The pre-SA and post-SA questionnaires were completed by 132 and 101 students, respectively. The mean age of the pre-SA and post-SA participating students was 21.1±1.6, and 21.1±1.6, respectively. Females made up 72.7 % of the before SA and 82.7 % of the after SA participants. During the pre-student activity, 73.5 % of the students has thought about how to break bad news, 42 % had witnessed a case of BBN, and only 18.9 % had delivered bad news to patients and their families. Furthermore, only 6.1 % of them had BBN training (Table 1).
Table 1
pre -knowledge and training of BBN pre-SA N=132
Question
|
category
|
Frequency (%)
|
Have you ever thought about the task of BBN ?
|
Yes
|
97 (73.5%)
|
No
|
35 (26.5%)
|
Have you ever witnessed an occasion of BBN?
|
Yes
|
55 (42%)
|
No
|
76 (58%)
|
Have you ever experienced BBN to patients or their families?
|
Yes
|
25 (18.9%)
|
No
|
107 (81.1%)
|
Did you receive training on how to break bad news?
|
Yes
|
8 (6.1%)
|
No
|
124 (93.9%)
|
Values are presented as n (%).
*P-value has been calculated using the Chi-square test.
Pre-SA, 67.4 % of students believed patients should be told everything about their serious disease, but after the SA, this percentage statistically significantly increased to 84.7 (p value=.012). The majority of those who will tell their patients everything would do it in one or more visits, depending on their evaluation of the case. Pre-SA, 41.7 % thought that BBN reduces patients' hope. Post-SA, 33% thought the same; nevertheless, this change was not statistically significant (P=.240) (Table 2) (at the end of file)
46.2% of students believed that Sudanese patients want to know about their diagnosis pre-SA, but post-SA, this percentage increased to 46.9% only.
Students were asked about their response if patients' relatives wanted to keep the patients' diagnosis from them, and the results showed that 40.5% of pre-SA and 43.9% of post-SA choose not to agree with the relatives and inform their patients of their diagnoses, and this difference is not statistically significant. On the other hand, 19.1% of the students pre-SA and 14.3% post-SA agreed with the patient's relatives, but similar to those who disagreed; this difference was not statistically significant (p-value > 0.05) (Table 2)
Table 2
BBN from students' perspective pre-SA N=132 and post-SA N=101
Questions
|
Responses
|
P-value*
|
Do you think the patient should be told everything about their serious illness?
|
|
Pre-SA
|
Post-SA
|
0.012
|
Yes
|
67.4 %
|
84.7%
|
No
|
16.7%
|
8.2
|
Not sure
|
15.9%
|
7.1
|
If yes, do you think the patient should receive information in how many visits?
|
|
Pre-SA
|
Post-SA
|
0.649
|
-In one visit.
|
6.6%
|
7.2%
|
-In many visits.
|
19.8%
|
14.5%
|
-Depend in the Situation
|
73.6%
|
78.3%
|
Do you think Sudanese patients do not want to know about their diagnosis and prognosis of a severe illness?
|
|
Pre-SA
|
Post-SA
|
0.863
|
Yes
|
32.6 %
|
29.6 %
|
No
|
46.2 %
|
46.9%
|
Not sure
|
21.2%
|
23.5%
|
Do you think telling all information about the bad news to the patient reduce their hopes?
|
|
Pre-SA
|
Post-SA
|
0.240
|
Yes
|
41.7%
|
33.0%
|
No
|
27.3%
|
37.1%
|
Not sure
|
31.1%
|
29.9%
|
If relatives want to hide the diagnosis of a severe illness from their patients, what will you do?
|
|
Pre-SA
|
Post-SA
|
0.543
|
-Agree with the relatives and avoid telling the diagnosis to the patient.
|
19.1%
|
14.3%
|
-Tell them to go to another doctor.
|
3.1%
|
1.0%
|
-Tell them if the patients Ask me, I will tell them.
|
37.4%
|
40.8%
|
- Disagree with the relatives and tell the diagnosis to the patient.
|
40.5%
|
43.9%
|
Which one of the following is more stressful for you?
|
|
Pre-SA
|
Post-SA
|
0.000
|
-Breaking bad news.
|
40.5%
|
36.7%
|
-Giving false hope to a terminally ill patient.
|
59.5%
|
63.6%
|
Values are presented as n (%).
*P-value has been calculated using the Chi-square test.
Regarding difficulties in BBN, 59.5% of students, pre-SA, felt that giving false hope is more difficult than breaking bad news. While post-SA this percentage increased to 63.3% and this difference was not statistically significant (Table 2). Students stated that the most challenging part of breaking bad news was dealing with high expectations from patients or relatives, with 58.9% and 63.9% of students believing this pre and post-SA, respectively (Table 4) (at the end of file).
The majority of students thought their BBN abilities were ordinary (54.2% before SA and 61.2%after SA). Their requirement for training in BBN was mostly rated as moderate as well (pre-SA 39.2%and post-SA 37.1%)
Pre-SA and post-SA changes in students' ability to BBN and their assessment of the need for BBN training were shown to be statistically significant (P value <0.001) (Table 3).
During pre-SA and post-SA, the majority of students viewed Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) as bad news with percentages of 89.1 and 90.7, respectively (Table 4). Following SA, 73.8% and 80.6% of students considered it at least moderately or extremely enjoyable and useful, respectively (Table5)
Table 3
Assessment of the students' ability, and need for training on BBN pre-and post-SA
Questions
|
|
Answers
|
P-value*
|
|
Pre-SA
|
Post-SA
|
How do you estimate your ability to BBN?
|
Very good.
|
8.4%
|
5.1%
|
<0.001
|
Good.
|
13.7%
|
14.3%
|
Average.
|
54.2%
|
61.2%
|
Bad.
|
18.3%
|
18.4%
|
Very bad.
|
5.3%
|
1%
|
How do you assess your need to be highly trained for breaking bad news?
|
|
Pre-SA
|
Post-SA
|
|
Very high.
|
20.8%
|
19.6%
|
<0.001
|
High.
|
34.6%
|
36.1%
|
Moderate.
|
39.2%
|
37.1%
|
Low.
|
2.3%
|
6.2%
|
Very low.
|
3.1%
|
1%
|
*P-value has been calculated using chi-square test.
Table 4
Difficulties and medical conditions perceived as bad news from students' perspective pre-and post-SA
Questions
|
|
Answers
|
|
You can choose more than one response. Which of the following you think it’s one of the difficulties in breaking bad news you will face:
|
|
Pre-SA
|
Post-SA
|
P-value*
|
Yes
|
No
|
Yes
|
No
|
-That you will be blamed.
|
18.6%
|
81.4%
|
40.2%
|
59.8%
|
0.000
|
- Personal fear of illness or death.
|
44.2%
|
55.8%
|
39.2%
|
60.8%
|
0.268
|
-Fear of not knowing all the answers to the patients or the relatives' questions.
|
24%
|
55.8%
|
24.7
|
75.3%
|
0.512
|
-High expectation of the outcome from the patients or relatives
|
58.9%
|
41.1%
|
63.9%
|
36.1%
|
0.266
|
You can choose more than one response, which of the following you consider as bad news:
|
|
Pre-SA
|
Post-SA
|
P-value*
|
Yes
|
No
|
Yes
|
No
|
-HIV/AIDS.
|
89.1%
|
10.9%
|
90.7%
|
9.3%
|
0.698
|
-Cancer.
|
83.7%
|
16.3%
|
84.5%
|
15.5%
|
0.868
|
-Hypertension, Asthma or diabetes mellitus.
|
9.3%
|
90.7%
|
17.5%
|
82.5%
|
0.067
|
-A child with cerebral palsy.
|
59.7%
|
40.3%
|
62.9%
|
37.1%
|
0.626
|
-A child with Down syndrome.
|
45.7%
|
54.3%
|
48.5%
|
51.5%
|
0.685
|
-Physical handicap e.g. paralysis.
|
67.4%
|
32.6%
|
69.1%
|
30.9%
|
0.795
|
-Tuberculosis.
|
27.9%
|
72.1%
|
24.7%
|
75.3%
|
0.594
|
-Other, mention please
|
19.4%
|
80.6%
|
16.5%
|
83.5%
|
0.577
|
Table 5
Opinions of the students toward BBN
Questions
|
Answers
|
Did you find the seminar (student activity) enjoyable?
|
Not at all. 5.1%
Slightly. 6.1%
Somewhat 15.2%
Moderately. 46.5%
Extremely. 27.3%
|
Did you find the seminar (student activity) useful?
|
Not at all. 1.0%
Slightly. 8.2%
Somewhat. 10.2%
Moderately. 52.0%
Extremely. 28.6%
|