Comparison of Two Simulation Tools to Develop Empathic Communication Skills in Nursing Students Breaking Bad News: A Randomized Controlled Study

Background: The announcement of a pathology that could have a negative impact on a patient's future (i.e., breaking bad news, BBN) is a common and difficult task that nurses feel unprepared for. This study compared the effectiveness of two online simulation-based training tools: a standardized patient, currently the most commonly used method, and 360 degrees immersive videos, which could represent an alternative that demands fewer resources. Method: Sixty-nine nursing students were involved in a randomized controlled noninferiority trial and allocated to one of three conditions: standardized patient (SP); 360 degrees immersive videos (360IV); and control group (CG). In all three conditions, pre, post, and one-month follow-up measurements were based on recorded role-plays with patient-actors and questionnaires. Using recordings, external raters assessed students' communication skills along three dimensions related to BBN: empathic communication, building shared understanding, and shared decision-making. Right after the prepost role-plays, patient-actors assessed perceived empathy and confidence. Participants completed questionnaires assessing empathy, stress, and self-efficacy. Results: Empathy perceived by the patient-actors increased in all conditions, but this increase was only maintained in the 360IV condition. In contrast, the SP condition produced the best communication results, as assessed by external raters. Conclusions: The two training tools induced complementary changes in BBN skills among undergraduate nurses, opening up new possibilities for BBN training. Cite this article: Tools to Develop Empathic Communication Skills in Nursing Students Breaking Bad News: A Randomized