Introduction
Good communication and the ability to break bad news are essential skills for clinicians but are underemphasised in training programmes. In recent years, digital learning has come to the forefront in healthcare education. However, the evidence for its use in breaking bad new (BBN) training is limited. This thesis explores clinicians’ digital learning needs, highlights pre-existing curricular requirements for BBN training, and examines how this translates into clinical practice.

Methods
Digital learning needs and curricular requirements for BBN training were established through (i) a systematic review and narrative synthesis of the literature, (ii) a thematic analysis of semi-structured interviews exploring clinicians’ perceptions, and (iii) a content analysis of UK postgraduate medical and nursing curricula. From this, a novel digital learning framework for BBN training was presented and used to evaluate pre-existing digital learning resources (DLRs). The acceptability of one DLR and its impact on confidence in BBN was tested with clinicians in a pre-post mixed-methods pilot study.

Results
Three digital learning needs were identified from the narrative synthesis of a heterogenous group of 26 studies, including positioning the learner as an active participant in a safe digital environment. Five learning needs were extracted from interviews with doctors (n=16) and nurses (n=16), including accessibility and catering to learning preferences. Thirty-one pre-existing curriculum requirements were identified from the content analysis of curricula. The learning needs and curriculum requirements were collated to form a digital learning framework. In the pilot study, a mobile learning application (VitalTips) proved to enable skills acquisition and improve confidence in BBN, as it was user-friendly, emulated clinical practice, and highlighted challenges for learning in the workplace.


Conclusions
The research presented in this thesis showcases the requirements for and effectiveness of digital learning for BBN training. Though it may not replace learning through clinical practice, digital learning can be a powerful adjunct. As digital learning develops, there will be exciting future advancements in this field of education.