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Training for difficult conversations and breaking bad news over the phone in the emergency department
  1. Anna Collini1,
  2. Helen Parker2,
  3. Amy Oliver3
  1. 1 Education Academy, Newham University Hospital, Barts Health NHS Trust, London, UK
  2. 2 Emergency Department, Newham University Hospital, Barts Health NHS Trust, London, UK
  3. 3 Role Plays for Training (RPfT), London, UK
  1. Correspondence to Dr Anna Collini, Education Academy, Newham University Hospital, London E13 8SL, UK; anna.collini{at}


Due to the COVID-19 pandemic, there have been strict limits on visitors to hospitals. This has led to clinicians having an increasing number of difficult conversations with patients and their relatives over the phone. There is a lack of published literature examining how to do this well, but it is recognised that phone communication does differ from face to face interactions, and requires specific training. What is most important to patients and their families when receiving bad news is privacy, adequate time without interruptions, clarity and honesty when delivering the information, and an empathetic and caring attitude. Much of the work done on breaking bad news has been done in oncology and focusses on face to face interaction; there has been an assumption that this is transferrable to the emergency department, and more recently that this is applicable to conversations over the phone. Multiple educational interventions to improve the delivery of bad news have been developed, with differing frameworks to help clinicians carry out this stressful task. Simulation is widely used to train clinicians to break bad news, and has solid theoretical foundations for its use. The psychological safety of participants must be considered, especially with emotive subjects such as breaking bad news. We believe there is a need for specific training in breaking bad news over the phone, and developed an innovative simulation-based session to address this. The training has been well received, and has also highlighted the need for a space where clinicians feel able to discuss the emotional impact of the difficult conversations they are having.

  • training
  • education
  • communications

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  • Handling editor Jo Daniels

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  • Contributors All authors have made substantial contributions to the development of this training session. AC wrote the first and subsequent manuscript drafts and all authors contributed to revising it, as well as final approval for the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.