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Teaching breaking bad news to medical students: An efficacy study comparing two teaching programs
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Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
attachment disorganisation, but little is known about the predictors of Unresolved loss following the experience of loss in adults. We assume that mentalization, and affect regulation jointly predict Unresolved loss. The aim of this study is a) to reveal associations between mentalization in terms of emotional awareness and physiological indicators of affect regulation in terms of heart rate variability (HRV) in bereavement and separation, and b) investigate the contributions of mentalization and HRV to presence vs. absence of Unresolved status in the AAI. Method: In wave 1, 114 adults aged between 25 and 57, who experienced loss through bereavement and/or separation up to 3 years previously, were administered the Levels of Emotional Awareness Scale (LEAS; Lane et al., 1990). HRV (PNN50, RMSSD, and SDNN) was assessed during a laboratory session involving baseline conditions (e.g. resting state) and films eliciting sadness and anxiety. One year later, the AAI (Main & Goldwyn, 1985/2002) is being administered. Results & Conclusion: Only HRV data below 5% artefact ratio were used (n = 84; 23 male). 72 participants had lost a close friend or relative through death (11 of them in addition to separation), 12 participants had experienced separation and/or divorce from an intimate partner. Participants with high LEAS scores demonstrated higher PNN50 (F = 15.14), RMSSD (F = 16.05), and SDNN (F = 9.18) than those with low LEAS scores (all ps b .05), thus confirming the affect regulatory function of emotional awareness (Subic-Wrana et al., 2011). An interaction, (F = 2.91; p b .05) between type of loss and laboratory condition revealed higher SDNN during resting state in the “separated only” group than in the group who had experienced bereavement, suggesting that bereavement weakens baseline HRV more than does separation. Another interaction, i.e. between LEAS competence and type of loss, showed that it was the “separation only” group that accounted for the differences in HRV depending on LEAS competence. It can be concluded that, in newly separated individuals, strengthening mentalization in terms of emotional awareness may help protect HRV regulatory function. AAI administration and coding are under way, and will reveal in how far emotional awareness and HRV predict attachment status in bereaved and separated individuals. doi:10.1016/j.jpsychores.2015.03.024
The effect of gender on health-related quality of life in depressed post-cardiac surgery patients M. Beresnevaitea, R. Benetisa, S. Rasinskieneb, S. Kindurisa a Lithuanian University Health Sciences, Institute of Cardiology, Kaunas, Lithuania, b Kaunas Vytautas Magnus University, Kaunas, Lithuania Background: It is known about the men prevalence among patients with cardiac diseases. While studies have also documented about depression relations to cardiovascular diseases, depressed postcardiac surgery (CS) patients' health related quality of life (HRQOL) and the effect of gender on it remains uncertain. Therefore, the aim of this study was to investigate HRQOL and the gender association with different HRQOL aspects in depressed post-cardiac surgery patients. Method: A convenience sample of 460 post-surgery patients was recruited from the outpatient department from January 2012 to December 2014 two months after CS. Patients completed instruments that included a SCL-90R (Symptom Checklist Revised) depression scale and nine SF-36 (Medical Outcomes Study 36-item Short Form Health Survey) scales, which define nine different aspects of HRQOL. Only the patients with increased depression scale score and without contraindications were included into the study. Total sample consisted of 153 patients. Data were analyzed in the whole group and in two subgroups – females and males. Analyses
used descriptive statistics, including mean and standard deviations; independent-sample Student's t-tests, linear and logistic regression analyses. P b 0.05 was considered as statistically significant. Results: The mean score of depression scale was moderate in the group, it didn't differ between the subgroups. The Results have demonstrated the low HRQOL according to the three aspects (limitations for physical and mental problems, general health perception). The mean scores of mental health, energy/vitality and general health perception scale scores were significantly lower in the female subgroup. The significant relations of depression to three SF-36 scales in whole group; to five SF36 scales in the female subgroup; and to three ones in the male subgroup were found. All associations were stronger in the female subgroup. According to the logistic regression analysis a worse energy/ vitality scale's score was related with the female gender; the associations with mental health and general health perception scales have shown the tendency for significance. Conclusion: Gender impacts the HRQOL in depressed postoperative cardiac patients – the Results demonstrated some worse HRQOL aspects in females. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes. doi:10.1016/j.jpsychores.2015.03.025
Teaching breaking bad news to medical students: An efficacy study comparing two teaching programs A. Berney Hospital University Lausanne, Switzerland Background: Breaking bad news (BBN) is an important clinical task. There is a lack of undergraduate teaching on BBN which may represent a key to the improvement of physicians' communication skills. We examined the impact of a communication skills training program in BBN for medical students and compared two teaching formats. Method: Master level medical students (N = 239) were randomized into small group training (control group: CG) – or individual supervision (intervention group: IG). In both groups, the training used video-taped interviews with simulated patients (SP). Posttraining, each student performed a video-taped SP encounter to assess the outcome. Interviews were rated using the Roter Interaction Analysis System (RIAS), a check list of teaching objectives, as well as several non-verbal dimensions. Results: RIAS coding showed that students in the intervention group were significantly less verbally dominant after the training (p = 0.013), and compared to control group students (p = 0.031); they were also significantly more empathetic than students in the control group (p = 0.022). Ratings on the check list of teaching objectives also favored intervention group. Conclusion: Dominance and empathy are key dimensions of patientcentered communication, and our data suggests that students receiving one-to-one teaching are more able to adjust to patient's values, needs and preferences. doi:10.1016/j.jpsychores.2015.03.026
Differences in psychodynamic diagnostics between patients with burnout-syndrome and patients with somatoform disorders VM Beyera, J Behringerb, D Tuffnerc, W Söllnera a Paracelsus Medical University, Nuremberg General Hospital, Department of Psychosomatic Medicine & Psychotherapy, Germany, b Friedrich Alexander University, Institute of Psychology, Erlangen, Germany, c University Hospital, Interdisciplinary Pain Centre, Erlangen, Germany
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
attachment disorganisation, but little is known about the predictors of Unresolved loss following the experience of loss in adults. We assume that mentalization, and affect regulation jointly predict Unresolved loss. The aim of this study is a) to reveal associations between mentalization in terms of emotional awareness and physiological indicators of affect regulation in terms of heart rate variability (HRV) in bereavement and separation, and b) investigate the contributions of mentalization and HRV to presence vs. absence of Unresolved status in the AAI. Method: In wave 1, 114 adults aged between 25 and 57, who experienced loss through bereavement and/or separation up to 3 years previously, were administered the Levels of Emotional Awareness Scale (LEAS; Lane et al., 1990). HRV (PNN50, RMSSD, and SDNN) was assessed during a laboratory session involving baseline conditions (e.g. resting state) and films eliciting sadness and anxiety. One year later, the AAI (Main & Goldwyn, 1985/2002) is being administered. Results & Conclusion: Only HRV data below 5% artefact ratio were used (n = 84; 23 male). 72 participants had lost a close friend or relative through death (11 of them in addition to separation), 12 participants had experienced separation and/or divorce from an intimate partner. Participants with high LEAS scores demonstrated higher PNN50 (F = 15.14), RMSSD (F = 16.05), and SDNN (F = 9.18) than those with low LEAS scores (all ps b .05), thus confirming the affect regulatory function of emotional awareness (Subic-Wrana et al., 2011). An interaction, (F = 2.91; p b .05) between type of loss and laboratory condition revealed higher SDNN during resting state in the “separated only” group than in the group who had experienced bereavement, suggesting that bereavement weakens baseline HRV more than does separation. Another interaction, i.e. between LEAS competence and type of loss, showed that it was the “separation only” group that accounted for the differences in HRV depending on LEAS competence. It can be concluded that, in newly separated individuals, strengthening mentalization in terms of emotional awareness may help protect HRV regulatory function. AAI administration and coding are under way, and will reveal in how far emotional awareness and HRV predict attachment status in bereaved and separated individuals. doi:10.1016/j.jpsychores.2015.03.024
The effect of gender on health-related quality of life in depressed post-cardiac surgery patients M. Beresnevaitea, R. Benetisa, S. Rasinskieneb, S. Kindurisa a Lithuanian University Health Sciences, Institute of Cardiology, Kaunas, Lithuania, b Kaunas Vytautas Magnus University, Kaunas, Lithuania Background: It is known about the men prevalence among patients with cardiac diseases. While studies have also documented about depression relations to cardiovascular diseases, depressed postcardiac surgery (CS) patients' health related quality of life (HRQOL) and the effect of gender on it remains uncertain. Therefore, the aim of this study was to investigate HRQOL and the gender association with different HRQOL aspects in depressed post-cardiac surgery patients. Method: A convenience sample of 460 post-surgery patients was recruited from the outpatient department from January 2012 to December 2014 two months after CS. Patients completed instruments that included a SCL-90R (Symptom Checklist Revised) depression scale and nine SF-36 (Medical Outcomes Study 36-item Short Form Health Survey) scales, which define nine different aspects of HRQOL. Only the patients with increased depression scale score and without contraindications were included into the study. Total sample consisted of 153 patients. Data were analyzed in the whole group and in two subgroups – females and males. Analyses
used descriptive statistics, including mean and standard deviations; independent-sample Student's t-tests, linear and logistic regression analyses. P b 0.05 was considered as statistically significant. Results: The mean score of depression scale was moderate in the group, it didn't differ between the subgroups. The Results have demonstrated the low HRQOL according to the three aspects (limitations for physical and mental problems, general health perception). The mean scores of mental health, energy/vitality and general health perception scale scores were significantly lower in the female subgroup. The significant relations of depression to three SF-36 scales in whole group; to five SF36 scales in the female subgroup; and to three ones in the male subgroup were found. All associations were stronger in the female subgroup. According to the logistic regression analysis a worse energy/ vitality scale's score was related with the female gender; the associations with mental health and general health perception scales have shown the tendency for significance. Conclusion: Gender impacts the HRQOL in depressed postoperative cardiac patients – the Results demonstrated some worse HRQOL aspects in females. Therefore, gender should be considered in assessing and addressing the individual care needs of these patients in order to attain optimal treatment outcomes. doi:10.1016/j.jpsychores.2015.03.025
Teaching breaking bad news to medical students: An efficacy study comparing two teaching programs A. Berney Hospital University Lausanne, Switzerland Background: Breaking bad news (BBN) is an important clinical task. There is a lack of undergraduate teaching on BBN which may represent a key to the improvement of physicians' communication skills. We examined the impact of a communication skills training program in BBN for medical students and compared two teaching formats. Method: Master level medical students (N = 239) were randomized into small group training (control group: CG) – or individual supervision (intervention group: IG). In both groups, the training used video-taped interviews with simulated patients (SP). Posttraining, each student performed a video-taped SP encounter to assess the outcome. Interviews were rated using the Roter Interaction Analysis System (RIAS), a check list of teaching objectives, as well as several non-verbal dimensions. Results: RIAS coding showed that students in the intervention group were significantly less verbally dominant after the training (p = 0.013), and compared to control group students (p = 0.031); they were also significantly more empathetic than students in the control group (p = 0.022). Ratings on the check list of teaching objectives also favored intervention group. Conclusion: Dominance and empathy are key dimensions of patientcentered communication, and our data suggests that students receiving one-to-one teaching are more able to adjust to patient's values, needs and preferences. doi:10.1016/j.jpsychores.2015.03.026
Differences in psychodynamic diagnostics between patients with burnout-syndrome and patients with somatoform disorders VM Beyera, J Behringerb, D Tuffnerc, W Söllnera a Paracelsus Medical University, Nuremberg General Hospital, Department of Psychosomatic Medicine & Psychotherapy, Germany, b Friedrich Alexander University, Institute of Psychology, Erlangen, Germany, c University Hospital, Interdisciplinary Pain Centre, Erlangen, Germany