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Al Zomia AS, AlHefdhi HA, Alqarni AM, Aljohani AK, Alshahrani YS, Alnahdi WA, Algahtany AM, Youssef N, Ghazy RM, Alqahtani AA, Deajim MA. Examining Saudi Physicians' Approaches to Communicate Bad News and Bridging Generational Gaps. Healthcare (Basel) 2023; 11:2528. [PMID: 37761725 PMCID: PMC10531216 DOI: 10.3390/healthcare11182528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Breaking bad news is an intrinsic aspect of physicians' clinical practices. This study aims to investigate how Saudi physicians manage the process of communicating bad news and explore potential differences in breaking bad news practices between young physicians (interns) and their older colleagues. From 1 March to 15 April 2023, ok an anonymous online cross-sectional survey was conducted to explore the communication practices of Saudi physicians concerning breaking bad news using the Communicating Bad News Questionnaire. The physicians were recruited through convenience and snowball sampling methods, and the survey questionnaire was distributed on various social media platforms, including Facebook, Twitter, LinkedIn, and WhatsApp. Data were analyzed using R version 4.2.1. A total of 782 physicians were included in this study. Male physicians represented 50.9% of the participants. Three-quarters (74.7%) were aged 25-30 years. The largest proportion of physicians (45.3%) were interns, followed by junior residents (22.9%), senior residents (11.0%), and specialists (6.5%). The median years of experience was 1.0, ranging from 0 to 45 years. Regarding the place of work, most physicians (86.6%) worked in hospitals, while 13.4% worked in primary healthcare centers. A total of 14.8% said they were not comfortable with discussing patients'/relatives' issues (20.60 among interns vs. 10.50% among non-interns, χ2 = 27.50, p = 0.0001), 66.6% reported being trained to break bad news (59.60% among interns vs. 72.40% among non-interns, χ2 = 14.34, p = 0.001), 59.1% reported breaking bad news to the patient, 37.9% reported to the family, and 3.1% reported to both, with no significant difference between interns and non-interns. A substantial proportion of physicians reported feeling uncomfortable discussing sensitive issues with patients and their relatives despite having received training to deliver bad news and being willing to communicate bad news directly to patients. Notably, our analysis identified a significant disparity between intern and non-intern physicians, particularly in terms of their comfort level in addressing patient-related concerns and access to breaking bad news training.
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Affiliation(s)
- Ahmed Saad Al Zomia
- Faculty of Medicine, King Khalid University, Abha 62529, Saudi Arabia; (Y.S.A.)
| | - Hayfa A. AlHefdhi
- Department of Family Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | | | | | | | | | | | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt;
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Diendorfer T, Roider-Schur S, Lütgendorf-Caucig C, Masel EK, Watzke H, Pötter R, Kirchheiner K. 'It needs experience and courage': Awareness towards end of life communication practices in oncologists: A mixed methods study. Eur J Cancer Care (Engl) 2022; 31:e13737. [PMID: 36254927 DOI: 10.1111/ecc.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE End of life communication (EOLC) is generally regarded as a challenging aspect of the medical profession, with high influences of culture, the physician's experience and awareness. The aim of the current study was to assess the awareness of Austrian oncologists towards EOLC practices in their daily clinical routine and to identify limiting and supporting factors of these conversations. METHODS Overall, 45 oncologists participated in the assessment in this cross-sectional, mixed-method design using semi-structured interviews and questionnaire. RESULTS Themes that occurred during the interviews included the initiation of EOLC, EOLC in practice, strategies for EOLC, limiting and supporting factors and consequences of EOLC. There were several variations in the EOLC approach, that is, the use of time frames, timing, initiation and the amount of details given to the patient. CONCLUSION Oncologists agreed that EOLC is important in their daily clinical routine and for their patients. Nevertheless, there seems to be an underlying variation in approaches chosen by Austrian oncologists. This variation might be reduced by asking patients about their information preferences in advance and by routine implementation of communication guidelines, nomograms and prognostic calculators to reduce uncertainty.
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Affiliation(s)
- Tamara Diendorfer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Sophie Roider-Schur
- Clinical Division of Oncology, Department of Internal Medicine I, Sankt Josef Hospital Vienna, Vienna, Austria
| | | | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Watzke
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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Katsaliaki K. Evaluating patient and medical staff satisfaction from doctor-patient communication. Int J Health Care Qual Assur 2022; ahead-of-print. [PMID: 35915934 DOI: 10.1108/ijhcqa-03-2022-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to investigate and compare the views of doctors, nursing staff and hospitalized patients on the level of information they provide and receive respectively in public hospitals, focusing on the factors that affect their communication. DESIGN/METHODOLOGY/APPROACH The study used a cross-sectional survey with a sample of 426 participants from two general hospitals in Greece-Pella and KAT Attica. Data were collected through a questionnaire in March-May 2020 and was analyzed with mean comparisons and correlations. FINDINGS The results showed discrepancy in the satisfaction rate, with 67.3% satisfied patients from doctors' communication vs. 83.7% satisfied doctors. Improvements in hospital staff - patient communication are required especially on alternative therapies' discussion and time spent on communication. All respondents agreed that staff shortage is a deterrent factor for effective communication. Seamless for all respondents' groups, the factors that affect the communication satisfaction level are the duration of communication, time allowed for expressing questions and interest in patients' personal situation. PRACTICAL IMPLICATIONS Strengthening the communication skills of medical staff and providing clear guidelines on when and how to inform patients are essential. ORIGINALITY/VALUE This study contributes to the growing body of research on doctor-patient communication. Its originality lies on the fact that communication satisfaction level was examined simultaneously for doctors, nurses and patients. The study provides additional evidence supporting the link among satisfaction and duration of communication and personalized relationship. The study's findings are important in the training of medical staff and the management of patients' expectations.
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Affiliation(s)
- Korina Katsaliaki
- School of Humanities, Social Sciences and Economics, International Hellenic University, Thessaloniki, Greece
- School of Social Sciences, Hellenic Open University, Patra, Greece
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Communication skills training for medical residents: Enhancing a psychosocial approach of patient care. Palliat Support Care 2022; 21:392-398. [PMID: 35256039 DOI: 10.1017/s147895152200030x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES One of the issues that has increasingly become relevant to medical practice is the ability to communicate well with patients. Better communication results in better care for the patient, as well as greater satisfaction for the physician. For this reason, the aim of this study was to assess the efficacy of a communication skills training program for medical residents (MR). METHOD Eighty-six MR underwent a 6-month training program in three phases: a 12-h theory and practice workshop, a period of real practice, and a 4-h workshop in which the most challenging scenarios were role played with an actress. In each phase (T0, T1, and T2), participants' beliefs about their competence in caring for patients' psychosocial aspects and their self-confidence in communication skills were assessed. RESULTS No differences were found between T0 and T1 in participants' beliefs of self-competence in psychosocial care. However, this competence significantly improved after completion of the entire program. Only 7 of the 12 areas explored in communication skills significantly improved between T0 and T1. However, after T2 completion, significant improvements were observed in all 12 areas. SIGNIFICANCE OF RESULTS The research results highlight the usefulness and importance of training young doctors to foster their psychosocial approach to patient care and improve their confidence in their own communication skills. The results also show the appropriateness of the structure of the training: the key features of the programme were the follow-up of the participants in three phases over 6 months, and a focus on the needs of the residents and the resolution of difficult clinical cases, with the support of an actress. Therefore, the training presented in this study may become a guide for other trainings in other contexts with similar objectives.
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Naghibi M, Skinner C, Burden S, Bozzetti F, Cuerda C, Joly F, Jeppesen P, Lamprecht G, Mundi M, Szczepanek K, Van Gossum A, Wanten G, Pironi L, Lal S. A multi-national survey of experience and attitudes towards commencing home parenteral nutrition for patients with advanced cancer. Clin Nutr ESPEN 2022; 47:246-251. [DOI: 10.1016/j.clnesp.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/16/2023]
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Bongelli R, Bertolazzi A, Piccioni L, Burro R. Italian onco-haematological patients' preferences in bad news communication: a preliminary investigation. BMC Cancer 2021; 21:555. [PMID: 34001021 PMCID: PMC8127256 DOI: 10.1186/s12885-021-08181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The manner in which bad news is communicated in oncological contexts can affect patients' engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients' experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. METHODS In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). RESULTS While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients' preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. CONCLUSIONS The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients' preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.
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Affiliation(s)
- Ramona Bongelli
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy.
| | - Alessia Bertolazzi
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Ludovica Piccioni
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Roberto Burro
- Department of Human Sciences, University of Verona, Verona, Italy
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Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care 2021; 11:128-132. [PMID: 33762267 DOI: 10.1136/bmjspcare-2020-002700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 11/04/2022]
Abstract
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed. METHODOLOGY In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation. RESULTS Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution. CONCLUSION Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.
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Affiliation(s)
| | - Jan Illing
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Brand-Gothelf A, Hasson-Ohayon I, Hertz-Palmor N, Basel D, Gothelf D, Karnieli-Miller O. The Delivery of Diagnosis by Child Psychiatrists: Process Characteristics and Correlates of Distress. Front Psychiatry 2021; 12:632207. [PMID: 33828493 PMCID: PMC8019702 DOI: 10.3389/fpsyt.2021.632207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/09/2021] [Indexed: 11/26/2022] Open
Abstract
We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task.
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Affiliation(s)
| | | | - Nimrod Hertz-Palmor
- Sheba Medical Center, Tel Hashomer, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Dana Basel
- Sheba Medical Center, Tel Hashomer, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Tel Hashomer, Israel
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Shali M, Joolaee S, Navab E, Esmaeili M, Nikbakht Nasrabadi A. White lies in pediatric care: a qualitative study from nurses' perspective. J Med Ethics Hist Med 2020; 13:16. [PMID: 33532045 PMCID: PMC7816540 DOI: 10.18502/jmehm.v13i16.4414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
Communication and sharing information with ill children are challenging. To protect a child from the bitter reality, sometimes use of well-intended untruths, or white lies is necessary. This research aimed at studying the experiences of nurses about the use of white lies in in pediatric clinical setting. In this qualitative, content-analysis study, 24 on-duty pediatric nurses were interviewed in 2019. Data were collected through purposeful sampling using semi-structured interviews, and the collected data were analyzed according to Granheim and Landman’s method using MAXQDA-10 software. Eighteen female and six male nurses with the mean age of 42 ± 3/7 years and mean work experience of 16 ± 4/1 years were selected to participate in this study. Data analysis showed that use of white lies depends on both situation and several other factors classified into five general categories: nature of data, childhood characteristics, family norms, treatment team’s capabilities and organization policies. Treatment team members need to improve their communication skills to convey therapeutic information to the ill child’s family appropriately. To do so, special guidelines should be prepared for healthcare staff in pediatric clinical setting.
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Affiliation(s)
- Mahboobeh Shali
- Reseacher, Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Joolaee
- Professor, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran; Researcher, Center for Health Evaluation & Outcome Sciences (CHEOS), University of British Columbia (UBC), Vancouver, BC, Canada
| | - Elham Navab
- Associate Professor, Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Researcher, Nursing Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Associate Professor, Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Dinh Ngoc C. Patients’ Needs In Breaking Bad News For Cancers Diagnosis: Preliminary Result. J Clin Med 2020. [DOI: 10.38103/jcmhch.2020.64.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: How to perform a breaking bad news consultation properly with the present circumstances and especially it fits the local people. The way to deliver bad news to cancer patients was studied and practiced widely in the world. Some studies were conducted in Vietnam but not yet in central Vietnam. The people here are quite different in thinking and personality. Hence, they may need and expect consultation differently. The study was performed to note the needs of patients in the breaking bad news of cancer and to explore their own experience of giving bad news.
Methods: A cross-sectional study was conducted on 44 cancer patients undergoing treatment at the Hue University of Medicine and Pharmacy hospital in July 2020.
Results: Of 44 patients, The age average was 56.73. Male was more prevalent in the study with 61.4%. About 45.5% of patients expected to be explained in a private room and most of them desired to hear the truth at the same time with their family (68.2%), only 4.5% of patients wanted the bad news to be delivered only to their families. One hundred percent of patients preferred their oncologists to explain the bad news. More than 80% of patients wanted you received all at once. Patients were interested in getting information about the diagnosis of cancer, stage of cancer, cost of the treatment, treatment option to be selected and results of clinical studies were less important to them. They mostly wanted the truth to be delivered to them than to the family for most of the information contents given by the researchers.
Conclusions: Patients in the study wanted to know the truth but some information was more important than others according to them. They mostly satisfied with the breaking bad news that has been done.
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Messerotti A, Banchelli F, Ferrari S, Barbieri E, Bettelli F, Bandieri E, Giusti D, Catellani H, Borelli E, Colaci E, Pioli V, Morselli M, Forghieri F, Galeazzi GM, Marasca R, Bigi S, D'Amico R, Martin P, Efficace F, Luppi M, Potenza L. Investigating the association between physicians self-efficacy regarding communication skills and risk of "burnout". Health Qual Life Outcomes 2020; 18:271. [PMID: 32762755 PMCID: PMC7409639 DOI: 10.1186/s12955-020-01504-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breaking bad news (BBN) may be associated with increasing risk of burnout in practising physicians. However, there is little research on the association between the way bad news is broken and burnout. We investigated the association between physicians’ self-efficacy regarding communication to patients and risk of burnout. Methods We performed a cross-sectional study by proposing an ad-hoc survey exploring attitudes and practice regarding BBN and the Maslach Burnout Inventory - Human Service Survey to 379 physicians from two University Hospitals in Italy. Associations were assessed by multivariable logistic regression models. Results Two-hundred twenty-six (60%) physicians returned the questionnaires. 76% of physicians acquired communication skills by observing mentors or colleagues, 64% considered BBN as discussing a poor prognosis, 56% reported discussing prognosis as the most difficult task, 38 and 37% did not plan a BBN encounter and considered it stressful. The overall burnout rate was 59%. Considering BBN a stressful task was independently associated with high risk of burnout (OR 3.01; p = 0.013). Planning the encounter (OR = 0.43, p = 0.037), mastering communication skills (OR = 0.19, p = 0.034) and the self-evaluation as good or very good at BBN (OR 0.32; 0.15 to 0.71; p = 0.0) were associated with low risk of burnout. Conclusions Our findings suggest that some physicians’ BBN attitudes and knowledge of conceptual frameworks may influence the risk of burnout and support the notion that increasing knowledge about communication skills may protect clinicians from burnout. Further research is needed in this area.
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Affiliation(s)
- Andrea Messerotti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Emiliano Barbieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bettelli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bandieri
- Oncology and Palliative Care Units, Civil Hospital Carpi, Local Health Agency, Carpi (Modena), Italy
| | - Davide Giusti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Hillary Catellani
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Borelli
- Department of Biomedic and Metabolic Science and Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Colaci
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Pioli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Morselli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Forghieri
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedic and Metabolic Science and Neuroscience, section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Marasca
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Sarah Bigi
- Department of Linguistic Sciences and Foreign Literatures, Catholic University of the Sacred Heart, Milan, Italy
| | - Roberto D'Amico
- Department of Medical and Surgical Sciencesm, Statistic Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Faculty of Health, Deakin University, Melbourne, Australia
| | - Fabio Efficace
- Italian Group for Adult Hematologic Disease (GIMEMA), Health Outcomes Research Unit, Rome, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Hsu TH, Li IC, Fang CK, Tang WR, Lin CT. A preliminary study of the effectiveness of cancer communication skills training for interdisciplinary staff. Jpn J Clin Oncol 2020; 49:734-742. [PMID: 31063193 DOI: 10.1093/jjco/hyz065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies have emphasized that the disclosure of a diagnosis and prognosis is the doctor's responsibility, but little attention has been given to the importance of interdisciplinary cooperation. OBJECTIVE Therefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan. METHODS This study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated. RESULTS Significant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors' scores for 'disclosing information in a monotonous tone' showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales' scores. CONCLUSION The CST for interdisciplinary professionals improved their cooperation and communication skills.
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Affiliation(s)
- Tsui-Hsia Hsu
- School of Nursing, National Yang-Ming University, Taiwan.,Health Promotion Administration, Ministry of Health and Welfare
| | - I-Chuan Li
- School of Nursing, National Yang-Ming University, Taiwan
| | - Chun-Kai Fang
- Department of Psychiatry and Suicide Prevention Center.,Department of Medicine, Mackay Medical College, New Taipei.,Mackay Memorial Hospital, Taipei.,Taiwan Psycho-Oncology Society
| | - Woung-Ru Tang
- Taiwan Psycho-Oncology Society.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan
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Álvarez-Del-Río A, Ortega-García E, Oñate-Ocaña L, Vargas-Huicochea I. Experience of oncology residents with death: a qualitative study in Mexico. BMC Med Ethics 2019; 20:93. [PMID: 31805925 PMCID: PMC6896685 DOI: 10.1186/s12910-019-0432-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physicians play a fundamental role in the care of patients at the end of life that includes knowing how to accompany patients, alleviate their suffering and inform them about their situation. However, in reality, doctors are part of this society that is reticent to face death and lack the proper education to manage it in their clinical practice. The objective of this study was to explore the residents' concepts of death and related aspects, their reactions and actions in situations pertaining to death in their practice, and their perceptions about existing and necessary training conditions. METHODS A qualitative approach was used to examine these points in depth based on interviews conducted with seven oncology residents. RESULTS Participants do not have a clear concept of death and, although it is seen as a common phenomenon, they consider it an enemy to beat. The situations to which respondents react more frequently with frustration and sadness after the death of patients were when they felt emotionally involved, if they identify with the patient, in cases of pediatric patients and with patients who refuse treatment. To deal with death, participants raise barriers and attempt to become insensitive. Although residents in this study recognize the importance of training to learn how to better deal with death, it seems they are not fully invested in reaching more of it. CONCLUSIONS Participants face death in a daily basis without the necessary training, which appears to impact them more than they are willing to accept. They do not achieve their goals managing situations regarding death as well as they assume they do. Despite recognizing the need of more training and support for better coping with death, they prefer to continue to learn from their experience. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Asunción Álvarez-Del-Río
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Edwin Ortega-García
- Internal Medicine Resident, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Oñate-Ocaña
- Surgical Oncology Consultant, Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Ingrid Vargas-Huicochea
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico. .,Oficina 6 de la Coordinación de Investigación del Departamento de Psiquiatría y Salud Mental, Edificio F de la Facultad de Medicina de la UNAM, Colonia Copilco Universidad, Circuito interior y Cerro del Agua s/n, Ciudad Universitaria, Coyoacán, 04510, Ciudad de México, Mexico.
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Choe EK, Duarte ME, Suh H, Pratt W, Kientz JA. Communicating Bad News: Insights for the Design of Consumer Health Technologies. JMIR Hum Factors 2019; 6:e8885. [PMID: 31102374 PMCID: PMC6543800 DOI: 10.2196/humanfactors.8885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/05/2018] [Accepted: 02/07/2019] [Indexed: 11/25/2022] Open
Abstract
Background As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.
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Affiliation(s)
- Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States
| | - Marisa E Duarte
- School of Social Transformation, Arizona State University, Tempe, AZ, United States
| | - Hyewon Suh
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Julie A Kientz
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
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Affiliation(s)
- Catherine Sweeney
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
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Fainsinger RL, Núñez-Olarte JM, Demoissac DM. The Cultural Differences in Perceived Value of Disclosure and Cognition: Spain and Canada. J Palliat Care 2019. [DOI: 10.1177/082585970301900108] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A previous multicentre international study on sedation at the end of life has detected major differences between Canadian and Spanish patients. This was particularly evident in the need to sedate Spanish patients for psychological/existential distress. This study was designed to explore the hypothesis that marked differences in the value patients and families attach to disclosure and cognition were a factor. The study population included patients referred to two palliative care consulting services based in acute care hospitals in Madrid, Spain (M), and in Edmonton, Canada (E). Questions addressed the issue of clear thinking, pain/nausea-medication-induced somnolence/confusion, anxiety/antidepressant-medication-induced somnolence/confusion, details of diagnosis. One hundred patients were evaluated on each site. Patients and families in E placed a higher value on clear thinking, change in medication causing somnolence/confusion, and wanting full disclosure. Patients and families in E agreed almost 100% of the time, while agreement in M varied from 42% to 67%. These results suggest major differences in the perceived value of clear cognition and disclosure of information between patients and families in E and M. The lack of agreement between patients and families in M is a further significant factor that may complicate communication with patients and families, as well as medical management.
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Affiliation(s)
- Robin L. Fainsinger
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Juan M. Núñez-Olarte
- Unidad de Cuidados Paliativos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Donna M. Demoissac
- Palliative Care Program, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Ghoneim N, Dariya V, Guffey D, Minard CG, Frugé E, Harris LL, Johnson KE, Arnold J. Teaching NICU Fellows How to Relay Difficult News Using a Simulation-Based Curriculum: Does Comfort Lead to Competence? TEACHING AND LEARNING IN MEDICINE 2019; 31:207-221. [PMID: 30428732 DOI: 10.1080/10401334.2018.1490649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PROBLEM Neonatal Intensive Care Unit (NICU) clinicians must frequently relay difficult news to patient families, and the need for formal training for NICU trainees to develop this skill has been established. Although previous studies have shown improved trainee self-efficacy and comfort in handling difficult conversations after formal communication training, it remains unclear whether these interventions lead to improved objectively assessed short-term and long-term performance. INTERVENTION A simulation-based intervention emphasizing the SPIKES protocol for delivery of bad news was implemented for 15 fellows in the 3-year Baylor College of Medicine Neonatal-Perinatal Medicine fellowship program in the 2013-2014 academic year. Simulations involved video-recorded encounters between each fellow and a standardized parent (SP) involving communication of difficult news. Each fellow was evaluated before (preintervention), immediately after (postintervention), and 3-4 months after the intervention (follow-up) with an (a) evaluation of video-recorded sessions by two expert raters blinded to the timing of the encounter (blinded rater evaluation [BRE]), (b) Self-Assessment Questionnaire, (c) Content Test evaluating knowledge of taught concepts, and (d) SP evaluation (SPE). CONTEXT The 1st- and 2nd/3rd-year fellows participated in the study at separate times in the academic year to accommodate their schedules. First-year fellows had had more prior communication training and less NICU clinical experience than the 2nd/3rd-year fellows at the time of their intervention. OUTCOME Although all fellows displayed improved Self-Assessment and Content Test scores at postintervention with retention at the follow-up assessment, the BREs showed no statistically significant improvement in postintervention scores and showed a decline in follow-up scores. First-year fellows had higher BRE postintervention scores than the senior fellows. SPEs showed no difference in scores at all 3 assessment stages. LESSONS LEARNED As previously described in the literature, trainee self-efficacy and knowledge may improve in the short term and long term with a simulation-based curriculum in communication of difficult news. However, these results may be inconsistent with those of objective evaluations by expert raters and standardized parents. The impact of the curriculum may be heightened if it reinforces previously learned skills, but the effect may wane over time if not reinforced frequently with additional formal training or in the clinical setting. The results of this study highlight the importance of objective assessments in evaluating the utility of a simulation-based communication curriculum and the need for longitudinal curricula to promote retention of the concepts and skills being taught.
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Affiliation(s)
- Nada Ghoneim
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Vedanta Dariya
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Danielle Guffey
- b Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine , Houston , Texas , USA
| | - Charles G Minard
- b Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine , Houston , Texas , USA
| | - Ernest Frugé
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Leslie L Harris
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Karen E Johnson
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Jennifer Arnold
- a Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
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Abstract
In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenologi-cal, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.
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20
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Affiliation(s)
- Lucia Craxì
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy.
| | - Vito Di Marco
- Gastroenterolgy and Liver Unit, DiBiMIS, University of Palermo, Palermo, Italy
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Oksüzoğlu B, Abali H, Bakar M, Yildirim N, Zengin N. Disclosure of Cancer Diagnosis to Patients and their Relatives in Turkey: Views of Accompanying Persons and Influential Factors in Reaching those Views. TUMORI JOURNAL 2018; 92:62-6. [PMID: 16683385 DOI: 10.1177/030089160609200110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS AND BACKGROUND In Turkey, it is a common belief that most family members of patients with cancer would not want them to be informed of a diagnosis of cancer. Our aim was to evaluate the attitudes and opinions of people accompanying cancer patients, regarding cancer diagnosis disclosure. METHODS In a cross-sectional study 270 caregivers accompanying cancer patients during outpatient chemotherapy sessions were asked to fill in a questionnaire to determine their opinions regarding whether the diagnosis of cancer should be disclosed to the patients and their relatives or not. Timing of telling the diagnosis and from whom it should be learned were queried as well. Possible influential factors for the answers were analyzed with the chi-square test. RESULTS Of the 270 accompanying persons, 130 (48.2%) said that the patients should be informed of the diagnosis, whereas a greater number (236, 87.4%) believed that the patient's relatives should be informed. Being younger than 40 years old (P = 0.0005), being unmarried (P = 0.002), having a higher educational status (P = 0.0001) and having passed less than four months since the diagnosis (P = 0.005) positively affected opinions regarding telling the truth to the patient. Higher education (P = 0.012) and high monthly income (P = 0.002) positively affected opinions regarding disclosing a diagnosis of cancer to the patient's relatives. CONCLUSION As a result, in a survey of caregivers' points of view, more than half of the accompanying persons did not agree with disclosing a cancer diagnosis to patients, whereas the majority agreed with disclosing it to the relatives, and educational level seemed to be the major influential factor.
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Affiliation(s)
- Berna Oksüzoğlu
- Numune Education and Research Hospital, Department of Medical Oncology, Ankara, Turkey.
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22
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Romito F, Corvasce C, Montanaro R, Mattioli V. Do elderly cancer patients have different care needs compared with younger ones? TUMORI JOURNAL 2018; 97:374-9. [DOI: 10.1177/030089161109700320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The increasingly older population confronts oncologists with an imposing challenge: older cancer patients have specific healthcare needs both independent of and associated with the diagnosis of cancer. The aim of the present study is to examine whether elderly versus younger cancer patients have different needs with respect to attendance, treatment and information. Methods and study design This is an observational and cross-sectional study. Cancer patients aged 35 to 82 years were consecutively interviewed. The group was divided into two subgroups aged ≤65 and ≥66 years old. The Needs Evaluation Questionnaire (NEQ) was used to assess patients' needs and demographic variables were collected. Data analysis was carried out by means of cross-tabulation analyses and the chi-square test. Results The requests most frequently expressed by the older group concerned financial-insurance information (73.9%), the need to talk to people with the same illness (71.7%), the need to receive more comprehensible information from doctors and nurses (71.7%), and the need for a better dialogue with clinicians (69.6%). Few significant differences between the two age subgroups were found, with the exception of issues such as the need for intimacy and support. Conclusions Elderly patients have informational and relational needs similar to those of younger patients. In fact, most of the whole sample flagged up the need for higher levels of satisfaction especially concerning a better dialogue with health staff, along with a new factor: the need to talk to people with the same illness.
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Affiliation(s)
- Francesca Romito
- Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Chiara Corvasce
- Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Rosanna Montanaro
- Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - Vittorio Mattioli
- Experimental Unit of Psychological Oncology, Department of Critical Area and Surgery, National Cancer Institute Giovanni Paolo II, Bari, Italy
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Cavanna L, Anselmi E, Lazzaro A, Seghini P, Di Nunzio C, Dallanegra L, Monfredo M. Cancer Diagnosis Disclosure in a Northern Italian Hospital Report on 312 Consecutive Cancer Patients. TUMORI JOURNAL 2018; 93:290-1. [PMID: 17679466 DOI: 10.1177/030089160709300311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate cancer diagnosis disclosure in a cohort of cancer patients attending an outpatient oncology unit, a prospective observational study was performed. Three hundred twelve consecutive patients were accrued between January and June 2005. A questionnaire was given to each patient; the questions were very simple and related to demographics, residence, sex, educational background, employment status, time elapsed after diagnosis, treatment received, existence of relatives, and health insurance. All patients but one entered the study. There were 185 women and 127 men; 120 patients had breast cancer, 84 colorectal cancer, 34 lung cancer, 28 ovarian cancer, 34 gastric cancer, and 12 pancreatic cancer. Of the total 311 evaluable cancer patients, 171 (54.98%) were correctly informed; of the remaining 140 patients, 67 (21.54%) were not sure, and 73 (23.47%) thought their disease was not cancer. These data suggest that the majority of cancer patients attending our outpatient oncology unit are being correctly informed about their diagnosis. In our series the type of tumor had an important impact on diagnosis disclosure, while age and educational status did not.
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Affiliation(s)
- Luigi Cavanna
- Medical Oncology and Hematology Department, Hospital of Piacenza, Italy.
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Ferraz Gonçalves JA, Almeida C, Amorim J, Baltasar R, Batista J, Borrero Y, Fallé JP, Faria I, Henriques M, Maia H, Fernandes T, Moreira M, Moreira S, Neves C, Ribeiro A, Santos A, Silva F, Soares S, Sousa C, Vicente J, Xavier R. Information of patients with life-threatening diseases: A survey of the attitude of Portuguese family practitioners. Porto Biomed J 2017; 2:250-253. [PMID: 32258778 DOI: 10.1016/j.pbj.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022] Open
Abstract
Highlights The attitudes of family physicians regarding breaking bad news are heterogeneous.Younger doctors seem to see the delivery of bad news more positively.This trend suggests that there will be a more open communication in the future. Background Family practice is the specialty with the highest number of doctors and covers all of Portugal, but, as far as we know, no studies have been carried out on the attitudes and practices of Portuguese family practice doctors about breaking bad news. However, the attitude of these doctors may have a high impact on patients. Objective To study the practice of family physicians on breaking bad news. Methods A questionnaire, specifically developed for this survey, was given to 196 doctors about 10% of the family physicians of Northern Portugal. Results One hundred fifty-nine (81%) of them participated in this study. The median age was 43 (26-64) and 108 (68%) of them were female. One hundred and seven (67%) doctors disclosed on principle the diagnosis and that rate rose to 81% when patients requested the disclosure. One hundred and two (64%) proactively questioned patients about their wish to know the diagnosis and then decided whether to convey it or not. Forty-seven 47 (30%) doctors disclosed the prognosis on principle and that rate rose to 48% when patients requested the disclosure. Seventy-three (46%) often questioned patients proactively about their wish to know the prognosis and then decided whether to convey it or not. One hundred and two (64%) doctors frequently include patients in treatment decisions. Physicians think that the disclosure may affect hope but may also give patients more control of the situation. Conclusion Family practitioners disclose the diagnosis of a chronic life-threatening disease often, especially at patients' request. General practitioners do not disclose the prognosis of a life-threatening disease often, even at patients' request.
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Affiliation(s)
| | - Carla Almeida
- Unidade de Saúde Familiar Famílias, Santa Maria da Feira, Portugal
| | - Joana Amorim
- Unidade de Saúde Familiar Santa Clara, Póvoa de Varzim/Vila do Conde, Portugal
| | - Rita Baltasar
- Unidade de Saúde Familiar Santa Maria, Bragança, Portugal
| | - Joana Batista
- Unidade de Saúde Familiar Terras de Ferreira, Paços de Ferreira, Portugal
| | | | - João Pedro Fallé
- Unidade de Saúde Familiar Lagoa - Senhora da Hora, Matosinhos, Portugal
| | - Igor Faria
- Unidade de Saúde Familiar Gil Eanes, Viana do Castelo, Portugal
| | | | - Helena Maia
- Unidade de Saúde Familiar Porta do Sol, Matosinhos, Portugal
| | | | - Mariana Moreira
- Unidade de Saúde Familiar Mar, Póvoa de Varzim/Vila do Conde, Portugal
| | | | - Camila Neves
- Unidade de Saúde Familiar São Mamede Infesta, Matosinhos, Portugal
| | - Ana Ribeiro
- Unidade de Saúde Familiar Oceanos, Matosinhos, Portugal
| | - Ana Santos
- Unidade de Saúde Familiar São João, Porto, Portugal
| | - Filipa Silva
- Unidade de Saúde Familiar Nova Lousada, Lousada, Portugal
| | - Susana Soares
- Unidade de Saúde Familiar São Martinho, Penafiel, Portugal
| | | | - Joana Vicente
- Unidade de Saúde Familiar Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal
| | - Rita Xavier
- Unidade de Saúde Familiar Aldoar, Porto, Portugal
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Kavas MV. How to Increase the Quality of a Suffering Experience: Lessons Derived From the Diary Narratives of a Dying Adolescent Girl. OMEGA-JOURNAL OF DEATH AND DYING 2017; 76:256-295. [DOI: 10.1177/0030222817694667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Personal narratives are assumed to be primary sources of the essential meaning of lived experiences of dying. In this study, I analyzed the personal diary of Miraç Fidan, a terminally ill adolescent with advanced cancer who kept a diary until her death at the age of 15. Miraç’s Diary, also published as a book, was subjected to hermeneutic phenomenological narrative analysis. Inferences were drawn regarding the following basic elements: (a) The dynamics in which Miraç lived and (2) her perceptions of herself, her immediate environment, and her experiences. Suffering seems to be the main experience dominating Miraç’s life, which I examined with regard to two dimensions: suffering caused by inevitable factors and suffering caused by preventable/changeable factors. The results suggest that if various causes among contextual factors are neutralized, then the quality of the existential experience determined by the inevitable factors would increase.
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Affiliation(s)
- Mustafa Volkan Kavas
- Department of History of Medicine and Ethics, Ankara University Faculty of Medicine, Turkey
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Cristina E, Carlo S, Gabriella D, Mirella P. Factors associated with the decision-making process in palliative sedation therapy. The experience of an Italian hospice struggling with balancing various individual autonomies. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1290307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Endrizzi Cristina
- Hospice Il Gelso, Local Health Alessandria (ASL AL), Via San Pio V, 41, Alessandria, Italy
| | - Senore Carlo
- The Reference Centre for Epidemiology and Cancer Prevention, Regional Hospitals of City of Science and Health “AOU Città della Salute e della Scienza”, Turin, Italy
| | - D’Amico Gabriella
- Hospice Il Gelso, Local Health Alessandria (ASL AL), Via San Pio V, 41, Alessandria, Italy
| | - Palella Mirella
- Hospice Il Gelso, Local Health Alessandria (ASL AL), Via San Pio V, 41, Alessandria, Italy
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Rao A, Ekstrand M, Heylen E, Raju G, Shet A. Breaking Bad News: Patient Preferences and the Role of Family Members when Delivering a Cancer Diagnosis. Asian Pac J Cancer Prev 2017; 17:1779-84. [PMID: 27221852 DOI: 10.7314/apjcp.2016.17.4.1779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Western physicians tend to favour complete disclosure of a cancer diagnosis to the patient, while non-Western physicians tend to limit disclosure and include families in the process; the latter approach is prevalent in clinical oncology practice in India. Few studies, however, have examined patient preferences with respect to disclosure or the role of family members in the process. MATERIALS AND METHODS Structured interviews were conducted with patients (N=127) in the medical oncology clinic of a tertiary referral hospital in Bangalore, India. RESULTS Patients ranged in age from 18-88 (M=52) and were mostly male (59%). Most patients (72%) wanted disclosure of the diagnosis cancer, a preference significantly associated with higher education and English proficiency. A majority wanted their families to be involved in the process. Patients who had wanted and not wanted disclosure differed with respect to their preferences regarding the particulars of disclosure (timing, approach, individuals involved, role of family members). Almost all patients wanted more information concerning their condition, about immediate medical issues such as treatments or side effects, rather than long-term or non-medical issues. CONCLUSIONS While most cancer patients wanted disclosure of their disease, a smaller group wished that their cancer diagnosis had not been disclosed to them. Regardless of this difference in desire for disclosure, both groups sought similar specific information regarding their cancer and largely favoured involvement of close family in decision making. Additional studies evaluating the influence of factors such as disease stage or family relationships could help guide physicians when breaking bad news.
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Affiliation(s)
- Abha Rao
- St. John's Research Institute Medical College Hospital, Bangalore, India E-mail :
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Lanfroy R, Batt M, Verhaegen F, Steffens N, Trognon A, Rivasseau-Jonveaux T, Taillandier L. L’annonce de cancer : fonctions des pronoms « je » pour le dialogue et « nous » pour l’engagement dans une relation incertaine — étude exploratoire. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0595-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- M.A. Kurer
- Department of General Surgery, Colorectal Unit, Hull-York Medical School, York Hospitals NHS Foundation Trust Wigginton Road York
| | - J.M. Zekri
- Department of Medical Oncology, Clatterbridge centre for Oncology, Clatterbridge Road, Bebington, Wirral. UK
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Ni YH, Alræk T. What circumstances lead to non-disclosure of cancer-related information in China? A qualitative study. Support Care Cancer 2016; 25:811-816. [PMID: 27832368 PMCID: PMC5266771 DOI: 10.1007/s00520-016-3464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Withholding information from cancer patients is a common practice in many Asian countries, including China, Japan, and Singapore, as well as in some Western countries, such as Spain, Greece, and Italy. Much research has investigated why doctors withhold information from cancer patients generally, both in the West and the East, but little research has been done on specifically why Chinese doctors withhold such information. METHODS Three focus group interviews were conducted with a total of 16 oncologists in China. The interviews were recorded, transcribed, and translated. Qualitative data were analyzed using systematic text condensation. RESULTS The result of this study revealed numerous circumstances that can lead to non-disclosure of cancer-related information. Many of these circumstances have been described in previous studies about non-disclosure in other countries. We found two additional circumstances that have not been described in previous literature and might therefore expand our current knowledge about this phenomenon; they are contradiction between laws and fear for personal safety. CONCLUSION Numerous circumstances can lead to non-disclosure of cancer-related information. This study found two additional circumstances that might lead to non-disclosure. The findings of this study suggest further assessment and clarification about the laws that govern doctor-patient communication and that action should be taken to ensure safe working environments for Chinese oncologists.
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Affiliation(s)
- Yi Hu Ni
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Kalfarveien 31, 5020, Bergen, Norway.
| | - Terje Alræk
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Institute of Health Sciences, Kristiania University College, PB 1190 Sentrum, 0107, Oslo, Norway
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Luff D, Martin EB, Mills K, Mazzola NM, Bell SK, Meyer EC. Clinicians' strategies for managing their emotions during difficult healthcare conversations. PATIENT EDUCATION AND COUNSELING 2016; 99:1461-1466. [PMID: 27423178 DOI: 10.1016/j.pec.2016.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To examine strategies employed by clinicians from different disciplines to manage their emotions during difficult healthcare conversations. METHODS Self-report questionnaires were collected prior to simulation-based Program to Enhance Relational and Communication Skills (PERCS) workshops for professionals representing a range of experience and specialties at a tertiary pediatric hospital. In response to an open-ended prompt, clinicians qualitatively described their own strategies for managing their emotions during difficult healthcare conversations. RESULTS 126 respondents reported emotion management strategies. Respondents included physicians (42%), nurses (29%), medical interpreters (16%), psychosocial professionals (9%), and other (4%). Respondents identified 1-4 strategies. Five strategy categories were identified: Self-Care (51%), Preparatory and Relational Skills, (29%), Empathic Presence (28%), Team Approach (26%), and Professional Identity (20%). CONCLUSIONS Across disciplines and experience levels, clinicians have developed strategies to manage their emotions when holding difficult healthcare conversations. These strategies support clinicians before, during and after difficult conversations. PRACTICE IMPLICATIONS Understanding what strategies clinicians already employ to manage their emotions when holding difficult conversations has implications for educational planning and implementation. This study has potential to inform the development of education to support clinicians' awareness of their emotions and to enhance the range and effectiveness of emotion management during difficult healthcare conversations.
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Affiliation(s)
- Donna Luff
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Anesthesia, Harvard Medical School, Boston, USA.
| | - Elliott B Martin
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Psychiatry, Newton-Wellesley Hospital/Tufts University School of Medicine, Newton, USA
| | - Kelsey Mills
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Simmons College, 300 The Fenway, Boston, USA
| | - Natalia M Mazzola
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; FernUniversität in Hagen, Institut für Psychologie, Hagen, Germany
| | - Sigall K Bell
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Elaine C Meyer
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Psychiatry, Harvard Medical School, Boston, USA
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Huang B, Chen H, Deng Y, Yi T, Wang Y, Jiang Y. Diagnosis, disease stage, and distress of Chinese cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:73. [PMID: 27004220 DOI: 10.3978/j.issn.2305-5839.2016.02.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective is to assess how cancer patients know about their diagnosis what they know about their real stage, and the relationship between cancer stage and psychological distress. METHODS A questionnaire including the Distress Thermometer was delivered to 422 cancer inpatients. Multivariate logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Most of patients (68.7%) knew the bad news immediately after diagnosis. Half of patients knew their diagnosis directly from medical reports. Nearly one third of patients were informed by doctors. Cancer stages, which patients believed, differed significantly from their real disease stages (P<0.001). Over half of patients did not know their real disease stages. Patients with stage I-III cancer were more likely to know their real disease stage than patients with stage IV cancer (P<0.001). Distress scores of cancer patients were determined by the real cancer stage (P=0.012), not the stage which patients believed. CONCLUSIONS Although most of participants knew the bad news immediately after diagnosis, less than half of them knew their real disease stage. Patient with stage I-III cancer was more likely to know the real disease stage and had a DT score <4 than patient with stage IV disease.
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Affiliation(s)
- Boyan Huang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Huiping Chen
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yaotiao Deng
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Tingwu Yi
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yuqing Wang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Jiang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Martin EB, Mazzola NM, Brandano J, Luff D, Zurakowski D, Meyer EC. Clinicians' recognition and management of emotions during difficult healthcare conversations. PATIENT EDUCATION AND COUNSELING 2015; 98:1248-1254. [PMID: 26277283 DOI: 10.1016/j.pec.2015.07.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. METHODS Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. RESULTS 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. CONCLUSIONS Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. PRACTICE IMPLICATIONS Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed.
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Affiliation(s)
- Elliott B Martin
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Natalia M Mazzola
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Jessica Brandano
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Donna Luff
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - David Zurakowski
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
| | - Elaine C Meyer
- The Institute for Professionalism and Ethical Practice, Boston Children's Hospital at Waltham, 9 Hope Avenue, Waltham, MA 02453, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
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Sun W, Wang Z, Fang S, Li M. Factors influencing the attitudes of Chinese cancer patients and their families toward the disclosure of a cancer diagnosis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:20-25. [PMID: 24931287 DOI: 10.1007/s13187-014-0687-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The disclosure of a cancer diagnosis to patients has been a core topic in oncology departments. Previous studies have demonstrated that Chinese cancer patients and their families differ in their attitudes toward cancer diagnosis disclosure. However, the influencing factors regarding their different attitudes remain unknown. In the present study, a questionnaire was delivered to 266 cancer patients and 266 matched family members. The results showed that cancer patients were more likely to desire to be informed of their condition than family members (85 vs. 18%, P < 0.01). The patients' age had a significant influence on their attitudes (P < 0.01), while the family members' gender, profession, educational level, and their relationship with the patients could significantly affect their attitudes (all P < 0.05). Further multivariate analyses indicated that a family member's gender (odds ratio (OR) = 2.928, 95% confidence interval (CI) 1.379-6.213, P = 0.005), profession (OR = 2.814, 95% CI 1.548-5.119, P = 0.001), and educational level (OR = 0.105, 95% CI 0.053-0.211, P < 0.001) remained significant variables. Due to a lower educational level, only 74% of families knew about chemotherapy, and 90% of families were not familiar with molecular targeted therapy. However, 78% of patients expected to be cured of their cancer, 16.5% expected to reduce the severity of their condition, and 4.9% expected to lengthen their lives. Therefore, physicians have a responsibility to appropriately provide knowledge regarding cancer to the patients' families if their educational level is lower and if they have no knowledge of recent treatments, which may improve their acceptability of a cancer diagnosis for patients.
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Affiliation(s)
- Wenwen Sun
- Department of Oncology, Shandong Cancer Hospital, No.440 Jiyan Road, Jinan, Shandong, 250117, People's Republic of China
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Costantini A, Grassi L, Picardi A, Brunetti S, Caruso R, Nanni MG, Bonetti L, de Feudis R, Barni S, Marchetti P. Awareness of cancer, satisfaction with care, emotional distress, and adjustment to illness: an Italian multicenter study. Psychooncology 2015; 24:1088-96. [DOI: 10.1002/pon.3768] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Anna Costantini
- Psycho-Oncology Departmental Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance, and Health Promotion; Italian National Institute of Health; Rome Italy
| | - Serena Brunetti
- Psycho-Oncology Departmental Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit, Psycho-Oncology and Psychiatry in Palliative Care Program; Department of Mental Health; Ferrara Italy
| | - Luisa Bonetti
- Psycho-Oncology Service; Azienda Ospedaliera Treviglio; Treviglio Italy
| | - Rossana de Feudis
- Clinical Psychology Unit, Medical Oncology Unit; San Paolo Hospital; Bari Italy
| | - Sandro Barni
- Division of Medical Oncology; Azienda Ospedaliera Treviglio; Treviglio Italy
| | - Paolo Marchetti
- Unit of Medical Oncology, Sant'Andrea Hospital, Faculty of Medicine and Psychology; La Sapienza University of Rome; Rome Italy
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Abstract
Cancer stigma has undergone an important transformation in recent decades. In general, this disease no longer fits squarely into Goffman’s classic taxonomy of stigmatized conditions. This review will demonstrate that, with important adaptations, an identity-threat model of stigma can be used to organize cancer stigma research post-Goffman. This adapted model postulates that one’s personal attributions, responses to situational threat, and disease/treatment characteristics can be used to predict identity threat and well-being of individuals with cancer. Implications for further research and clinical practice are discussed.
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Abdulla S, Vielhaber S, Machts J, Heinze HJ, Dengler R, Petri S. Information needs and information-seeking preferences of ALS patients and their carers. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:505-12. [PMID: 25007829 DOI: 10.3109/21678421.2014.932385] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to investigate information-seeking behaviour in patients with ALS and their caregivers and their rating of the usefulness of different information sources in Germany. Surveys were made on 106 patients and 100 caregivers in two university ALS outpatient clinics. Before seeing a doctor, 28% of patients and 23% of caregivers had used other sources to find symptom related information, mostly the internet. Although two-thirds were satisfied with the means of diagnosis disclosure, 88% of patients and 85% of caregivers searched for additional information, most often the internet (patients 72%, caregivers 85%), followed by patient brochures (patients 58%, caregivers 66%). Internet, patient brochures and the 'German Neuromuscular Disease Society' were rated most frequently as useful/very useful. Traditional print media and interpersonal contacts were also frequently used and most respondents relied on more than one source for information. Only few respondents used the internet for exchange with other patients. Two-thirds wanted to discuss web contents with their physician. In conclusion, patients with ALS and their caregivers clearly have additional information needs. Besides traditional information sources, the internet is frequently used. Therefore, reliable and useful websites should be provided. Patients' and caregivers' need to discuss their findings with the physician should be acknowledged.
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Affiliation(s)
- Susanne Abdulla
- Department of Neurology, Otto-von-Guericke University Magdeburg , Germany
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Tanzi S, Biasco G, Baile WF. Enhancing the Empathic Connection: Using Action Methods to Understand Conflicts in End-of-Life Care. J Patient Exp 2014; 1:14-19. [PMID: 28725796 DOI: 10.1177/237437431400100104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Empathy is a core feature of patient-centered care. It enables practitioners to better understand the patient and family concerns that are key to patient and family satisfaction, prevention of anxiety and depression, and provider empowerment. Current methods of teaching communication skills do not specifically focus on enhancing the ability to "stand in the patient's shoes" as a way of connecting with the patient and/or family experience and understanding feelings that may be a source of conflict with providers. In this paper, we present a model for deepening empathic understanding based upon action methods (role-reversal and doubling) derived from psychodrama and sociodrama. We describe these techniques and illustrate how they can be used to identify hidden emotions and attitudes and reveal that which the patient and family member may be thinking or feeling but be afraid to say. Finally, we present data showing that these methods were valuable to participants in enhancing their professional experience and skills.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Guido Biasco
- Academy of Sciences of Palliative Medicine, Bentivoglio, Bologna, Italy
| | - Walter F Baile
- Departments of Behavioral Science and Faculty and Academic Development, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Evans N, Costantini M, Pasman HR, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, Deliens L, Onwuteaka-Philipsen B. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries. J Pain Symptom Manage 2014; 47:604-619.e3. [PMID: 23932176 DOI: 10.1016/j.jpainsymman.2013.04.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/22/2013] [Accepted: 05/02/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Effective communication is central to high-quality end-of-life care. OBJECTIVES This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. METHODS This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. RESULTS In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. CONCLUSION The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases.
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Affiliation(s)
- Natalie Evans
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Massimo Costantini
- Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy
| | - H R Pasman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Gé A Donker
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | | | - Milagros Gil
- Public Health Directorate, Ministry of Health, Castille and León, Spain
| | - Nicole Boffin
- Scientific Institute of Public Health, Brussels, Belgium
| | - Oscar Zurriaga
- Public Health and Research General Directorate, Valencian Regional Health Administration, Valencia, Spain; Higher Public Health Research Centre, Valencia, Madrid, Spain; Spanish Consortium for Research on Epidemiology and Public Health, Madrid, Spain
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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Cancer in the elderly: is it time for palliative care in geriatric oncology? J Geriatr Oncol 2014; 5:197-203. [PMID: 24560041 DOI: 10.1016/j.jgo.2014.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/26/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Persons aged 65 and over are the fastest growing segment of the population in most Western countries. Although cancer-related death occurs far more commonly in older people than in any age group, studies on palliative care in older adults are lacking. OBJECTIVE This paper aims at evaluating the needs in elderly patients affected by cancer and the state of the art of the research in palliative care in this setting. MATERIALS AND METHODS A literature search was performed (PubMed) to identify relevant studies. Papers were reviewed for relevance to palliative care in the elderly. RESULTS Elderly who need palliative care are frequently disregarded as individuals and may experience discrimination because of their age. Palliative care for older patients relates particularly to multiple treatments for various conditions. This causes extra complexities for the researchers. CONCLUSIONS The aim of the study was not fully achieved due to the paucity of literature focusing upon these issues. The areas of investigation that need to be addressed comprise: establishing the prevailing symptoms in elderly patients, understanding patients' psychological/spiritual well-being and quality of life and elucidating the sources of caregiver burden, adapting research methodologies specifically for palliative care and comparing the needs and the outcomes of this age group to younger patients.
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Ethical, Socioeconomic, and Cultural Considerations in Gynecologic Cancer Care in Developing Countries. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/141627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gynaecologic cancers contribute significantly to the cancer burden in developing countries, resulting in higher mortality and morbidity rates among women in these nations. This situation is further compounded by the occurrence of wars, famine, poverty and natural disasters, and infectious diseases like hepatitis B and HIV/AIDS. In addition, merge resources and manpower lack in these countries further compound this very delicate situation. Often times, socioeconomic, cultural, and ethical factors such as truth-telling, choice of place of care, place of death, treatment choices, medication use, and terminal sedation can interfere in patient management. Availability and use of oral morphine for pain relief, spiritual care and availability of palliative care services, the individuals’ autonomy, and family and community participation in care, end of life issues, and preservation of fertility are also big issues that determine the course of care. This review discusses these pertinent factors, discusses how they affect cancer care in women, and proffers ideas for healthcare workers and policy makers on implementation of sustainable models for cancer care in developing countries. Addressing socioeconomic, cultural, and ethical issues affecting gynaecologic cancer care will aid in ensuring development of viable models of cancer care in resource-limited countries.
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Sarafis P, Tsounis A, Malliarou M, Lahana E. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Glob J Health Sci 2013; 6:128-37. [PMID: 24576372 PMCID: PMC4825228 DOI: 10.5539/gjhs.v6n2p128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. AIMS Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. METHOD Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. RESULTS There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.
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Affiliation(s)
- Pavlos Sarafis
- Faculty of Nursing, Technological Educational Institute of Sterea Ellada.
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44
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Budkaew J, Chumworathayi B. Knowledge and Attitudes toward Palliative Terminal Cancer Care among Thai Generalists. Asian Pac J Cancer Prev 2013; 14:6173-80. [DOI: 10.7314/apjcp.2013.14.10.6173] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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45
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Álvarez-Del-Río A, Marván ML, Santillán-Doherty P, Delgadillo S, Oñate-Ocaña LF. Facing Death in Clinical Practice: A View from Physicians in Mexico. Arch Med Res 2013; 44:394-400. [PMID: 23867786 DOI: 10.1016/j.arcmed.2013.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/17/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Asunción Álvarez-Del-Río
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México D.F., Mexico.
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Martis L, Westhues A. A synthesis of the literature on breaking bad news or truth telling: potential for research in India. Indian J Palliat Care 2013; 19:2-11. [PMID: 23766589 PMCID: PMC3680834 DOI: 10.4103/0973-1075.110215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The high incidence of fatal diseases, inequitable access to health care, and socioeconomic disparities in India generate plentiful clinical bad news including diagnosis of a life-limiting disease, poor prognosis, treatment failure, and impending death. These contexts compel health care professionals to become the messengers of bad news to patients and their families. In global literature on breaking bad news, there is very little about such complex clinical interactions occurring in India or guiding health care providers to do it well. The purpose of this article is to identify the issues for future research that would contribute to the volume, comprehensiveness, and quality of empirical literature on breaking bad news in clinical settings across India. Towards this end, we have synthesized the studies done across the globe on breaking bad news, under four themes: (a) deciding the amount of bad news to deliver; (b) attending to cultural and ethical issues; (c) managing psychological distress; and (d) producing competent messengers of bad news. We believe that robust research is inevitable to build an indigenous knowledge base, enhance communicative competence among health care professionals, and thereby to improve the quality of clinical interactions in India.
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Affiliation(s)
- Lawrence Martis
- Social Aetiology of Mental Illness - CIHR Postdoctoral Fellow, Centre for Addiction and Mental Health, 455 Spadina Avenue, Toronto, Ontario, M5S 2G8, Canada
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Nwankwo KC, Anarado AN, Ezeome ER. Attitudes of cancer patients in a university teaching hospital in southeast Nigeria on disclosure of cancer information. Psychooncology 2012; 22:1829-33. [DOI: 10.1002/pon.3220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/01/2012] [Accepted: 10/11/2012] [Indexed: 11/05/2022]
Affiliation(s)
- K. C. Nwankwo
- Radiation Oncology Unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - Agnes N. Anarado
- Oncology Nursing unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - E. R. Ezeome
- Surgical Oncology unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
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48
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Tang WR, Fang JT, Fang CK, Fujimori M. Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice. Psychooncology 2012; 22:1605-10. [PMID: 22962020 DOI: 10.1002/pon.3174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/01/2012] [Accepted: 08/16/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. METHODS The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. RESULTS Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p<0.001), and the means for these parameters had a moderate difference, especially in three aspects: method, emotional support, and providing additional information (p<0.001). Regardless of this difference, students were satisfied with the truth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19). CONCLUSIONS To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice.
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Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Fritzsche K, Scheib P, Ko N, Wirsching M, Kuhnert A, Hick J, Schüßler G, Wu W, Yuan S, Cat NH, Vongphrachanh S, Linh NT, Viet NK. Results of a psychosomatic training program in China, Vietnam and Laos: successful cross-cultural transfer of a postgraduate training program for medical doctors. Biopsychosoc Med 2012; 6:17. [PMID: 22929520 PMCID: PMC3546304 DOI: 10.1186/1751-0759-6-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 08/24/2012] [Indexed: 11/16/2022] Open
Abstract
Background With the “ASIA-LINK” program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context. Methods The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers. Results Regional training centers were formed in China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of “breaking bad news,” the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice. Conclusions The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.
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Affiliation(s)
- Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany.
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Locatelli C, Piselli P, Cicerchia M, Repetto L. Physicians' age and sex influence breaking bad news to elderly cancer patients. Beliefs and practices of 50 Italian oncologists: the G.I.O.Ger study. Psychooncology 2012; 22:1112-9. [DOI: 10.1002/pon.3110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/07/2022]
Affiliation(s)
| | - P. Piselli
- Department of Epidemiology; INMI “L. Spallanzani”; Rome; Italy
| | | | - L. Repetto
- UOC Oncology; Borea Hospital, Sanremo (IM); Italy
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