Training activity information
Details
Deliver bad news results following predictive and/or prenatal tests, reflect on the family context and circumstances under supervision
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Counselling techniques for delivering bad news
- Implications of the genetic test results for diagnosis/prognosis and reproductive options
- Communicating genetic test results in an empathic manner
- Communicating genetic test results with clarity about the boundaries of certain/uncertain information
- Communicating genetic test results taking into account patients’ current concerns, health literacy and cognitive ability
- Helping patients adapt to and accept their result
- SPIKES model
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Consider how delivering bad news in an empathic and supportive manner would look; what would you notice in your patient if this went well?
- Consider how the learning outcomes apply, specifically in relation to ensuring that you consider and reflect upon the specific family context and circumstances.
- Discuss with your training officer to gain clarity of what is expected of you in relation to managing patient grief and emotional responses, and the boundaries of your supportive role during bad news delivery.
What is your prior experience of this activity?
- Think about what you already know about delivering difficult or sensitive information.
- Consider possible challenges you might face during the activity, including timing, location and coordinating follow up care.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom.
- You will need to seek advice from your Training Officer when required, for example if a patient exhibits an extreme emotional response (e.g., profound denial or severe anger), or if you require assistance with follow up care (such as arranging a referral for termination of pregnancy).
- Acknowledge how you feel about the emotional demands of delivering bad news.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as specific communication skills for delivering bad news and supporting patients.
- Identify the specific insights you hope to gain, such as the impact of individual circumstances or viewpoints on how news is received and processed.
What additional considerations do you need to make?
- Consider your previous experiences of delivering difficult news or observing similar consultations, including how others have negotiated the delivery of this sort of news.
- Identify what specific information you need to consider, such as your plan for managing your own emotional response during and after delivering bad news, and what support systems are in place for patient.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively delivering bad news results under supervision?
- Are you encountering situations such as:
- The individual/couple exhibits profound denial or an extreme emotional response (e.g., severe anger or detachment) that differs from their expected reaction?
- A critical, previously unrevealed detail about the family context (e.g., recent trauma or severe financial difficulty) is disclosed immediately after the bad news delivery?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to emotional support and immediate follow-up to address the acute reaction?
- Consider the steps you are taking in the moment, such as: Immediately pausing to allow space and validating the emotional response or involving your supervising Genetic Counsellor for support.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain empathy and composure? Are you feeling self-conscious about your role? Is it affecting your capacity to be clear about the result or prognosis?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to deliver the news and provide support? Did you successfully document the patient/family response reaction and follow up plan? re you needing support with some aspect of this?
- What are you learning as a result of the unexpected development? For example, are you mastering techniques for managing distress, or gaining insight into the importance of personal/family context?
On action
What happened?
- Begin by summarising the key steps you took when delivering bad news results from a predictive or prenatal test, including how you prepared.
- Consider specific events, actions, or interactions which felt important, such as the ways you noticed the individual/couple/family exhibiting their emotional response.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the delivery to allow silence and validating the emotional response, or if the supervising GC intervened or collaborated with you to manage distress.
- How did you feel during this experience, e.g., did you feel surprised or worried by the patient’s response? How was your sense of emotional rapport as you navigated the news with your patient?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding bad news delivery. What strengths did you demonstrate, e.g., applying essential communication and counselling skills appropriate for delivering difficult news?
- What skills and/or knowledge gaps were evident, e.g., managing acute emotional responses or integrating complex family context into the immediate support plan?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in reflecting on family context and circumstances during the consultation?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding when acute distress exceeds the boundaries of routine counselling and requires specialist psychological intervention, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to refining your approach to support individuals/families receiving difficult results.
- What will you do differently next time you approach delivering bad news, for instance, reviewing specific coping resources and utilising supervision to work through challenging emotional case dynamics?
- Do you need to practise any aspect of the activity further, such as role-playing supporting grief reactions or utilising communication frameworks such as SPIKES?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of delivering bad news led you to revisit your initial approach or decisions during that activity? For example, observing a senior counsellor manage a patient who exhibited profound denial or anger (not typical grief) may have prompted you to re-evaluate your ability to manage your own emotional response and effectively support the patient and family during your first attempt at this training activity.
- Considering what you understand about grief models, emotional regulation, and reflecting on family context now, how have you adapted your bad news delivery technique? For example, have you explored your feelings about giving bad news in supervision, leading to feeling more at ease with allowing silence? Has catching a patient off-guard led to you explicitly confirming consent before sharing news?
- Has discussing cases with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, hearing a senior colleague talk about effectively supporting a patient whose trauma history complicated their bad news consultation, requiring additional resources.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences of delivering bad news, contributed to your overall confidence and ability in managing emotionally charged consultations?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to delivering bad news results?
- How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation?
- Looking holistically at your training journey, how has this initial bad news delivery experience, revisited with your current perspective, contributed to your development regarding supervision, communication, and ethical practice?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply communication skills to provide complex genomic test results in an empathic manner. |