PURPOSE Studies showed beneficial effect of light therapy on well-being at work. Our randomized cross-over study aimed at analyzing the effects of light exposition with the use of Luminette® in a hospital department without access to natural light. MATERIALS AND METHODS The study design proposed an alternation between two periods of four weeks of use of Luminette® and two periods of four weeks without Luminette®. After every period, participants completed questionnaires (sociodemographic data, seasonal and general depression, anxiety, quality of sleep, slumber and general health). RESULTS Twenty-five persons participated in the study (average age=36.5, SD=7.7). The sample showed several benefits after one month of Luminette®: diurnal slumber (P=0.046), general health perception (P=0.026), physical functioning (P=0.042), pains (P=0.023) and role limitations due to emotional problems (P=0.013). One month later, certain benefits remained without light therapy: diurnal slumber (P=0.028), pains (P=0.044) and emotional problems (P=0.042). CONCLUSION This study has showed that the use of Luminette® could lead to similar positive results to those obtained with light therapy in other studies. This study has confirmed that Luminette® could have a positive effect on well-being at work.

Predictors and correlates of burnout in residents working with cancer patients.

There are few studies which have investigated variables associated with the development of burnout among residents working with cancer patients. The aim of this study is to identify variables leading to residents’ burnout in order to develop effective interventions. Burnout was assessed with Maslach Burnout Inventory. Person- (i.e., emotional-focused coping) and work-related (i.e., changes in lack of organizational support index) variables explain 28% of the variance in changes in emotional exhaustion. Training programs may be improved by adding specific modules for residents, about problem-focused coping in interviewing patients, and for supervisors, about effective team management.

Group interventions to reduce emotional distress and fatigue in breast cancer patients: a 9-month follow-up pragmatic trial

Background:Long-term effects of psychosocial interventions to reduce emotional distress, sleep difficulties, and fatigue of breast cancer patients are rarely examined. We aim to assess the effectiveness of three group interventions, based on cognitive behavioural therapy (CBT), yoga, and self-hypnosis, in comparison to a control group at a 9-month follow-up.Methods:A total of 123 patients chose to participate in one of the interventions. A control group was set up for those who agreed not to participate. Emotional distress, fatigue, and sleep quality were assessed before (T0) and after interventions (T1), and at 3-month (T2) and 9-month follow-ups (T3).Results:Nine months after interventions, there was a decrease of anxiety (P=0.000), depression (P=0.000), and fatigue (P=0.002) in the hypnosis group, and a decrease of anxiety (P=0.024) in the yoga group. There were no significant improvements for all the investigated variables in the CBT and control groups.Conclusions:Our results showed that mind–body interventions seem to be an interesting psychological approach to improve the well-being of breast cancer patients. Further research is needed to improve the understanding of the mechanisms of action of such interventions and their long-term effects on quality of life.

Working conditions, job strain and work engagement among Belgian Radiation Oncologists

PURPOSE This national survey has measured the working conditions, work engagement, job strain, burn out, and the negative work-home interaction among Belgian radiation oncologists with validated questionnaires. In fact, previous studies had in general shown an interest to burn out and its association with working conditions among oncology workers, but not focused on radiation oncologists in particular. Moreover, few studies concerned work engagement and its association with working conditions although this could be important in preventing burn out. METHODS We used the WOrking Conditions and Control Questionnaire, the Positive and Negative Occupational States Inventory, the Maslach Burn out Inventory, and the negative work-home interaction subscale of the Survey Work-home Interaction Nijmegen. One open question asked about problematic job situations. RESULTS Sixty-six radiation oncologists participated (30% response rate). Median scores of most of working conditions corresponded to normal scores. Control over time management (45.8) was close to low score, while control over future (60.9) was high. Median score of job strain (48.9) was normal, whereas median score of work engagement (60) was high. Median score of burn out was low. The mean of negative work-home interactions (1.1) was higher than the mean of 0.84 in a reference sample (t=4.3; P<0.001). The most frequent problematic situations referred to work organization (e.g. time pressure) and specific resources (e.g. chief support). CONCLUSIONS Radiation oncologists showed a very high level of work engagement and experienced several job resources. However, some resources (as supervisor support) were missing and needed to be developed. These results were discussed in the context of motivational process described in the Job Demands-Resources Model.

NHL-ChirEx: An interprofessional cross-border education initiative in the Greater Region with a focus on radiation morbidity and patient safety

NHL-ChirEx is an interprofessional cross-border education project that addresses the potential excess of radiation induced morbidity throughout the radiation planning and treatment process. NHL-ChirEx is supported by ESTRO and the University of the Greater Region and has been recently approved and funded under INTERREG VA Programme.