Mobile Learning to Improve Clinician's Ability to Break Bad News
Condition: Education
Study type: Interventional

Summary: 
      Design:

      A pre-post mixed methods pilot study. All participants granted access to a breaking bad news
      mobile learning resource (VitalTips).

      Baseline and post-intervention questionnaires, pre- and post-intervention simulated patient
      encounters, and post-intervention semi-structured interviews.

      Objective:

      To assess if a selected breaking bad news mobile learning resource can improve the ability of
      clinicians to break bad news.

      Population/Eligibility:

      15-20 junior doctors and nurses working within two NHS hospitals trusts and one private
      hospital in England.

      Duration:

      25th February 2019 to 8th July 2019.
    

Detailed description: 
      Purpose:

      Digital and mobile learning is at the forefront of healthcare education. Though there is
      evidence for the use of digital learning for practical skills acquisition, there is little
      evidence of the use of digital learning for breaking bad news training. This pre-post mixed
      methods pilot study aimed to address this gap in knowledge by assessing how a mobile learning
      resource may impact the ability of clinicians to break bad news.

      Hypothesis:

      The addition of a breaking bad news mobile learning resource to clinical practice improves
      the confidence and ability of junior doctors and nurses to break bad news.

      Study objective:

      To assess if a breaking bad news mobile learning resource can improve the confidence and
      ability of clinicians to break bad news.

      Methodology:

      Potential participants were sent an invitation and participant information sheet (PIS) via
      e-mail. Potential participants were given up to two weeks to decide if they wanted to
      participate, with a reminder sent after one week. Each potential participant was referenced
      by a participant ID number for confidentiality purposes.

      Once potential participants read the PIS and given consent, they were asked to complete a
      baseline questionnaire to understand their demographics, their previous exposure to breaking
      bad news (through formal or informal training) and their engagement with digital resources.

      Following this, participants were asked to complete a baseline simulated patient encounter
      (SPE) with a simulated patient (SP) (role-played by an actor) to assess their baseline
      ability to break bad news. Participants were given a task sheet with a brief history of the
      SP and what news they needed to deliver. The details and history of the SP was documented on
      a character sheet for the actor's reference. Each participant was given 15 minutes to
      complete the SPE which was video-recorded. The SPEs were evaluated against the validated
      Breaking bad news Assessment Schedule (BAS) mark sheet completed by the chief investigator,
      actor and an independent assessor (by watching the video footage).

      Access to the mobile learning resource was granted following the baseline SPE. The mobile
      learning resource was the freely available VitalTips mobile application, provided by
      VitalTalks. Participants were expected to spend at least three hours using the mobile
      learning resource, ensuring that this time did not impact on their clinical and academic
      commitments.

      Four to six weeks later, participants were asked to complete a second videoed SPE, which was
      marked as described above. The participants were asked to complete a post-intervention
      questionnaire to gauge the impact on their clinical practice and their engagement with the
      mobile resources.

      The questionnaires utilised a five-point Likert scale ranking of the user's confidence and
      agreeability with statements. The questionnaires are novel to this study and were developed
      using the principles of Kirkpatrick's Model of Learning Evaluation, the Theory of Planned
      Behaviour and the Technology Acceptance Model, whilst also drawing on the most important
      curricula competencies derived from the content analysis of a sample of medical and nursing
      curricula followed by an expert consensus.

      Soon after the completion of the post-intervention questionnaire, the participants were asked
      to participate in a 15-30 minutes semi-structured interview with the chief investigator. The
      participant was asked about their general impressions of the mobile learning resource, their
      use of the resource in and outside of the clinical environment, their perception of their
      ability to break bad news before and after the intervention, their perception of their
      performance in the SPE and any impact on their practice.

      Data handling and confidentiality:

      Following consent, participants were referenced by their participant ID number (e.g. MLR001).
      Their e-mail address was recorded next to their participant ID number, gender, role (i.e.
      doctor or nurse) and training grade, on an Excel spreadsheet for the purpose of contacting
      participants as the study progressed. Once their commitment to the study had ended, the
      e-mail addresses were deleted.

      Video recordings from the SPEs were transferred from the recording device to a password
      protected USB stick referenced by the participant ID followed by SPE1 (baseline) or SPE2
      (post-intervention), e.g. MLR001_SPE1. Once the independent reviewer had viewed the video and
      marked the participant, the video file was destroyed.

      Audio files from the interviews was transferred from the recording device onto a password
      protected computer using a USB stick. Once the transfer was completed, the files were deleted
      from the USB stick. The transferred files were stored on the password protected computer till
      the returned transcriptions were checked by the chief investigator. Once the files had been
      checked, the recordings were deleted.
    

Intervention name(s): VitalTips mobile application
Intervention type(s): Other
Intervention description(s): VitalTips is a mobile learning application with learning on breaking bad news. Participants were expected to spend at least three hours using the mobile learning resource, ensuring that the time did not impact on their clinical and academic commitments.
Intervention model: Single Group Assignment
Intervention model description: A pre-post mixed methods pilot educational study
Masking: None (Open Label)
Primary purpose: Other
Keywords: Healthcare education; Breaking bad news; Digital learning