Exploring Chinese medical students’ communication pattern in delivering bad news using an ethnographic discourse analysis approach: a case study in Hong Kong

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Abstract Summary

Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios.

Fifty Year-6 medical students attending the 'Serious Illness Communication Module' were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients.

Submission ID :

AILA148

Submission Type

Oral Presentation

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[SYMP42] Language, work and vocational education: teaching, training and learning through language use in professional contexts

Argument :

Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients' emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients' attention to treatment options; (4) acknowledging concerns about dying patients' physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients' emotional and physical needs. They also often informed and acknowledged the patients' family members.

When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients' participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.

References:

Pun, J.& Wong, W. (2022). Navigating communication between conventional medicine and traditional Chinese medicine: A case study of patients with cancer in Hong Kong.Supportive Care in Cancer.https://doi.org/10.1007/s00520-022-06986-8.
Pun, J. (2021). Communication about Advance Directives and Advance Care Planning in the East Asian context: A systematic review. Oncology Nursing Forum. DOI: 10.1188/22.ONF.58-70
Pun, J. Cheung K.M. & Chow, C.H.J. (2021). A Systematic Review of Teaching End of Life Communication: the Priorities, the Challenges and the Scope. BMJ Supportive & Palliative Care.http://dx.doi.org/10.1136/bmjspcare-2020-002725
Pun, J. (2021). A study of Chinese medical students' communication pattern in delivering bad news: An ethnographic discourse analysis approach. BMC Medical Education. https://doi.org/10.1186/s12909-021-02724-6