Practices, Perceptions, and Challenges of Postgraduate Medical Students on Breaking Bad News – A Mixed-Methods Study

Background: Any information which will affect adversely and drastically a patient’s view of his/her future is called as bad news. Breaking a bad news involves issues related to ethical, legal, professional, and human rights. This results in miscommunication of information and ultimately lack of trust and piling up of legal cases. However, there was no proper training currently among most of the postgraduate (PG) medical students of India and very limited studies are available on this topic. Aim: This study was planned to assess the practices of PG medical students of a medical college in breaking bad news (BBN) and to explore the perceptions and challenges faced by them during the communication of the bad news. Materials and Methods: Utilizing a pre-validated questionnaire via Google Forms and a focus group discussion (FGD) guide, a mixed-methods study was carried out among 122 medical postgraduate students at a tertiary care hospital in Tamil Nadu using the Universal Sampling Method. Quantitative data were analyzed through SPSS software and qualitative data were analyzed through manual thematic analysis. Results: Approximately 89% had previously delivered bad news, and of that, 75.3% involved declaring a death, 67.1% involved informing patients of COVID-19 positivity, 64.7% involved informing patients of a disease's irreversible complications, 38.8% involved informing patients of a cancer diagnosis, 18.8% involved informing them of HIV positivity, and 10.6% involved informing them of positive genetic test results. Conclusion: Even though they underwent initial training at the PG orientation program, three-fourths of them stated that they still require additional training for breaking bad news. They also highlighted a number of difficulties, such as language barriers and a lack of counselling and communication skills. Hence, reinforcement of training in BBN should be part of their teaching to reduce ethical and legal issues in future.