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Yousuf AAAA, Stewart DC, Kane T, Soltani A, Al-Khal A, Sethi A. Health professionals' views and experiences of breaking bad news in the Eastern Mediterranean Region: a scoping review. Front Med (Lausanne) 2024; 11:1440867. [PMID: 39290389 PMCID: PMC11407430 DOI: 10.3389/fmed.2024.1440867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Breaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization's (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals' experiences in delivering bad news within the WHO's Eastern Mediterranean Region. Methods This scoping review was conducted according to the Joanna Brigg Institute's scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to "breaking bad news" and "health professionals" was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO's Eastern Mediterranean Region. Results Out of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants. Conclusion The scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO's Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.
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Affiliation(s)
| | | | - Tanya Kane
- QU Health, Qatar University, Doha, Qatar
| | | | - Abdullatif Al-Khal
- QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
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Dronia MC, Dillen K, Elsner F, Schallenburger M, Neukirchen M, Hagemeier A, Hamacher S, Doll A, Voltz R, Golla H. Palliative care education and knowledge transfer into practice - a multicenter survey among medical students and resident physicians in Germany using a mixed-methods design. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc27. [PMID: 39131897 PMCID: PMC11310786 DOI: 10.3205/zma001682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 08/13/2024]
Abstract
Objective In 2009, Palliative care was incorporated into the medical curriculum as Cross-Sectional Subject 13 (QB13) by means of the revision of the Medical Licensing Regulations for Physicians. The aim of this study was to determine the strengths and deficits of QB13 student education for palliative care in clinical practice in a multi-centre setting and to identify potential for improvement. Methods Online questionnaires filled out by medical students during their Practical Year (PY) and resident physicians from the university hospitals in Aachen, Düsseldorf, and Cologne were descriptively analyzed using SPSS; free-text responses were categorized and quantified. Semi-structured interviews with the resident physicians (using a mixed-methods design) were analyzed through content analysis. Emerging categories were quantified. Results Analysis of 130 fully completed questionnaires and 23 interviews revealed that participants particularly benefited from patient- and practice-oriented small-group sessions for their clinical work. Despite some university-specific differences, the PY students identified a need for training in end-of-life-care, while resident physicians saw a need for training primarily in dealing with patients and their relatives. They also reported deficits in transferability. Conclusion QB13 should be organised in cross-university curricula and provide sufficient resources for practical-oriented small-group teaching. Based on the "unit of care", besides caring for palliative patients, dealing with patients' families should also be an education focus. To improve transferability into clinical practice, students should be actively involved in the care of palliative patients.
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Affiliation(s)
- Marie-Christin Dronia
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Kim Dillen
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Frank Elsner
- RWTH Aachen University, Medical Faculty, Clinic for Palliative Medicine, Aachen, Germany
| | - Manuela Schallenburger
- Heinrich-Heine University Düsseldorf, Medical Faculty, Interdisciplinary Centre for Palliative Medicine, Düsseldorf, Germany
- University Hospital Düsseldorf, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Martin Neukirchen
- Heinrich-Heine University Düsseldorf, Medical Faculty, Interdisciplinary Centre for Palliative Medicine, Düsseldorf, Germany
- University Hospital Düsseldorf, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
- Heinrich-Heine University Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Department of Anaesthesiology, Düsseldorf, Germany
| | - Anna Hagemeier
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital Cologne, Institute for Medical Statistics and Bioinformatics, Cologne, Germany
| | - Stefanie Hamacher
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital Cologne, Institute for Medical Statistics and Bioinformatics, Cologne, Germany
| | - Axel Doll
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
| | - Raymond Voltz
- University of Cologne, Faculty of Medicine, Cologne, Germany
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
- University Hospital, Centre for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Cologne, Germany
- University Hospital, Centre for Health Services Research Cologne (ZVFK), Cologne, Germany
| | - Heidrun Golla
- University Hospital, Centre for Palliative Medicine, Cologne, Germany
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Koch M, Seifart C. Rethinking parameters of "success" in breaking bad news conversations from patient's perspective: the successful delivery process model. Support Care Cancer 2024; 32:181. [PMID: 38386098 PMCID: PMC10884081 DOI: 10.1007/s00520-024-08354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Studies that focus on improving the difficult process of breaking bad news in oncology should include the patient perspective and be guided by appropriate outcome measures. Endpoints such as "patient satisfaction" fall short to capture the complex nature of breaking bad news (BBN) conversations. However, this is true of many studies. The present study attempts to develop a framework model from a new, patient-centered perspective, which can be applied equally in clinical practice and in education. METHODS Semi-structured in-depth interviews with twelve cancer patients were conducted. Transcripts were analyzed by "qualitative content analysis" following Mayring. Outcomes were further extrapolated in interpretational steps, and a model of "success" from patients view in BBN was developed. RESULTS Two central needs of the patients could be identified: understanding and feelings. Their fulfillment depends on two groups of variables: first, structural characteristics, such as the inevitable shock, individuality, and processability; second, strongly influenceable variables, such as relationship, transfer of knowledge, and atmosphere. From these results, a framework model for successful breaking of bad news from the patient's perspective was developed: The successful delivery process model (SDP model). CONCLUSION As a basic model for the framework for breaking bad news from the patient's perspective, the SDP model can be applied to many different situations in oncology and help to frame the difficult conversations by tailoring the BBN conversations on determinants that favorably influence the process in a patient centered manner. In this sense, the model can be useful in clinical practice as well as in education.
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Affiliation(s)
- Martin Koch
- Clinic for Internal Medicine I, University Hospital, Technical University, Dresden, Germany
| | - Carola Seifart
- Research Group Ethics in Medicine, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.
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Andersen IC, Siersma V, Marsaa K, Preisel N, Høegholm A, Brodersen J, Bodtger U. Is it okay to choose to receive bad news by telephone? An observational study on psychosocial consequences of diagnostic workup for lung cancer suspicion. Acta Oncol 2022; 61:1446-1453. [PMID: 36394954 DOI: 10.1080/0284186x.2022.2143280] [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: 11/18/2022]
Abstract
BACKGROUND In-person meeting is considered the gold standard in current communication protocols regarding sensitive information, yet one size may not fit all, and patients increasingly demand or are offered disclosure of bad news by, e.g., telephone. It is unknown how patients' active preference for communication modality affect psychosocial consequences of receiving potentially bad news. AIM To explore psychosocial consequences in patients, who themselves chose to have results of lung cancer workup delivered either in-person or by telephone compared with patients randomly assigned to either delivery in a recently published randomised controlled trial (RCT). METHODS An observational study prospectively including patients referred for invasive workup for suspected lung cancer stratified in those declining (Patient's Own Choice, POC group) and those participating in the RCT. On the day of invasive workup and five weeks later, patients completed a validated, nine-dimension, condition-specific questionnaire, Consequences of Screening in Lung Cancer (COS-LC). Primary outcome: difference in change in COS-LC dimensions between POC and RCT groups. RESULTS In total, 151 patients were included in the POC group versus 255 in the RCT. Most (70%) in the POC group chose to have results by telephone. Baseline characteristics and diagnostic outcomes were comparable between POC and RCT groups, and in telephone and in-person subgroups too. We observed no statistically significant between-groups differences in any COS-LC score between POC and RCT groups, or between telephone and in-person subgroups in the POC group. CONCLUSION Continually informed patients' choice between in-person or telephone disclosure of results of lung cancer workup is not associated with differences in psychosocial outcomes. The present article supports further use of a simple model for how to prepare the patient for potential bad news.
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Affiliation(s)
- Ingrid C Andersen
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Naestved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Volkert Siersma
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Nikolaj Preisel
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark
| | - John Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The Primary Health Care Research Unit, Region Zealand, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Poei DM, Tang MN, Kwong KM, Sakai DH, Choi SY, Chen JJ. Increasing Medical Students' Confidence in Delivering Bad News Using Different Teaching Modalities. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:302-308. [PMID: 36381258 PMCID: PMC9647369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Opportunities to learn how to deliver bad news and practice this important skill are limited in most medical school programs. To address this gap, an integrated curriculum was created for first-year medical students at the University of Hawai'i John A. Burns School of Medicine that used a problem-based learning case, a didactic session, and a simulated patient experience to teach students how to deliver bad news using the 6-step SPIKES protocol. Students' competency was evaluated using a video-recorded simulated patient encounter. Students also completed a post-experience questionnaire to assess their confidence in delivering bad news before and after the simulation as well as the perceived benefit of different teaching modalities. A sample of 60 students completed an average of 16/17 (94%) tasks on the 17-item SPIKES checklist. Students' confidence in delivering bad news improved from 32% to 91%, before and after the educational experience. The majority of students agreed or strongly agreed that the simulated patient encounter helped them learn how to deliver bad news (96%), felt that the presentation prepared them to deliver bad news (87%), and expressed desire to have more simulated patient experiences in the future (87%). Overall, this curricular improvement project showed that students had a positive perception of the different teaching modalities, increased confidence at delivering bad news following the simulated patient encounter, and a preference for more simulated patient encounters linked to problem-based learning cases in the future.
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Affiliation(s)
- Darin M. Poei
- Department of Medical Education, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Maluikeau N. Tang
- Department of Medical Education, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Kelsey M. Kwong
- Department of Medical Education, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Damon H. Sakai
- Department of Medical Education, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - So Yung Choi
- Department of Medical Education, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Bodtger U, Marsaa K, Siersma V, Bang CW, Høegholm A, Brodersen J. Breaking potentially bad news of cancer workup to well-informed patients by telephone versus in-person: A randomised controlled trial on psychosocial consequences. Eur J Cancer Care (Engl) 2021; 30:e13435. [PMID: 33989444 DOI: 10.1111/ecc.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of telephone in delivering cancer care increases, but not in cancer workup. Current protocols for breaking bad news assume a single in-person meeting. Cancer workup involves multiple opportunities for patient information. We investigated the psychosocial consequences in gradually informed patients of receiving lung cancer workup results by telephone versus in-person. METHODS A randomised, controlled, open-label, assessor-blinded, single-centre trial including patients referred for invasive workup for suspected malignancy (clinical trials no. NCT04315207). Patients were informed on probable cancer at referral, after imaging, and on the day of invasive workup (Baseline visit). Primary endpoint: change (Δ) from baseline to follow-up (4 weeks after receiving workup results) in scores of a validated, sensitive, condition-specific questionnaire (COS-LC) assessing consequences on anxiety, behaviour, dejection and sleep. RESULTS Of 492 eligible patients, we randomised 255 patients (mean age: 68 years; female: 38%; malignancy diagnosed: 68%) to the telephone (n = 129) or in-person (n = 126) group. Groups were comparable at baseline and follow-up, and no between-groups difference in ΔCOS-LC was observed in the intention-to-treat population, or in subgroups diagnosed with or without malignancy. CONCLUSION Breaking final result of cancer workup by telephone is not associated with adverse psychosocial consequences compared to in-person conversation in well-informed patients.
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Affiliation(s)
- Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense M, Denmark.,Department of Respiratory Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Kristoffer Marsaa
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark.,Palliative Unit, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Christine Winther Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Zealand University Hospital Naestved, Naestved, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Pieters HC, Green E, Sleven M. "It Just Hit Me Like a Ton of Bricks": Improving the Patient Experience of Receiving a Breast Cancer Diagnosis at an Older Age. Res Gerontol Nurs 2021; 14:79-89. [PMID: 33492403 DOI: 10.3928/19404921-20210115-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to describe the experiences of older women receiving a diagnosis of early-stage breast cancer. Thematic analysis informed by techniques from constructivist grounded theory was used to analyze interviews with 54 women aged ≥65 years an average of 19.6 months after diagnosis. Two themes were identified: The Overwhelming Shock of Receiving a Diagnosis and Contextualizing the Diagnosis in Relation to Age. Results suggest these participants were deeply shocked by a diagnosis that clinicians may view as highly treatable. Age-related factors impacting how the bad news was received include misunderstanding risk factors, the impact of comorbidities, concurrent life events, and evolving perceptions of cancer at her life stage. To establish a solid foundation for age-appropriate communication when giving bad news, these participants help clinicians acknowledge what women may be thinking. Potential clinician responses to the variety of concerns are presented. [Research in Gerontological Nursing, 14(2), 79-89.].
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Harrison Dening K, Scates C, McGill G, De-Vries K. A training needs analysis of admiral nurses to facilitate advance care planning in dementia. Palliat Care 2019; 12:1178224219850183. [PMID: 31258328 PMCID: PMC6585248 DOI: 10.1177/1178224219850183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
Education of health and social care professionals is essential in preparation to confidently and effectively support families affected by dementia to undertake advance care planning. This article describes a training needs analysis of Admiral Nurses, dementia specialists, in facilitating advance care planning for future care. METHODS A questionnaire survey was completed by Admiral Nurses attending end-of-life care masterclasses in 2017 and 2018. Both quantitative (years registered as a nurse, years as an Admiral Nurse and subjective level of confidence in completing advance care plannings) and qualitative data (interventions perceived to increase confidence) were collected. FINDINGS There were 75 completed responses (two incomplete returns). There was no correlation between levels of confidence and years registered as a nurse. However, there was a small positive correlation between confidence and number of years as an Admiral Nurse (r = 0.23; p < 0.05). Themes identified qualitatively to enhance practice were advanced communication skills, supervised practice, resources to frame conversations and a guide and template for advance care planning. CONCLUSION Although Admiral Nurses are specialists in dementia, several educational initiatives could be employed to better enable them to support advance care planning for families affected by dementia. This training needs analysis is contributed towards developing an educational intervention for Admiral Nurses to improve advance care planning support.
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Affiliation(s)
- Karen Harrison Dening
- Dementia UK, London, UK; Faculty of Health and Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | | | | | - Kay De-Vries
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, De Montfort University, Leicester, UK
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Sanson-Fisher R, Hobden B, Carey M, Mackenzie L, Hyde L, Shepherd J. Interactional skills training in undergraduate medical education: ten principles for guiding future research. BMC MEDICAL EDUCATION 2019; 19:144. [PMID: 31092235 PMCID: PMC6521390 DOI: 10.1186/s12909-019-1566-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/22/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND High-quality healthcare requires practitioners who have technical competence and communication skills. Medical practitioners need interpersonal skills for gathering and transferring information to their patients, in addition to general consultation skills. Appropriate information gathering increases the likelihood of an accurate diagnosis. Transferring information should be performed in a way that promotes patient understanding and increases the probability of adherence to physician recommendations. This applies to: (i) primary prevention such as smoking cessation; (ii) secondary prevention including preparation for potentially threatening interventions; and (iii) tertiary care, including breaking bad news regarding treatment and prognosis. DISCUSSION This debate paper delineates factors associated with undergraduate medical communication skills training where robust research is needed. Ten key principles are presented and discussed, which are intended to guide future research in this field and ensure high quality studies with methodological rigour are conducted. The literature on communication skills training for medical school undergraduates continues to grow. A considerable portion of this output is represented by commentaries, descriptive studies or poorly designed interventions. As with any field of healthcare, quality research interventions are required to ensure practice is grounded in high-level evidence.
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Affiliation(s)
- Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Lisa Hyde
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Level 4 West, HRMI Building, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia
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Communication skills training for healthcare professionals in oncology over the past decade: a systematic review of reviews. Curr Opin Support Palliat Care 2019; 13:33-45. [DOI: 10.1097/spc.0000000000000409] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lelorain S, Cortot A, Christophe V, Pinçon C, Gidron Y. Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial. J Clin Med 2018; 7:jcm7100364. [PMID: 30336582 PMCID: PMC6210310 DOI: 10.3390/jcm7100364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
Abstract
This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and a Karnofsky performance status ≥60 assessed their oncologist’s empathy using the CARE questionnaire, which provides a general score and two sub-dimensions: listening/compassion and active/positive empathy. Survival was recorded until April 2018. Usual medical, social and psychological confounders were included in the Cox regression. The median follow-up time was 3.1 years. There was a statistical interaction between listening/compassion empathy and TC (p = 0.016) such that in bad news consultations, higher listening/compassion predicted a higher risk of death (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.03–1.23; p = 0.008). In follow-up consultations, listening/compassion did not predict survival (HR = 0.94; 95% CI: 0.85–1.05; p = 0.30). The same results were found with the general score of empathy, but not with active/positive empathy. In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death. Further studies are warranted to confirm these results and find out the determinants of patient perception of physician empathy.
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Affiliation(s)
- Sophie Lelorain
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Alexis Cortot
- University of Lille, Department of Thoracic Oncology, Albert Calmette University Hospital, F-59000 Lille, France.
| | - Véronique Christophe
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Claire Pinçon
- University of Lille, CHU Lille, EA 2694, Public Health: Epidemiology and Quality of Care, F-59000 Lille, France.
| | - Yori Gidron
- University of Lille, CNRS, CHU Lille, UMR 9193-SCALab-Cognitive and Affective Sciences, F-59000 Lille, France.
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Affiliation(s)
- Eoin Walker
- Advanced Paramedic Practitioner, London Ambulance Service NHS Trust, London
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Rat AC, Ricci L, Guillemin F, Ricatte C, Pongy M, Vieux R, Spitz E, Muller L. Development of a Web-Based Formative Self-Assessment Tool for Physicians to Practice Breaking Bad News (BRADNET). JMIR MEDICAL EDUCATION 2018; 4:e17. [PMID: 30026180 PMCID: PMC6072977 DOI: 10.2196/mededu.9551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/22/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although most physicians in medical settings have to deliver bad news, the skills of delivering bad news to patients have been given insufficient attention. Delivering bad news is a complex communication task that includes verbal and nonverbal skills, the ability to recognize and respond to patients' emotions and the importance of considering the patient's environment such as culture and social status. How bad news is delivered can have consequences that may affect patients, sometimes over the long term. OBJECTIVE This project aimed to develop a Web-based formative self-assessment tool for physicians to practice delivering bad news to minimize the deleterious effects of poor way of breaking bad news about a disease, whatever the disease. METHODS BReaking bAD NEws Tool (BRADNET) items were developed by reviewing existing protocols and recommendations for delivering bad news. We also examined instruments for assessing patient-physician communications and conducted semistructured interviews with patients and physicians. From this step, we selected specific themes and then pooled these themes before consensus was achieved on a good practices communication framework list. Items were then created from this list. To ensure that physicians found BRADNET acceptable, understandable, and relevant to their patients' condition, the tool was refined by a working group of clinicians familiar with delivering bad news. The think-aloud approach was used to explore the impact of the items and messages and why and how these messages could change physicians' relations with patients or how to deliver bad news. Finally, formative self-assessment sessions were constructed according to a double perspective of progression: a chronological progression of the disclosure of the bad news and the growing difficulty of items (difficulty concerning the expected level of self-reflection). RESULTS The good practices communication framework list comprised 70 specific issues related to breaking bad news pooled into 8 main domains: opening, preparing for the delivery of bad news, communication techniques, consultation content, attention, physician emotional management, shared decision making, and the relationship between the physician and the medical team. After constructing the items from this list, the items were extensively refined to make them more useful to the target audience, and one item was added. BRADNET contains 71 items, each including a question, response options, and a corresponding message, which were divided into 8 domains and assessed with 12 self-assessment sessions. The BRADNET Web-based platform was developed according to the cognitive load theory and the cognitive theory of multimedia learning. CONCLUSIONS The objective of this Web-based assessment tool was to create a "space" for reflection. It contained items leading to self-reflection and messages that introduced recommended communication behaviors. Our approach was innovative as it provided an inexpensive distance-learning self-assessment tool that was manageable and less time-consuming for physicians with often overwhelming schedules.
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Affiliation(s)
- Anne-Christine Rat
- EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Rheumatology, Nancy University Hospital, Nancy, France
- CIC 1433 Clinical Epidemiology, INSERM, Nancy University Hospital, Nancy, France
| | - Laetitia Ricci
- CIC 1433 Clinical Epidemiology, INSERM, Nancy University Hospital, Nancy, France
- Equipe de psychologie de la santé de Metz, EA 4360 APEMAC, Université de Lorraine, Metz, France
| | - Francis Guillemin
- EA 4360 APEMAC, Université de Lorraine, Nancy, France
- CIC 1433 Clinical Epidemiology, INSERM, Nancy University Hospital, Nancy, France
| | - Camille Ricatte
- Equipe de psychologie de la santé de Metz, EA 4360 APEMAC, Université de Lorraine, Metz, France
| | - Manon Pongy
- Equipe de psychologie de la santé de Metz, EA 4360 APEMAC, Université de Lorraine, Metz, France
| | - Rachel Vieux
- EA 4360 APEMAC, Université de Lorraine, Nancy, France
- Department of Pediatrics, Besançon University, Besançon, France
| | - Elisabeth Spitz
- Equipe de psychologie de la santé de Metz, EA 4360 APEMAC, Université de Lorraine, Metz, France
| | - Laurent Muller
- Equipe de psychologie de la santé de Metz, EA 4360 APEMAC, Université de Lorraine, Metz, France
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15
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Bumb M, Keefe J, Miller L, Overcash J. Breaking Bad News: An Evidence-Based Review of Communication Models for Oncology Nurses. Clin J Oncol Nurs 2018; 21:573-580. [PMID: 28945712 DOI: 10.1188/17.cjon.573-580] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A diagnosis of cancer is a stressful, difficult, and life-altering event. Breaking bad news is distressing to patients and families and is often uncomfortable for the nurse delivering it. Evidence-based communication models have been developed and adapted for use in clinical practice to assist nurses with breaking bad news.
. OBJECTIVES The purpose of this article is to provide an overview on breaking bad news and to review the utility of the SPIKES and PEWTER evidence-based communication models for oncology nurses.
. METHODS Perceptions of breaking bad news from the nurse and patient perspectives, as well as barriers and consequences to effective communication, will be presented. Clinical examples of possible situations of breaking bad news will demonstrate how to use the SPIKES and PEWTER models of communication when disclosing bad news to patients and their families.
. FINDINGS By using the evidence-based communication strategies depicted in this article, oncology nurses can support the delivery of bad news and maintain communication with their patients and their patients' families in an effective and productive manner.
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Affiliation(s)
- Meridith Bumb
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Joanna Keefe
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lindsay Miller
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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16
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Phillips CR, Haase JE, Broome ME, Carpenter JS, Frankel RM. Connecting with healthcare providers at diagnosis: adolescent/young adult cancer survivors' perspectives. Int J Qual Stud Health Well-being 2017; 12:1325699. [PMID: 28617094 PMCID: PMC5510205 DOI: 10.1080/17482631.2017.1325699] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
Adolescents and young adults (AYAs) with cancer are a vulnerable and underserved population. AYAs' cancer survivorship is complicated by physical and psychosocial late effects which requires long-term follow-up. Connectedness with healthcare providers (HCPs) is a protective factor that may improve long-term follow-up behaviours of AYAs. However, little is known about AYAs' experiences connecting with HCPs. The purpose of this study was to describe AYA cancer survivors' experiences connecting with HCPs. This empirical phenomenological study interviewed nine AYA cancer survivors diagnosed during adolescence. Individual interviews were conducted and analysed using an adapted Colaizzi approach. The essential structure reveals that AYAs begin their experience of connectedness with a sense of disconnectedness prior to treatment. The diagnosis is a period of confusion and emotional turmoil that interfere with the AYAs' ability to connect. When AYAs come to accept their illness and gain familiarity with the environment, they then put forth an effort to connect with HCPs. Although it takes time for AYAs to reciprocate efforts to connect, HCPs should be aware that AYAs carefully assess and make judgments about whether or not HCPs can be trusted. Findings raise awareness of the actions and behaviours of HCPs that hinder connectedness, and targeted in future research.
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Affiliation(s)
- Celeste R. Phillips
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Joan E. Haase
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Marion E. Broome
- Division of Healthcare of Women and Children, Duke University School of Nursing, Durham, North Carolina, United States
| | - Janet S. Carpenter
- Department of Science Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Richard M. Frankel
- Department of Internal Medicine, Indiana University, School of Medicine Indianapolis, INUnited States
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17
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Nelson M, Kelly D, McAndrew R, Smith P. 'Just gripping my heart and squeezing': Naming and explaining the emotional experience of receiving bad news in the paediatric oncology setting. PATIENT EDUCATION AND COUNSELING 2017; 100:1751-1757. [PMID: 28478124 DOI: 10.1016/j.pec.2017.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore recipients' perspectives on the range and origins of their emotional experiences during their 'bad news' consultations. METHODS Participants were four bereaved families of children who had changed from active treatment to palliative care in paediatric oncology. Data was collected using emotional touchpoint storytelling. The names (descriptors) given to the emotional experiences were linguistically classified. Explanations of their perceived origins were examined using applied thematic analysis. RESULTS 26 descriptors were given, relating to bodily sensations, affective states, evaluations and cognitive conditions. Three themes were identified in the origins of these experiences - 'becoming aware', 'the changes' and 'being in this situation'. Parents described strong emotional displays during the consultation including physical collapse. These related to the internal process of 'becoming aware'. Three descriptors were given as originating from the clinicians and their delivery of the news - 'supported', 'included', 'trusting'. CONCLUSIONS Recipients perceive their emotional experiences as mainly originating from the news itself, and perceived consequences of it, rather than its delivery. Strong emotional reactions during the interaction are not necessarily an indicator of ineffectual delivery. PRACTICE IMPLICATIONS Findings offer a thematic framing that may support and deepen practitioners understanding of recipients' emotional reactions during bad news consultations.
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Affiliation(s)
- Mia Nelson
- School of Health in Social Science, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Heath Park Campus, Cardiff, CF14 4XN, United Kingdom.
| | - Rachel McAndrew
- Dpt Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, 9 Sciennes Road, Edinburgh, EH9 1LF, United Kingdom.
| | - Pam Smith
- School of Health in Social Science, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom.
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18
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Tuffrey‐Wijne I, Rose T, Grant R, Wijne A. Communicating about death and dying: Developing training for staff working in services for people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1099-1110. [DOI: 10.1111/jar.12382] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Irene Tuffrey‐Wijne
- Faculty of HealthSocial Care and EducationKingston University & St George's University of London London UK
| | - Tracey Rose
- Faculty of HealthSocial Care and EducationKingston University & St George's University of London London UK
- Kent Community Health NHS Foundation Trust Ashford UK
| | - Robert Grant
- Faculty of HealthSocial Care and EducationKingston University & St George's University of London London UK
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Christie D, Glew S. A clinical review of communication training for haematologists and haemato-oncologists: a case of art versus science. Br J Haematol 2017; 178:11-19. [PMID: 28543173 DOI: 10.1111/bjh.14606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The art of communication at times seems at odds with the science of medicine. Poor communication is associated with risks for patient and physician. Communication skills are highly relevant for haematologists and are associated with increased physician and patient satisfaction, positive psychosocial outcomes and possible health outcomes. Medical communication training has recently become widespread but is largely restricted to junior medical professionals. In haematology, the proliferation of high quality communication skills is low and there are few interventions catering for the required skillset. A review identified five applicable interventions for haematologists. There is variation in intervention length and structure, and most studies measure targeted skill fidelity rather than patient outcomes. Work on motivation and empowerment holds potential for haematological conditions, but is largely absent from care. This review highlights the need for new interventions for haematologists which focus on producing and maintaining positive patient outcomes.
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Affiliation(s)
- Deborah Christie
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK.,UCL Institute of Epidemiology and Public Health, London, UK
| | - Sarah Glew
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK
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20
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Taylor CJ, Hobbs FDR, Marshall T, Leyva-Leon F, Gale N. From breathless to failure: symptom onset and diagnostic meaning in patients with heart failure-a qualitative study. BMJ Open 2017; 7:e013648. [PMID: 28283487 PMCID: PMC5353318 DOI: 10.1136/bmjopen-2016-013648] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore 2 key points in the heart failure diagnostic pathway-symptom onset and diagnostic meaning-from the patient perspective. DESIGN Qualitative interview study. SETTING Participants were recruited from a secondary care clinic in central England following referral from primary care. PARTICIPANTS Over age 55 years with a recent (<1 year) diagnosis of heart failure confirmed by a cardiologist following initial presentation to primary care. METHODS Semistructured interviews were carried out with 16 participants (11 men and 5 women, median age 78.5 years) in their own homes. Data were audio-recorded and transcribed. Participants were asked to describe their diagnostic journey from when they first noticed something wrong up to and including the point of diagnosis. Data were analysed using the framework method. RESULTS Participants initially normalised symptoms and only sought medical help when daily activities were affected. Failure to realise that anything was wrong led to a delay in help-seeking. Participants' understanding of the term 'heart failure' was variable and 1 participant did not know he had the condition. The term itself caused great anxiety initially but participants learnt to cope with and accept their diagnosis over time. CONCLUSIONS Greater public awareness of symptoms and adequate explanation of 'heart failure' as a diagnostic label, or reconsideration of its use, are potential areas of service improvement.
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Affiliation(s)
- C J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - T Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - F Leyva-Leon
- Aston Medical Research Insitutue, Aston Medical School, Birmingham, UK
| | - N Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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21
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Salmon P, Young B. A new paradigm for clinical communication: critical review of literature in cancer care. MEDICAL EDUCATION 2017; 51:258-268. [PMID: 27995660 PMCID: PMC5324633 DOI: 10.1111/medu.13204] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To: (i) identify key assumptions of the scientific 'paradigm' that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients' own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better. METHODS A critical review, focusing on cancer care. We identified assumptions about patients' and clinicians' roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve. RESULTS The current paradigm constructs patients simultaneously as needy (requiring clinicians' explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians 'communication skills' has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients' vulnerability and clinicians' goal-directed expertise. Attachment theory provides a knowledge base to inform both research and education. CONCLUSIONS Researchers will need to be alert to political interests that seek to mould patients into 'consumers', and to professional interests that seek to add explicit psychological dimensions to clinicians' roles. New approaches to education will be needed to support clinicians' curiosity and goal-directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.
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Affiliation(s)
- Peter Salmon
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
| | - Bridget Young
- Department of Psychological SciencesUniversity of LiverpoolLiverpoolUK
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22
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Metse AP, Wiggers JH, Wye PM, Wolfenden L, Prochaska JJ, Stockings EA, Williams JM, Ansell K, Fehily C, Bowman JA. Smoking and Mental Illness: A Bibliometric Analysis of Research Output Over Time. Nicotine Tob Res 2016; 19:24-31. [PMID: 27980040 DOI: 10.1093/ntr/ntw249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The prevalence of smoking among persons with a mental illness has remained unchanged, being 2-3 times higher than the general population in high-income countries. Assessment of the volume and characteristics of research output over time can assist in identifying research priorities to promote progress within a field. The aim of this study was to undertake such an assessment in the field of smoking and mental illness. METHODS A descriptive repeat cross-sectional study was conducted of peer-reviewed publications in Medline and PsycINFO for the periods 1993-1995, 2003-2005, and 2013-2015. Publications were classified as data- or non-data-based; data-based publications were further categorized by study type, population, setting, and for intervention-focused publications by level of evidence and research translation phase. RESULTS Included were 547 articles published in 1993-1995 (n = 65), 2003-2005 (n = 153), and 2013-2015 (n = 329). The number and proportion of data-based publications significantly increased over time, although their focus remained predominantly descriptive (≥83%); less than 14% of publications in any period had an intervention focus. The proportion of publications reporting on study populations with multiple diagnostic categories and recruiting from nonmental health settings, significantly increased from 1993-1995 to 2003-2005, however then plateaued by 2013-2015. The level of evidence provided by intervention-focused publications was suggested to increase over time, however there was no evident variation in translation phase. CONCLUSIONS Research has increased over time to characterize smoking among those with a mental illness; however more is needed to inform the development and implementation of effective cessation interventions for this group. IMPLICATIONS This is the first study to examine the volume and characteristics of research publications in the field of smoking and mental illness over time. The number of publications increased fivefold between 1993-1995 and 2013-2015. Between 1993-1995 and 2003-2005, progression was also indicated by increased: data-based publications, diagnostic diversity of samples, and variation in study settings; however further increases in such measures were not evident in 2013-2015. Notably, it continues to be the case that few intervention studies are undertaken. To achieve meaningful changes in the smoking prevalence of this group, a greater focus on research that assesses the effectiveness and implementation of tailored cessation interventions is required.
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Affiliation(s)
- Alexandra P Metse
- School of Psychology, University of Newcastle, Callaghan, Australia; .,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Paula M Wye
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - Emily A Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
| | - Jill M Williams
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Kerryn Ansell
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Caitlin Fehily
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny A Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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Abstract
This article discusses health professionals use of protocol in the breaking of bad news, focusing particularly on the well-known SPIKES framework. The evidence of impact on the patient experience is examined and recommendations are made for further outcome-based research. Existing evidence suggests that the model as commonly interpreted may not fully meet the needs of patients or reflect the clinical experience of breaking bad news for some professionals and further guidance may be needed to support them in their practice. The ethos of the step-wise protocol is debated, questioning whether it helps or hinders individualised care and the formation of a genuine relationship between patient and professional. Finally, recommendations for practice are offered.
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Affiliation(s)
- Antonia Dean
- Lecturer Practitioner, Hospice of St Francis, Berkhamsted, UK
| | - Susan Willis
- Senior Lecturer, Department of Allied Health Professionals, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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24
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Porensky EK, Carpenter BD. Breaking bad news: Effects of forecasting diagnosis and framing prognosis. PATIENT EDUCATION AND COUNSELING 2016; 99:68-76. [PMID: 26238257 DOI: 10.1016/j.pec.2015.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Research to support guidelines for breaking bad news is lacking. This study used an experimental paradigm to test two communication strategies, forecasting bad news and framing prognosis, in the context of cancer. METHODS In a 2×2 design, 128 participants received bad news in a hypothetical consultation. A videotaped physician presented diagnostic and prognostic information, varying warning (warning shot vs. no warning), and framing (positive vs. negative). Effects on psychological distress, recall accuracy, and subjective interpretations of the news were assessed. RESULTS Warning was not associated with lower psychological distress or improved recall. Individuals who heard a positively-framed prognosis had significantly less psychological distress, rated their prognosis better, and were more hopeful than those who heard a negatively-framed prognosis. However, they also showed a trend toward reduced accuracy in recalling prognostic statistics. CONCLUSIONS Results contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care. PRACTICE IMPLICATIONS Although research in clinical settings is needed to bolster results, findings suggest that when providers use positive framing to reduce distress about prognosis, they should also consider ways to overcome potential reductions in recall accuracy, such as repeating statistical information or supplementing with written information.
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Affiliation(s)
- Emily K Porensky
- Department of Psychology, Washington University in St. Louis, St. Louis, USA.
| | - Brian D Carpenter
- Department of Psychology, Washington University in St. Louis, St. Louis, USA
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25
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Integrating early palliative care (EPC) in the management of lung cancer: The role of the thoracic oncologist. Lung Cancer 2015; 90:135-8. [PMID: 26341958 DOI: 10.1016/j.lungcan.2015.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/06/2015] [Accepted: 08/24/2015] [Indexed: 12/25/2022]
Abstract
Early introduction of palliative care in the management of patients with metastatic lung cancer is recommended since it improves quality of life and improves survival rates. In many hospitals the focus of palliative teams is often on terminal care due to limited resources. How is Early palliative care (EPC) in this setting implemented in daily oncologic care? It seems obvious that thoracic oncologists will have to become involved in EPC for lung cancer patients. In this review we want to determine the assignments for the thoracic oncologist in EPC and to give some practical tools how we started EPC in collaboration with the palliative team.
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Improving Physicians' Communication Skills and Reducing Cancer Patients' Anxiety: A Quasi-Experimental Study. TUMORI JOURNAL 2015; 101:131-7. [DOI: 10.5301/tj.5000230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2014] [Indexed: 01/06/2023]
Abstract
Aims and Background This study is aimed at evaluating the effectiveness of a physician-centered communication skills training program on cancer patient anxiety levels. Methods and Study design In this quasi-experimental study, physicians from 9 units of 5 general hospitals and 1 cancer research institute were recruited. The unit heads chose which physicians would attend the training program (treatment group) and which would not (control group). The effectiveness of the course was evaluated by assessing the evolution of state anxiety in a sample of cancer patients before and after clinical consultations. Results Thirty-eight physicians and 339 outpatients were assessed. Patients from the treatment and control groups did not differ in pre-examination anxiety or psychological distress levels. Patients examined by physicians from the treatment group displayed a higher decrease in state-anxiety levels compared with those examined by physicians from the control group. A higher proportion of high anxiety levels was found in women, in less educated patients, and in those with a high distress level. Conclusions Our findings suggest the effectiveness of the communication skills training program with reference to patient anxiety levels. Given the potential gap between training and clinical impact, further studies investigating the effect of communication training on patient outcomes are needed.
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Igier V, Muñoz Sastre MT, Sorum PC, Mullet E. A mapping of people's positions regarding the breaking of bad news to patients. HEALTH COMMUNICATION 2014; 30:694-701. [PMID: 25186427 DOI: 10.1080/10410236.2014.898013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of this study was to map people's positions regarding the breaking of bad news to patients. One hundred forty adults who had in the past received bad medical news or whose elderly relatives had in the past received bad news, 25 nurses, and 28 nurse's aides indicated the acceptability of physicians' conduct in 72 vignettes of giving bad news to elderly patients. Vignettes were all combinations of five factors: (a) the severity of the disease (severe but not lethal, extremely severe and possibly lethal, or incurable), (b) the patient's wishes (insists on knowing the full truth vs. does not insist), (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about communicating bad news (tell the patient that the illness is not severe and minimize the severity of the illness when talking to the patient's relatives, tell the full truth to her relatives, or tell the full truth to both the elderly patient and her relatives). Four qualitatively different positions were found. Twenty-eight percent of participants preferred the full truth to be told; 36% preferred the truth to be told but understood that the physician would inform the family first; 13% did not think that telling the full truth is best for patients; and 23% understood that the full truth would be told in some cases and not in others, depending on the physician's perception of the situation. The present mapping could be used to detect the position held by each patient and act accordingly. This would be made easier if breaking bad news was conceived as a communication process involving a range of health care professionals, rather than as a single occurrence in time.
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Kopchak Sheehan D, Burke Draucker C, Christ GH, Murray Mayo M, Heim K, Parish S. Telling adolescents a parent is dying. J Palliat Med 2014; 17:512-20. [PMID: 24745829 DOI: 10.1089/jpm.2013.0344] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When a parent is terminally ill, one of the major challenges facing families is informing children of the parent's condition and prognosis. This study describes four ways in which parents disclose information about a parent's life-threatening illness to their adolescent children. METHODS We audio-recorded and transcribed 61 individual interviews with hospice patients who were recruited from a large hospice in northeastern Ohio, their spouses/partners, and their adolescent children. The interviews were coded and analyzed using a constant comparison approach. RESULTS AND CONCLUSIONS Families inform adolescents about the progression of a parent's terminal illness in characteristic ways that remain fairly consistent throughout the illness, and are aimed at easing the adolescents' burden and distress. The families engaged in the process of disclosure in one of four ways: measured telling, skirted telling, matter-of-fact telling, and inconsistent telling. These results will inform the development of interventions that assist families with disclosure and are tailored to each family's communication style.
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Kuroki LM, Zhao Q, Jeffe DB, Powell MA, Hagemann AR, Thaker PH, Massad LS, Mutch DG, Zighelboim I. Disclosing a diagnosis of cancer: considerations specific to gynecologic oncology patients. Obstet Gynecol 2014; 122:1033-1039. [PMID: 24104784 DOI: 10.1097/aog.0b013e3182a9bf42] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize gynecologic oncology patients' perceptions of the process of disclosure of a cancer diagnosis. METHODS We surveyed 100 gynecologic oncology patients between December 2011 and September 2012. An 83-item tool based on three validated assessment tools evaluated patient-centered factors, physician behavior and communication skills, and environmental factors. Associations between patients' satisfaction and these variables were analyzed using Wilcoxon rank-sum, Kruskal-Wallis, and Spearman's rho tests. Poisson regression was used to assess factors associated with patient's satisfaction. RESULTS Twenty-four percent of patients were notified of their diagnosis by phone, 60% in the physician's office, and 16% in the hospital. Disclosure was performed by an obstetrician-gynecologist (58%), gynecologic oncologist (26%), primary care physician (8%), or other (8%). Fifty-two percent of all patients were accompanied by a support person. Higher patient satisfaction scores were associated with face-to-face disclosure (mean score 91% compared with over the phone 72%, P=.02), a private setting (mean score 92% compared with impersonal setting 72%, P=.004), and duration of the encounter of greater than 10 minutes (mean score 94% compared with less than 10 minutes 79%, P<.001). Multivariate analysis confirmed that both physician communication skills (P<.001) and patient-centered factors (eg, perception of physician sensitivity and empathy, opportunities to ask questions and express emotion, and set the pace of conversation; P=.013) were associated with higher patient satisfaction. CONCLUSIONS Effective physician communication skills and patient-centered factors resulted in higher patient satisfaction with the gynecologic cancer diagnosis disclosure experience. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lindsay M Kuroki
- Division of Gynecologic Oncology and the Division of Clinical Research, Department of Obstetrics and Gynecology, and the Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, and the Alvin J. Siteman Cancer Center, St. Louis, Missouri. Dr. Zighelboim's current affiliation: St. Luke's Cancer Care Associates, Temple University School of Medicine, Bethlehem, Pennsylvania
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van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A, Loneragan R, McCaughan B, Boyer M, Feigen M, Currow D, Schofield P, Nick Pavlakis BI, McLean J, Marshall H, Leong S, Keena V, Penman A. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5:E254-307. [PMID: 24416529 PMCID: PMC3886874 DOI: 10.3978/j.issn.2072-1439.2013.11.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/24/2022]
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Sterba KR, Zapka J, Gore EI, Ford ME, Ford DW, Thomas M, Wallace K. Exploring Dimensions of Coping in Advanced Colorectal Cancer: Implications for Patient-Centered Care. J Psychosoc Oncol 2013; 31:517-39. [DOI: 10.1080/07347332.2013.822049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Martins RG, Carvalho IP. Breaking bad news: patients' preferences and health locus of control. PATIENT EDUCATION AND COUNSELING 2013; 92:67-73. [PMID: 23523195 DOI: 10.1016/j.pec.2013.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/22/2013] [Accepted: 03/03/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To identify patients' preferences for models of communicating bad news and to explore how such preferences, and the reasons for the preferences, relate with personality characteristics, specifically patients' health locus of control (HLC): internal/external and 'powerful others' (PO). METHODS Seventy-two patients from an oncology clinic watched videotaped scenarios of a breaking bad news moment, selected the model they preferred, filled an HLC scale and were interviewed about their choices. Data were analyzed with Chi-square, Kruskal-Wallis and Mann-Whitney tests. Interviews were content-analyzed. RESULTS 77.8% preferred an "empathic professional", 12.5% a "distanced expert" and 9.7% an "emotionally burdened expert". Preferences varied significantly with HLC scores (patients with higher internal locus of control (ILC) and lower PO preferred the empathic model), presence of cancer, age and education. Patients explained their preferences through aspects of Caring, Professionalism, Wording, Time and Hope. ILC registered significant differences in regards to Wording and Time, whereas PO was associated with Hope and Time. CONCLUSIONS HLC is an important dimension that can help doctors to better know their patients. PRACTICE IMPLICATIONS Knowing whether patients attribute their health to their own behaviors or to chance/others can help tailor the disclosure of bad news to their specific preferences.
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Affiliation(s)
- Raquel Gomes Martins
- Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Oporto, Portugal.
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Mackenzie LJ, Carey ML, Paul CL, Sanson-Fisher RW, D'Este CA. Do we get it right? Radiation oncology outpatients' perceptions of the patient centredness of life expectancy disclosure. Psychooncology 2013; 22:2720-8. [PMID: 23801643 DOI: 10.1002/pon.3337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/26/2013] [Accepted: 05/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. METHODS Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. RESULTS Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was -0.04 (95% CI, -0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). CONCLUSIONS In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure.
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Affiliation(s)
- Lisa J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, Australia
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
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Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA. What do you mean, a spot?: A qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules. Chest 2013; 143:672-677. [PMID: 22814873 PMCID: PMC3590883 DOI: 10.1378/chest.12-1095] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/26/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND More than 150,000 Americans each year are found to have a pulmonary nodule. Even more will be affected following the publication of the National Lung Screening Trial. Patient-doctor communication about pulmonary nodules can be challenging. Although most nodules are benign, it may take 2 to 3 years to rule out cancer. We sought to characterize patients’ perceptions of communication with their providers about pulmonary nodules. METHODS We conducted four focus groups at two sites with 22 adults with an indeterminate pulmonary nodule. Transcripts were analyzed using principles of grounded theory. RESULTS Patients described conversations with 53 different providers about the pulmonary nodule. Almost all patients immediately assumed that they had cancer when first told about the nodule. Some whose providers did not discuss the actual cancer risk or explain the evaluation plan experienced confusion and distress that sometimes lasted for months. Patients were frustrated when their providers did not address their concerns about cancer or potential adverse effects of surveillance (eg, prolonged uncertainty, radiation exposure), which in some cases led to poor adherence to evaluation plans. Patients found it helpful when physicians used lay terms, showed the CT image, and quantified cancer risk. By contrast, patients resented medical jargon and dismissive language. CONCLUSIONS Patients commonly assume that a pulmonary nodule means cancer. What providers tell (or do not tell) patients about their cancer risk and the evaluation plan can strongly influence patients’ perceptions of the nodule and related distress. We describe simple communication strategies that may help patients to come to terms with an indeterminate pulmonary nodule.
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Affiliation(s)
- Renda Soylemez Wiener
- Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven Woloshin
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Lisa M Schwartz
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Jack A Clark
- Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
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Waxler JL, Cherniske EM, Dieter K, Herd P, Pober BR. Hearing from parents: The impact of receiving the diagnosis of Williams syndrome in their child. Am J Med Genet A 2013; 161A:534-41. [DOI: 10.1002/ajmg.a.35789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 10/11/2012] [Indexed: 11/10/2022]
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Salmon P, Young B. The validity of education and guidance for clinical communication in cancer care: evidence-based practice will depend on practice-based evidence. PATIENT EDUCATION AND COUNSELING 2013; 90:193-9. [PMID: 22632737 DOI: 10.1016/j.pec.2012.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/03/2012] [Accepted: 04/13/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The validity of clinical communication skills education and guidance for cancer care is sometimes portrayed as self-evident. This view needs re-examination in light of critiques of the concept of communication skills. METHODS We critically examine principles that steer communication teaching and guidance in cancer care and draw on research that can inform the next generation of development in this field. RESULTS Unlike other areas of clinical skills, communication is highly contested. Any instance of communication is open to multiple interpretations; expert principles of communication are imprecise and often contradictory. The concept of communication skills will constrain development, because of its implication that universal, expert-defined components of communication are the building blocks of clinical relationships. Research on communication in practice indicates insights that could enrich future education and guidance. CONCLUSIONS Communication experts have more to learn from practitioners and patients than is commonly appreciated. Inductive, qualitative research should incorporate patient and practitioner perspectives as well as observations of communication. PRACTICE IMPLICATIONS Solutions to communication dilemmas might be found in detailed study of communication in practice, rather than in current expert principles. Incorporating such evidence will help to ensure the continued authority of communication curricula and guidance as evidence-based and patient-centred.
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Affiliation(s)
- Peter Salmon
- Division of Clinical Psychology, University of Liverpool, Liverpool, UK.
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Abstract
OBJECTIVES To develop a model for breaking bad news that meets the needs of people with intellectual disabilities (IDs). DESIGN A two-phase qualitative study featuring: (I) focus group meetings, on-line focus groups and one-to-one interviews; (II) structured feedback from participants and other stakeholders. SETTING Participants were drawn from National Health Service hospitals, Primary Care Trusts, independent organisations and on-line forums across England. PARTICIPANTS 109 participants were purposively selected: 21 people with mild/moderate IDs, 28 family carers, 26 ID professionals and 34 general health professionals. OUTCOME MEASURE Feedback on a preliminary model for breaking bad news to people with IDs was collected from 60 participants and other stakeholders to assess relevance and acceptability, before the model was finalised. RESULTS Breaking bad news is best seen as a process, not an event or a linear series of events. Bad news situations usually constitute a wide range of discrete items or chunks of information. 'Building a foundation of knowledge' is central to the model. Information needs to be broken down into singular chunks of knowledge that can be added over time to people's existing framework of knowledge. Three other aspects should be considered at all times: capacity, people and support. CONCLUSIONS Patients who have IDs do not easily process verbal information in a clinical setting. The new model for breaking bad news to people with IDs needs to be tested in practice using robust outcome measures. The model's relevance to wider patient groups should also be evaluated.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Division of Population Health Sciences and Education, St George's University of London, London, UK.
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Mackenzie LJ, Carey ML, Sanson-Fisher RW, D'Este CA, Hall AE. Cancer patients' willingness to answer survey questions about life expectancy. Support Care Cancer 2012; 20:3335-41. [PMID: 22576980 PMCID: PMC3480580 DOI: 10.1007/s00520-012-1477-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to determine the proportion and characteristics of radiation oncology outpatients who were willing to answer questions about their life expectancy. METHODS A cross-sectional patient self-report survey was conducted using touch screen computers in Australian radiation oncology treatment centers. The primary outcome was the respondent's willingness to complete a survey subsection about life expectancy. Demographic and disease characteristics were also collected, and level of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. RESULTS Of the 469 oncology outpatients who completed the survey, 327 (70 %; 95 % CI, 65 %, 74 %) indicated that they were willing to answer questions about life expectancy. Being female (p < 0.001), older (p < 0.05), born in Asia (p < 0.05), and being diagnosed with cancer types other than breast and prostate cancer (p < 0.01) were associated with lower odds of answering life expectancy questions. CONCLUSIONS The opportunity to opt-out of survey questions about sensitive issues such as life expectancy is a feasible method for accessing important information about patient preferences while minimizing burden. Further research may be needed to improve acceptability of life expectancy research to some patient groups.
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Affiliation(s)
- L J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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Yoshida S, Shiozaki M, Sanjo M, Morita T, Hirai K, Tsuneto S, Shima Y. Pros and Cons of Prognostic Disclosure to Japanese Cancer Patients and Their Families from the Family's Point of View. J Palliat Med 2012; 15:1342-9. [DOI: 10.1089/jpm.2012.0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Saran Yoshida
- Center for Cancer control and Information Services, National Cancer Center, Tokyo, Japan
| | - Mariko Shiozaki
- International Center for Human Sciences, Kinki University, Higashi-Osaka City, Japan
| | - Makiko Sanjo
- Department of Adult Health Nursing, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Kei Hirai
- Support Office for Large-Scale Education and Research Projects, Osaka University, Osaka, Japan
| | - Satoru Tsuneto
- Department of Palliative Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
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Burgers C, Beukeboom CJ, Sparks L. How the doc should (not) talk: when breaking bad news with negations influences patients' immediate responses and medical adherence intentions. PATIENT EDUCATION AND COUNSELING 2012; 89:267-273. [PMID: 22938871 DOI: 10.1016/j.pec.2012.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/16/2012] [Accepted: 08/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We investigate the role of specific formulations in a doctor's bad news delivery. We focus on the effects of negations and message framing on patients' immediate responses to the message and the doctor, and long-term consequences including quality of life and medical adherence intentions. METHODS Two lab experiments with 2 (language use: negations vs. affirmations)×2 (framing: positive vs. negative) between-subjects designs. After reading a transcription (experiment 1) or seeing a film clip (experiment 2), participants rated their evaluation of the message and the doctor, expected quality of life, and medical adherence intentions. RESULTS Positively framed bad news with negations score more negative on these dependent variables than positively framed affirmations (both experiments). For negatively framed negations, these results are reversed (experiment 2). Furthermore, the evaluations of the message (experiment 1) and the doctor (both experiments) mediate the interaction of framing and language use on medical adherence intentions. CONCLUSIONS Small linguistic variations (i.e., negations vs. affirmations) in breaking bad news can have a significant impact on the health message, doctor evaluation and medical adherence intentions. PRACTICE IMPLICATIONS Doctors should refrain from using negations to break positively framed news, and employ negations when breaking negatively framed news.
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Affiliation(s)
- Christian Burgers
- Department of Communication Studies, VU University Amsterdam, Amsterdam, The Netherlands.
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When clinicians telling the truth is de facto discouraged, what is the family’s attitude towards disclosing to a relative their cancer diagnosis? Support Care Cancer 2012; 21:1089-95. [DOI: 10.1007/s00520-012-1629-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
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Kudlacek S, Meran JG. [Case report of a patient with renal cell cancer and his fateful progress - Breaking Bad News]. Wien Med Wochenschr 2012; 162:3-7. [PMID: 22328047 DOI: 10.1007/s10354-011-0042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 10/20/2011] [Indexed: 10/14/2022]
Abstract
"Breaking Bad News" outlines a pathway for medical and other professional staff to deliver bad news to patients, clients, their families and carers. Bad news can mean different things to different people. Basically, it means any information which adversely and seriously affects an individual point of view of future or situations without any feeling of hope. The way a doctor or other health or social care professionals deliver bad news places an indelible mark on the doctor/professional-patient relationship. The debate about the levels of truth given to patients about their diagnosis has developed significantly over the last few years. While doctors and professionals now increasingly share information it has been the practice to withhold information because it was believed to be in the best interests of the patient. We discuss the situation of a patient with renal cancer who developed metastases after surgery. Unfortunately a tumour embolism from the kidney flashed into the pulmonary arteries. First it was not for sure if there were any metastases beside the tumour embolus. Months after embolectomy by thoracic surgery there was certain evidence of multiple pulmonary nodal lesions. First and second line chemotherapies failed and the patient died within several months after start of pharmacologic treatment. The case report discusses diagnosis and procedures, how the patient was supported and the way he got information at any critical date.
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Affiliation(s)
- Stefan Kudlacek
- Abteilung für Innere Medizin, Krankenhaus Barmherzige Brüder - Wien, Wien, Austria.
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Experiences and Needs of Families Regarding Prognostic Communication in an Intensive Care Unit. Crit Care Nurs Q 2012; 35:299-313. [DOI: 10.1097/cnq.0b013e318255ee0d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ormondroyd L, Banks R. The use of a CCTV link in head and neck oncology diagnostic clinics. Br J Oral Maxillofac Surg 2012; 50:e30. [DOI: 10.1016/j.bjoms.2011.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/11/2011] [Indexed: 11/16/2022]
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Schildmann J, Kupfer S, Burchardi N, Vollmann J. Teaching and evaluating breaking bad news: a pre-post evaluation study of a teaching intervention for medical students and a comparative analysis of different measurement instruments and raters. PATIENT EDUCATION AND COUNSELING 2012; 86:210-9. [PMID: 21571487 DOI: 10.1016/j.pec.2011.04.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 04/10/2011] [Accepted: 04/13/2011] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate changes of different domains of breaking bad news (bbn) competences after a teaching module for medical students, and to collage the results generated by different approaches of evaluation. METHODS Rating of medical student-SP interactions by means of a global rating scale and a detailed checklist used by SPs and independent raters. RESULTS Students improved their breaking bad news competency. However, the changes vary between the different domains of bbn competency. In addition, results generated by different evaluation instruments differ. CONCLUSION This study serves as a stimulus for further research on the training of specific elements of bbn and different approaches of evaluating bbn competency. PRACTICE IMPLICATIONS In light of the different facets of bbn competency, it is important to set priorities regarding the teaching aims and to provide a consistent approach.
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Affiliation(s)
- Jan Schildmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Germany.
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Abstract
Information that drastically alters the life world of the patient is termed as bad news. Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and well-orchestrated communication has a positive therapeutic effect. This is a process of negotiation between patient and physician, but physicians often find it difficult due to many reasons. They feel incompetent and are afraid of unleashing a negative reaction from the patient or their relatives. The physician is reminded of his or her own vulnerability to terminal illness, and find themselves powerless over emotional distress. Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of client-centered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Six-step SPIKES protocol is widely used for breaking bad news. In this paper, we put forward another six-step protocol, the BREAKS protocol as a systematic and easy communication strategy for breaking bad news. Development of competence in dealing with difficult situations has positive therapeutic outcome and is a professionally satisfying one.
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Affiliation(s)
- Vijayakumar Narayanan
- Department of Oncology and Palliative Medicine, St. Gregorios Medical Mission Hospital, Parumala, Pathanamthitta, Kerala, India
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Salmon P, Langewitz W, Deveugele M, van Dulmen S. Ten years of EACH (European Association for Communication in Healthcare) and priorities for the next ten years. PATIENT EDUCATION AND COUNSELING 2011; 85:1-3. [PMID: 21807475 DOI: 10.1016/j.pec.2011.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/04/2011] [Indexed: 05/31/2023]
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Barth J, Lannen P. Efficacy of communication skills training courses in oncology: a systematic review and meta-analysis. Ann Oncol 2011; 22:1030-1040. [DOI: 10.1093/annonc/mdq441] [Citation(s) in RCA: 186] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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