ArticleBMC medical education2026
Transforming challenging telephone conversations - investigating the effectiveness of an adapted ISBAR tool for delivering bad news.
Article in BMC medical education, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCommunication is a cornerstone of medical practice. Clear dialogue between healthcare professionals, patients, and families underpins trust, shared decision-making, and patient satisfaction. Remote consultations have increased reliance on telephone communication, introducing additional challenges. Communication is already a leading source of healthcare complaints, and remote interactions can further complicate clarity, empathy, and structure. To address these challenges, a structured telephone communication tool, ISBAR Plus, was developed. This tool builds on the established ISBAR framework ('Introduction', 'Situation', 'Background', 'Assessment', 'Recommendation'), already used for clinical communication in healthcare settings, and adapts its core principles for telephone-based delivery of difficult information. The ISBAR Plus tool comprises 'Prepare', 'Introduction', 'Situation', 'Background', 'Acknowledge shock', 'Recommendation', with each element containing detailed description. A dedicated ISBAR Plus training programme was also designed to support nurses and doctors in applying the tool effectively in practice.
aimTo evaluate the impact of the ISBAR Plus telephone communication tool and associated training programme on nurses' and doctors' ability to deliver bad news by telephone.
methodsA single-group pre-post quantitative study assessed simulated telephone communication performance of nurses and doctors when breaking bad news, before and after ISBAR Plus training. A 'yes/no' 20-point content and clarity checklist was used, together with a Global Rating Score (GRS) measuring overall communication quality. Participants completed a feedback questionnaire to evaluate the tool's practicality and perceived value.
resultsSeventy-four participants completed the study. The proportion achieving full marks for content and clarity increased from 1% pre-training to 49% post-training. Overall communication quality scores improved from 15% to 51% (p < 0.001). Participant feedback was highly positive: 99% reported that ISBAR Plus was practical and applicable to clinical practice, and 91% recommended that the training be delivered annually to staff.
conclusionImplementation of the ISBAR Plus tool and structured training programme demonstrated an association between the intervention and improved performance in an educational context. A significant improvement in nurses' and doctors' performance and overall quality in delivering bad news via telephone in a simulated environment was observed. The intervention was well received and demonstrates strong potential as a practical, scalable approach to standardising and improving remote clinical communication.
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