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MEET & MAKE CleaR PROCESS: a new framework for sharing serious information
Etienne Rivière1,2,3, Amandine Mathé4, Thibaud Haaser5,6,7
1Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Center of Bordeaux, Pessac, 33604, France. etienne.riviere@u-bordeaux.fr.
Introduction:
Sharing serious information (SSI) is a critical communication skill for physicians. Existing frameworks vary in their teaching and application, and many physicians desire better training. This study aimed to develop a theory-informed framework and cognitive aid for sharing serious information (SSI) through a multiphased development process involving a systematic review and expert focus groups.
Method:
A multiphased approach was used: (1) a systematic review of four databases (1983-2024) to identify core components of SSI; and (2) twelve multidisciplinary focus groups (2022-2024) using the nominal group technique to integrate these components into a structured framework. A modified PICO/PEO approach (Population, Exposure/Intervention, Outcomes) guided study selection, and the AMSTAR2 tool was only used for quality appraisal of systematic reviews. From 4,892 titles/abstracts, 52 were selected for inclusion.
Results:
Thematic synthesis identified eight themes for optimal SSI: (1) limiting delay between diagnosis and SSI, (2) preparation time for meetings, (3) patient-centered communication, (4) discussion of emotions, (5) verifying understanding, (6) affirmation of treatment options, (7) offering a confidant, and (8) providing information resources. These themes, interpreted cautiously across heterogeneous evidence sources, informed the development of the MEET & MAKE CleaR PROCESS framework, encompassing preparation (MEET), sharing (MAKE), clarification (CleaR), and ongoing plan (PROCESS).
Discussion:
The MEET & MAKE CleaR PROCESS framework and its cognitive aid aim to equip educators and clinicians with a structured approach to instructing and managing SSI encounters especially with simulation-based education. We believe this up-to-date framework could minimize the negative impact of SSI on patients, relatives, and physicians.
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