Table 6 Themes and representative quotations from qualitative analysis of interviews with physicians who did not complete the training

Global feedback on the training

“The only thing was my discomfort facing other people during role play I think that role play should be avoided in the presence of other colleagues. [...] Observer teachers are one thing, because they have to help you see some mistakes, your colleagues are another thing.” (Ph 1)

“It was difficult ... Not so much when you play your part but when we analysed things ... Everyone has difficult cases outstanding ... It was difficult to cope with the return to the memory of cases that I had not yet worked out”. (Ph 4)

“I remember that during the theorethical lesson S.T. [the teacher] stated that we must be able to highlight with the patient the end of his/her life … and that we have to do this in a very clear way … which is something that I do not agree because … at the end you always have to give hope to the patient. Besides, our patients already know when their time has come, so there’s no point in stressing it. Then if we want to underline it with family members, that’s due!” (Ph 1)

“I remember the role plays very well. […]Role plays have impressed me a lot. I don’t remember anything in particular about the theoretical lesson ... “(Ph 3)

Organizational issues

“Also palliative care physicians have a number of things to do, and this could be a limitation …” (Ph 4)

“With reference to the training, I think that It should be planned having in mind both the characteristics of haematological patients and our great workload” (Ph 2).

Misunderstandings about the structure of the programme

Interviewer “May I ask you if you have completed all the communication training? Did you carry it out in all its parts?” […]

Ph 1: “Yes, I did. I had one problem only … My distress in front of other persons, during the role-playing sessions …”

“It was a training including either a theoretical, a practical and a field component. I still have to achieve this part because when I needed to communicate some kind of diagnosis, I could not arrange for a meeting with S. [the trainee]. Thus, I still have to do it. I will call S.T. when I will have to communicate a ‘bad’ diagnosis”.(Ph 3)

Problems in detecting the “right” situation

“I could not attend the bedside sessions because I needed to communicate an illness diagnosis, thus S.T. said that I should call her when I had to perform a truly difficult communication!” (Ph 4)

“Our patients can get worse from one moment to the next, so you make a good plan but ... it’s hard to keep up with this!” (Ph 1)