Views and experience of communication when receiving a serious mental health diagnosis: satisfaction levels, communication preferences, and acceptability of the SPIKES protocol

Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness

Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.

A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians' communication

OBJECTIVE

We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures.

METHODS

Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors.

RESULTS

Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items.

CONCLUSION

There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction.

PRACTICE IMPLICATIONS

Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.

Palliative care needs of Jordanian women's experience of living with stroke: a descriptive phenomenological study

BACKGROUND

Stroke is a prevalent neurological disease that can have a profound impact on women's physical, psychosocial, and spiritual well-being. In many cases, women living with stroke may have marginalized palliative care needs that are often not adequately addressed by healthcare providers. Unfortunately, the experience of women with stroke and their specific palliative care needs have been largely overlooked in research conducted in Jordan.

AIM

The purpose of this study is to examine the specific palliative care needs of women who have experienced a stroke and are currently living in Jordan. By conducting this research, we aim to identify the various physical, emotional, social, and spiritual needs of women with stroke and gain a better understanding of how these needs can be addressed through palliative care interventions.

METHODS

This research utilized a phenomenological descriptive study approach to explore the experiences of twelve women recruited from the outpatient clinic of rehabilitation centers. The data was collected through semi-structured interviews. The analysis was conducted using the method of Colaizzi (1978), which involves identifying significant statements, extracting meanings, and formulating an exhaustive description of the phenomenon under study.

RESULTS

The study findings uncovered three primary themes that reflect the palliative care needs of women who are currently living with stroke in Jordan, including (1) Spiritual practices, beliefs, and needs; (2) Coping with distressing symptoms; and (3) Managing the delivery of unfavorable news.

DISCUSSION

This study provides valuable insights into the experiences of Jordanian women living with stroke, highlighting the far-reaching consequences of this condition on various aspects of their lives. The findings reveal that stroke has a significant impact on women's physical, emotional, social, and spiritual well-being, with many facing unmet palliative care needs. By illuminating these challenges, our study underscores the importance of taking a holistic approach to stroke care that addresses the multifaceted needs of women living with stroke. Healthcare providers must consider these findings and integrate palliative care interventions into treatment plans to improve the quality of life of women living with stroke in Jordan.

CONCLUSION

This study provides valuable insights into the palliative care needs of women who have experienced a stroke. Our findings highlight the importance of addressing women's physical, psychosocial, and spiritual needs as part of a comprehensive approach to stroke care. We recommend integrating palliative care interventions into rehabilitation programs to improve the quality of life of women living with stroke in Jordan. By doing so, we can address the pain and complications that can arise from stroke, while also providing holistic support to address the emotional and spiritual impact of the illness. This approach has the potential to improve outcomes for women living with stroke and enhance their overall well-being.

Decision Making Near End of Life: A Qualitative Exploration of the Lived Experiences of Jordanian Healthcare Providers

BACKGROUND

Discussions related to a patient's prognosis and interventions near end of life are challenging and stressful for healthcare providers. Many reported experiencing emotional distress and discomfort during the decision-making process.

OBJECTIVES

The aim of this study was to describe the lived experience of nurses and physicians who participate in decision making near the end of a patient's life.

METHODS

A descriptive, phenomenological approach was used with a purposive sample of 7 nurses and 6 physicians from 2 palliative and end-of-life care institutions in Jordan. Data derived from focus group discussions conducted online via the ZOOM video communication application, and analysis followed Colaizzi's qualitative methodology.

RESULTS

Three major themes emerged from the healthcare providers' experiences. Initially, the participants described how they "strive toward optimal decision-making near end of life," "the overwhelming experience of decision making near end of life," and finally, their struggle in sharing details about the end of life when patients ask and whether to tell or not to tell them as "the time for hard talk."

CONCLUSIONS

The healthcare providers' experiences revealed several issues of decision making near a patient's end of life, such as a lack of appropriate training and administrative support, emotional distress, fear of legal liability, and the burden of a hard talk with patients. These findings necessitate institutional support of setting appropriate policies and guidelines, staff counseling, and healthcare provider support.

IMPLICATIONS FOR PRACTICE

Institutions providing palliative and end-of-life care can use this study's findings to support their staff by setting appropriate practice guidelines and providing staff training and counseling.

Communicating diagnoses to individuals with a first episode psychosis: A qualitative study of individuals perspectives

BACKGROUND

Receiving the label of a psychotic disorder influences self-perception and may result in negative outcomes such as self-stigma and decreased self-esteem. The way the diagnosis is communicated to individuals may affect these outcomes.

AIMS

This study aims to explore the experiences and needs of individuals after a first episode of psychosis with regard to the way in which information about diagnosis, treatment options and prognosis is communicated with them.

DESIGN AND METHODS

A descriptive interpretative phenomenological approach was used. Fifteen individuals who experienced a first episode of psychosis participated in individual semi-structured open-ended interviews on their experiences and needs regarding the process of providing information about diagnosis, treatment options and prognosis. Inductive thematic analysis was used to analyze the interviews.

RESULTS

Four recurring themes where identified (1) timing (when); (2) content (what); and (3) the way information is provided (how). Individuals also reported that the provided information could elicit an emotional reaction, for which they would require specific attention, therefore the fourth theme is (4) reactions and feelings.

CONCLUSION

This study provides new insights into the experiences and specific information needed by individuals with a first episode of psychosis. Results suggest that individuals have different needs regarding the type of (what), how and when to receive information about diagnosis and treatment options. This requires a tailor-made process of communicating diagnosis. A guideline on when, how and what to inform, as well as providing personalized written information regarding the diagnosis and treatment options, is recommended.

The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis

ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.

Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW

Purpose of Review

Physician communication skills are a critical part of care for amyotrophic lateral sclerosis (ALS) patients and caregivers. They shape the development of autonomy and quality of life, and they mitigate emotional trauma. Communication skills are especially critical at 2 different time points in the course of the disease: early when delivering and establishing the diagnosis, and later when clarifying goals of care.

Recent Findings

Several techniques for physician communication of difficult information are available, including SPIKES (Setting up the interview, assessing the patient's Perception, obtaining the patient's Invitation, giving Knowledge and information to the patient, addressing the patient's Emotions with Empathetic responses, and Strategy and Summary), ABCDE (Advance preparation, Build a therapeutic environment/relationship, Communicate well, Deal with patient and family reactions, Encourage and validate emotions), and BREAKS (Background, Rapport, Exploring, Announce, Kindling, Summarize). These emphasize the physician's accountability and responsibility for communicating effectively. Formal training in these techniques is limited, and their applicability specifically to ALS is inexact.

Summary

We propose an ALS-specific technique which we call ALS ALLOW to guide physicians in conducting difficult communications with ALS patients and caregivers to develop their understanding, establish autonomy, set goals, and mitigate emotional trauma. The techniques are useful in discussions both early and late stages in the disease.

A Review and Clinical Practice Guideline for Health Professionals Working With Indigenous and Culturally and Linguistically Diverse (CALD) Populations During COVID-19

Background: As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance.

Aims: To provide health professionals with a clinical practice guideline for clear and culturally sensitive communication of health information about COVID-19 to people of Indigenous and culturally and linguistically diverse (CALD) backgrounds.

Assessment of Guideline Options: The authors conducted a review of the literature on health communication, and the guidelines were developed with particular reference to the SPIKES protocol of “breaking bad news” in oncology and the use of the DSM-5 Cultural Formulation Interview (CFI).

Actionable Recommendations: The guideline combines two approaches, the Cultural Formulation Interview, developed for DSM-5, and the SPIKES protocol used for delivering “bad news” in oncology. The combined CFI-SPIKES protocol is a six-step clinical practice guideline that includes the following: (1) Set up (S) the interview; (2) Determine how the patient perceives the problem (P) using the Cultural Formulation Interview (CFI) to elicit the patient's cultural perception of the problem; (3) Obtain an invitation (I) from the patient to receive a diagnosis; (4) Provide the patient knowledge (K) of diagnosis in a non-technical way; (5) Address the patient's emotional reaction (E) to diagnosis; and (6) Provide the patient a summary (S) of healthcare and treatment.

Conclusions and Relevance: This article presents guidelines for assessing the cultural dimensions of patients' understanding of COVID-19 and delivering diagnostic and treatment recommendations in ways that are culturally safe and responsive, such as: (a) suspending the clinician's own cultural biases to understand the explanatory models and cultural values of their CALD or Indigenous patients; (b) encouraging the use of interpreters or cultural brokers to ensure that that the message is delivered in a way that the patient can understand; and (c) encouraging CALD or Indigenous patient to take an active part in the solution and treatment adherence, to minimize transmission of COVID-19 in CALD and Indigenous communities.

Development and validation of The Breaking Bad News Attitudes Scale

BACKGROUND

Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them.

METHODS

The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested.

RESULTS

The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively.

CONCLUSION

The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

Delivering Difficult News: Simulation-Enhanced Training Improves Psychiatry Residents' Clinical Communication Skills

Background: Delivering difficult news to individuals diagnosed with mental health disorders and their family members can be challenging. The use of simulated patients (SP) is an effective teaching method to enhance clinical skills, particularly those around communication. We developed, implemented, and evaluated the effectiveness of an SP-based training module to improve psychiatric residents' clinical communication skills in delivering difficult news. Methods: We conducted 5-h workshops consisting of 3 components: (1) a high-fidelity simulation session with a professional actor; (2) a 30-min lecture; and (3) role-playing of 3 short scenarios, during which residents rotated taking on different roles (as psychiatrist, patient, or family member). We observed through a 1-way mirror and videotaped each resident's simulation session and followed it with personalized debriefing. Following the workshop, each resident received the full-length video of their simulated interview, together with a list of questions as a take-home assignment. Two months after the workshop, the residents were invited to a second SP-based session, during which 2 independent evaluators, each a board-certified psychiatrist with expertise in medical simulation, evaluated the participants' communication skills using a previously validated instrument. To avoid observation bias, the 2 evaluators rated the videotapes blind to the timing of the simulation (pre- vs. post-training). Participants completed self-report questionnaires on satisfaction and self-confidence, before, after, and 2 months following the workshop. Findings: Of the 28 psychiatric residents who participated in the training day, 24 (86%) completed the post-workshop evaluation. Mean communication score increased from 24.9 to 27.8 (paired t-test: 5.6, p < 0.001). The mean score for the self-confidence questionnaire, calculated on a 1 to 5 Likert scale, increased from 3.4 to 4.0 after the training day, and remained unchanged (4.2) 2 months later (p < 0.001). Conclusions: An SP-based training module proved useful in improving the objectively measured communication skills of psychiatric residents delivering difficult news. The training further enhanced participants' subjective sense of confidence in those clinical skills.

Associations between patient experience and clinical outcomes in general mental health clinics: Findings from the veterans outcomes assessment survey

For mental health, evidence linking the patients' experiences of care with treatment outcomes is limited. We report findings from the Veterans Outcome Assessment (VOA) survey of Veterans beginning treatment in Veterans Health Administration (VHA) mental health programs with follow-up after approximately 3 months. In addition to assessments of symptoms and functioning, it includes key components of the Experience of Care and Health Outcomes (ECHO) survey including patient reports of communication with clinicians and of the overall quality of mental health care. For Veterans treated in VHA general mental health clinics, significant associations between ratings of communication and quality at baseline, and both retention in treatment and patient-reported outcomes assessed at follow-up demonstrate that better patient experience predicts more favorable outcomes. Further research is necessary to determine whether including them in measurement-based care could improve outcomes by facilitating the early identification of problems in providing care.

The Psychological Effects of Physicians' Communication Skills on COVID-19 Patients

PURPOSE

The COVID-19 pandemic has affected physician-patient communication (PPC) in multiple ways. This study aims to report on the impact of physician-patient communication (PPC) skills on COVID-19 patients' psychology in Jordan.

SAMPLE AND METHODS

In this study, two questionnaires were designed. The first questionnaire targeted physicians, with 72 responses, and the second questionnaire targeted patients, with 248 responses. Both questionnaires contained common sections covering nine aspects of communication such as empathy, honesty, optimism, simple and deliberateness.

RESULTS

This study found that the psychological effect of physicians' positive communication skills on COVID-19 patients is significant. There were almost statistical agreement between physicians' and patients' questionnaire responses that the physicians' communication skills have positively affected the patients' psychological status; all patients' responses confirmed this finding.

CONCLUSION

Based on this study's findings, appropriate and continuous training will advance physicians' communication skills in the form of exercises that could be as simple as class- or lecture-based activities, or using technology-based learning. Using a protocol or handbook to guide such communication is another essential strategy to enhance physician-patient communication (PPC). The study recommends that physicians must be aware that PPC skills required may vary depending on whether they are dealing with a pandemic or non-pandemic situation. Generally, appropriate or positive communication skills are considered one of the main factors effecting patients' psychological responses to their diagnosis.

European Psychiatric Association policy paper on ethical aspects in communication with patients and their families

BACKGROUND

Establishing a valid communication is not only a basic clinical need to be met but also a relevant ethical commitment.

METHODS

On the basis of the relevant literature, ethical issues arising from specific, important situations in clinical practice were identified.

RESULTS

The main ethical problems regarding communication about the disorder, both in general and in relation to prodromal stages, were described and discussed together with those regarding communication about voluntary and involuntary treatments, "dual roles" enacted in clinical practice, genetic counseling, and end-of-life conditions; on the basis of what emerged, ethically driven indications and suggestions were provided.

CONCLUSIONS

Several situations put the psychiatrist in front of relevant dilemmas and doubts which are no easy to face with; an ethically driven approach based upon the principle of the best interest of patients may support clinicians in their decisions.

General Medical Clinicians' Attitudes Toward People with Serious Mental Illness: A Scoping Review

Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians' attitudes may affect care provision or health outcomes. This review describes general medical clinicians' attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.

An evaluation of communication barriers and facilitators at the time of a mental health diagnosis: a survey of health professional practices

AIMS

To examine health professionals' views and practices relating to the specific barriers to communication that arise at the time of mental health diagnosis, and the strategies used to support individuals throughout this process.

METHODS

An online survey of the beliefs and practices of 131 mental health clinicians working in different clinical settings across Australia was conducted.

RESULTS

Exploratory factor analysis of the items relating to barriers to communication resulted in three latent factors ('stigma, diagnosis and risk'; 'service structure'; and 'individual circumstances' such as the person receiving the diagnosis being young, having a culturally and linguistically diverse background or being unwell at the time of conversation). Using linear regression it was found that variance in 'stigma, diagnosis and risk' was significantly explained by whether participating clinicians had medical training, their experience working with serious mental health problems, their confidence handling distress and attitude towards diagnosis. Variance in 'individual circumstances' was significantly explained by participating clinicians' confidence handling distress. The most frequently used strategies to support diagnostic discussions centred on the health professionals' communication skills, gauging the individual's perception of their circumstances, responding with empathy, following-up after discussion, addressing stigma concerns, using collaborative practice and setting up for the conversation.

CONCLUSIONS

Three main areas for health professionals to reflect on, plan for and ultimately address when discussing news with the individual concerned emerged ('stigma, diagnosis and risk'; 'service structure'; and 'individual circumstances'). Variations in practice indicate that practitioners should be cognisant of their own beliefs and background and how this impacts their communication practice.

Building a bridge: A case report on communicating mental-health diagnoses to patients of a culturally and linguistically diverse background

OBJECTIVE

This paper is based on a case report, describing a protocol to help practitioners communicate mental-health diagnosis to patients from culturally and linguistically diverse (CALD) backgrounds. The protocol was presented by integrating the DSM-5 Cultural Formulation Interview (CFI) and the SPIKES protocol for communicating the diagnosis of cancer, yielding a modified CFI-SPIKES protocol (i.e. S, Support; P, Perception using CFI; I, Invitation; K, Knowledge; E, Emotions). The protocol was demonstrated using a case report with a patient of a Middle-Eastern background experiencing generalised anxiety disorder.

CONCLUSIONS

The CFI-SPIKES protocol for communicating mental-health diagnosis allows for a collaborative process, whereby the CALD patient and practitioner can address the stigma associated with communicating a mental-health diagnosis, ensuring patient engagement and informed shared decision making.