1
|
Jalali R, Jalali A, Jalilian M. Breaking bad news in medical services: a comprehensive systematic review. Heliyon 2023; 9:e14734. [PMID: 37025874 PMCID: PMC10070541 DOI: 10.1016/j.heliyon.2023.e14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study was performed with the aims of screening the previous studies on breaking bad news in all medical wards. Methods Eligible observational studies were selected. The quality of the studies was assessed using the STROBE checklist. The findings were reported using Garrard's table. All the stages of the present study were performed in terms of the PRISMA statement. Results Totally, 40 articles were included in the study and 96 items were extracted. The results show that breaking bad news is a recipient-centered process. Respect, empathy, and support were reported. The news presenters are better to use guidelines based on evidence-based findings. It is suggested that the presenter should use simple and understandable content. Moreover, suitable time and space are important to present the news. The results show the importance of paying enough attention to the emotions of the recipient and the need to provide support after breaking bad news. Conclusion The recipient must be the center of the programs. It is necessary to pay attention to the characteristics of the news presenter, the news content, and finally the support.Practice Implication: Understand the recipient, trained presenter, and use of the evidence-based results, improve the breaking bad news outcome.
Collapse
|
2
|
Sangeorzan I, Andriopoulou P, Davies BM, McNair A. The information needs of people with degenerative cervical myelopathy: A qualitative study to inform patient education in clinical practice. PLoS One 2023; 18:e0285334. [PMID: 37205664 DOI: 10.1371/journal.pone.0285334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies. However, before clinicians can meet patients' information needs, they must first have an understanding of their baseline requirements. This study explores the information needs of people with DCM (PwCM). In doing so, it provides a starting point for the development of patient education and knowledge management strategies in clinical practice. METHODS Semi-structured interviews with PwCM were conducted using an interview guide. Interviews were audio-recorded and transcribed verbatim. Thematic analysis according to Braun and Clarke's six-phase approach was used to analyse the data. Findings were reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS Twenty PwCM (65% female, 35% male), with ages ranging from 39 to 74 years old participated in the interviews. The findings indicated that the provision of information to PwCM during clinical interactions varies. Accordingly, PwCM's information needs were broad-ranging, as was the nature of the information they found useful. Three main themes were identified (1) Variation in the provision of information to PwCM during clinical interactions, (2) Variations in the information needs of PwCM, and (3) Information that PwCM find useful. CONCLUSION Efforts must turn to adequately educating patients at the time of the clinical encounter. A comprehensive and consistent patient-centered information exchange in DCM is necessary to achieve this.
Collapse
Affiliation(s)
| | | | - Benjamin M Davies
- Myelopathy.org, Cambridge, Cambridgeshire, United Kingdom
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
| | - Angus McNair
- Centre for Surgical Research, Bristol Medical School, University of Bristol, United Kingdom
| |
Collapse
|
3
|
Maksymowicz S, Libura M, Malarkiewicz P. Overcoming therapeutic nihilism. Breaking bad news of amyotrophic lateral sclerosis—a patient-centred perspective in rare diseases. Neurol Sci 2022; 43:4257-4265. [PMID: 35149928 PMCID: PMC9213364 DOI: 10.1007/s10072-022-05931-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare, incurable, and fatal neurodegenerative disease with median survival time from onset to death ranging from 20 to 48 months. Breaking bad news about ALS diagnosis is a challenging task for physicians and a life-changing experience for patients. Several protocols for delivering difficult information are available, including SPIKES and EMPATHY. Our goal was to assess to what extent these guidelines are followed in Polish ALS patients’ experience as well as to identify any other patients’ preferences not addressed by the guidelines. Participants of our study were recruited via a neurology clinic. Twenty-four patients with confirmed ALS diagnosis were interviewed using in-depth interview and a self-constructed questionnaire: 9 females, 15 males in age ranging from 30–39 to 60–69. The analysis showed a pattern of shortcomings and fundamental violations of available protocols reported by ALS patients. Patients also had to deal with therapeutic nihilism, as they were perceived as “hopeless cases”; unlike in oncological setting, their end-of-life needs were not accommodated by some standard schemes. As a conclusion, we recommend using extended breaking bad news protocols with special emphasis on preparing a treatment plan, giving the patient hope and sense of purpose, offering psychological support and counselling directed to patients and caregivers, and providing the patient with meaningful information about the disease, social support, treatment options, and referral to appropriate health care centres.
Collapse
Affiliation(s)
- Stanisław Maksymowicz
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
- Instytut Terapii Komórkowych S.A., Olsztyn, Poland
| | - Maria Libura
- Medical Education and Simulation Department, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
| | - Paulina Malarkiewicz
- Department of Obstetrics and Gynaecology, School of Medicine, Collegium Medicum of the University of Warmia and Mazury, Olsztyn, Poland
| |
Collapse
|
4
|
Integrating Palliative Care into Physiatric Care: Perspective of the Association of Academic Physiatrists Physiatry Palliative Care Task Force. Am J Phys Med Rehabil 2022; 101:888-896. [DOI: 10.1097/phm.0000000000002001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
L'Hotta AJ, James AS, Curtin CM, Kennedy C, Kenney D, Tam K, Ota D, Stenson K, Novak CB, Fox IK. Surgery to Restore Upper Extremity Function in Tetraplegia-Preferences for Early and Frequent Access to Information. PM R 2022. [PMID: 35665476 DOI: 10.1002/pmrj.12862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/25/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. OBJECTIVE To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. DESIGN Prospective cohort study. Participants were followed for 24 months and completed up to three interviews. SETTING Tertiary care at academic and affiliated Veterans Administration Health Care Centers. PARTICIPANTS Adults with cervical SCI (n=35) ages 18 to 80 years with mid-cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least six months post-injury) and their caregivers (n=23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Semi-structured interviews about surgical knowledge and experiences. RESULTS Data were analyzed and three themes were identified. First, providing information about UE surgical options early post-injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. CONCLUSIONS Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and healthcare providers. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Aimee S James
- Washington University School of Medicine in St. Louis
| | | | - Carie Kennedy
- Washington University School of Medicine in St. Louis
| | | | - Katharine Tam
- Washington University School of Medicine in St. Louis.,VA St. Louis Health Care System
| | | | | | | | - Ida K Fox
- Washington University School of Medicine in St. Louis.,VA St. Louis Health Care System
| |
Collapse
|
6
|
Edwards WF, Malik S, Peters J, Chippendale I, Ravits J. Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW. Neurol Clin Pract 2022; 11:521-526. [PMID: 34992959 DOI: 10.1212/cpj.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Wesleigh F Edwards
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Sahana Malik
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Jonathan Peters
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Ivy Chippendale
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - John Ravits
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| |
Collapse
|
7
|
Patient perspective: diagnosis and prognosis of acute spinal cord injuries. Spinal Cord 2021; 59:865-873. [PMID: 34083745 DOI: 10.1038/s41393-021-00641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Qualitative study. OBJECTIVES The purpose of this study is to understand the patient perspective after diagnosis of an acute traumatic spinal cord injury (tSCI). Discussing the diagnosis and prognosis of a tSCI with a patient can be a challenging experience for both the patient and the physician. As such, this paper attempts to better understand the patient experience to improve communication when discussing this life-altering injury. SETTING Vancouver General Hospital, Vancouver, British Columbia, Canada. METHODS This study is a qualitative study utilizing grounded theory and semi-structured interviews. The interview transcripts were manually coded using manifest and latent content analysis. Major and minor codes were identified and discussed. RESULTS In total, 17 interviews were conducted, fifteen individuals with tSCI who received acute care at Vancouver General Hospital (VGH) and eleven family members were interviewed. Patient participants were interviewed individually or in a paired interview with a participating family member. Patient participants had varying spinal cord injuries from AIS A-D. Two major themes were identified from the interviews. The first major theme was physician demeanor (general approach and attitude towards patients) and the second major theme was delivery of information (content, timing, and source). CONCLUSIONS This study summarizes the preferences of patients who sustained a tSCI discussions regarding their diagnosis and prognosis in the acute care setting. The goal of this study is to help guide physician interactions at this difficult and vulnerable time for patients with hopes to improve patient care through effective communication.
Collapse
|
8
|
Swaffield E, Cheung L, Khalili A, Lund E, Boileau M, Chechlacz D, Musselman KE, Gauthier C. Perspectives of people living with a spinal cord injury on activity-based therapy. Disabil Rehabil 2021; 44:3632-3640. [PMID: 33561372 DOI: 10.1080/09638288.2021.1878293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Activity-Based Therapy (ABT) targets recovery of function below the injury level in individuals with spinal cord injury (SCI). This qualitative study is the first to capture the perspectives of individuals with SCI on community ABT programs in Canada. METHODS Ten participants (6 males, aged 23.0-65.0 years, 2.5-23.0 years post-SCI) were recruited using purposive sampling, and completed semi-structured interviews. Interview questions explored benefits and challenges, facilitators and barriers to access, and motivations for participating in ABT. Themes were identified using conventional content analysis and collaboratively analyzed using the DEPICT model. RESULTS An overarching theme of ABT as a key part of participants' evolving and lifelong recovery process emerged. Motivations for initiating ABT included dissatisfaction with early rehabilitation, and a desire to improve function and stay active. Participants perceived that ABT contributed to neurological recovery, physical and mental health benefits, independence, and hope. Factors contributing to recovery and factors limiting accessibility and participation in ABT were identified. Participants discussed advocating for ABT, and how ABT empowered self-management. CONCLUSIONS ABT was perceived to play a significant role in promoting ongoing recovery and well-being in individuals with SCI. Addressing limitations in awareness and availability of ABT may improve participation in ABT programs.Implications for rehabilitationActivity-Based Therapy (ABT) targets recovery of function and sensation below the level of injury in individuals with spinal cord injury (SCI).ABT plays a key role in the evolving and lifelong recovery process of individuals with SCI.Participants reported that ABT has a positive impact on physical, functional, and psychosocial domains, leading to improved independence and quality of life.Awareness and availability of ABT remain limited, highlighting a need to further explore and address factors limiting access to this therapy.
Collapse
Affiliation(s)
- Emma Swaffield
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Lovisa Cheung
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Avideh Khalili
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Emily Lund
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Michelle Boileau
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Damian Chechlacz
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cindy Gauthier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,KITE, Toronto Rehabilitation Institute- University Health Network, Toronto, Canada
| |
Collapse
|
9
|
|
10
|
Badenhorst M, Verhagen E, Lambert M, van Mechelen W, Brown J. When This Happens, You Want the Best Care: Players' Experiences of Barriers and Facilitators of the Immediate Management of Rugby-Related Acute Spinal Cord Injury. QUALITATIVE HEALTH RESEARCH 2019; 29:1862-1876. [PMID: 30864491 DOI: 10.1177/1049732319834930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.
Collapse
Affiliation(s)
- Marelise Badenhorst
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Evert Verhagen
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Federation University Australia, Ballarat, Victoria, Australia
| | - Mike Lambert
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Willem van Mechelen
- University of Cape Town, Cape Town, South Africa
- Amsterdam UMC, VU University, Amsterdam, The Netherlands
- The University of Queensland, Brisbane, Queensland, Australia
- University College Dublin, Dublin, Ireland
| | - James Brown
- Stellenbosch University, Stellenbosch, South Africa
- International Olympic Committee Research Centre, Cape Town, South Africa
| |
Collapse
|
11
|
Ozyemisci-Taskiran O, Coskun O, Budakoglu II, Demirsoy N. Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey. J Spinal Cord Med 2018; 41:347-354. [PMID: 28387153 PMCID: PMC6055950 DOI: 10.1080/10790268.2017.1311463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
UNLABELLED Prior abstract publication: 2nd Medical Rehabilitation Congress; Nov 4-7, 2010; Ankara, Turkey Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors. DESIGN A cross sectional, qualitative study. SETTING Community. PARTICIPANTS Fourteen spinal cord injury survivors. INTERVENTIONS Subjects participated in a semi-structured interview about 'when', 'where' 'by whom' and 'how' they received and 'would' prefer to receive bad news. OUTCOME MEASURES Answers to 'how' questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary). RESULTS Eight participants (57%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them. CONCLUSION Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation.
Collapse
Affiliation(s)
- Ozden Ozyemisci-Taskiran
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey,Correspondence to: Ozden Ozyemisci-Taskiran, Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Maltepe Mah, Davutpasa Cad, No:4, Topkapı 34010, Zeytinburnu, Istanbul, Turkey.
| | - Ozlem Coskun
- Department of Medical Education, Gazi University School of Medicine, Ankara, Turkey
| | - Isil Irem Budakoglu
- Department of Medical Education, Gazi University School of Medicine, Ankara, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
| |
Collapse
|
12
|
Ozyemisci-Taskiran O, Budakoglu II, Coskun O, Demirsoy N. Breaking bad news to patients with spinal cord injury in Turkey - physiatrists' perspective. J Spinal Cord Med 2017; 40:423-431. [PMID: 27817247 PMCID: PMC5537959 DOI: 10.1080/10790268.2016.1234735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To explore Turkish physiatrists' experiences and opinions about breaking bad news (BBN) to patients with spinal cord injury (SCI). DESIGN A cross sectional study. SETTING Turkey. PARTICIPANTS Sixty-nine physiatrists completed a questionnaire about experiences and opinions regarding BBN and self-assessment of communication skills (CS). RESULTS Eleven percent of specialists and 53% of residents were trained on basic CS. All participants believed that physiatrists should play a role in BBN and the majority reported that they delivered the bad news in their clinic. Sixty-seven percent believed that the primary responsibility belongs to physiatrists. Sixty-eight percent reported that the most appropriate time for BBN is during rehabilitation. Self-assessments of CS were considered satisfactory in most steps of SPIKES protocol. Twenty percent told absolute truth to patients while 80% stated that they did so sometimes or partially. Only 41% confirmed that they do not use unrealistic statements to comfort patients. Fewer than 60% stated that they performed the most appropriate and excellent behaviors for items in "empathy" section. CONCLUSION Physiatrists had different opinions about the style of BBN. Self-assessments of CS were optimistic, however physiatrists were not fully satisfied with their empathy skills.
Collapse
Affiliation(s)
- Ozden Ozyemisci-Taskiran
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey,Correspondence to: Ozden Ozyemisci-Taskiran, Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Maltepe Mah, Davutpasa Cad, No:4, Topkapı 34010, Zeytinburnu, Istanbul, Turkey.
| | - Isil Irem Budakoglu
- Department of Medical Education, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozlem Coskun
- Department of Medical Education, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
13
|
Fichtenbaum J, Kirshblum S, Ruppert L, Flaum T, Spill GR, Mukherjee D. Prognosis Disclosure in Spinal Cord Injury. PM R 2017; 9:76-82. [DOI: 10.1016/j.pmrj.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
|
14
|
Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery. Int J Behav Med 2016; 23:714-721. [DOI: 10.1007/s12529-016-9567-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
15
|
Kirshblum SC, Botticello AL, DeSipio GB, Fichtenbaum J, Shah A, Scelza W. Breaking the news: A pilot study on patient perspectives of discussing prognosis after traumatic spinal cord injury. J Spinal Cord Med 2016; 39:155-61. [PMID: 25897890 PMCID: PMC5072497 DOI: 10.1179/2045772315y.0000000013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE/BACKGROUND In spinal cord injury (SCI) medicine, informing a patient with a neurologically complete SCI of the poor prognosis ("bad news") for significant neurological recovery (e.g. ambulation) is difficult. Few guidelines exist for clinicians and the wishes of patients in receiving this information are currently not known. The goal of this pilot study was to determine when, by whom, and in what setting persons with neurologically complete traumatic SCI want to hear of their prognosis. METHODS Subjects with a >3 months motor complete SCI above T10 were recruited to complete an online survey, from three geographically different acute rehabilitation centers, to obtain retrospective information on their experiences of receiving poor prognosis. A mixed methods approach was used to obtain data on individual experiences and a combination of quantitative and qualitative analyses was used to assess patterns in individual responses. RESULTS 60 individuals were recruited for the study and 56 participants completed the survey. Most heard their prognosis from a physician, in the acute care hospital (61%), with the patient initiating the conversation (64%). Patient recommendations reveal that most individuals with traumatic SCI prefer to be given the poor prognosis for neurological recovery by a physician and early after injury. There were no differences in patient experience nor recommendations based on demographic background (i.e. sex, age, race, or education level). CONCLUSION The majority of patients surveyed report wanting to know their prognosis early after injury and to hear the information by a physician in a clear and sensitive manner. This study marks the first step towards defining how and when to break the news regarding poor prognosis for neurological recovery including ambulation after severe (neurological complete) traumatic SCI from the patients' perspective.
Collapse
Affiliation(s)
- Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Correspondence to: Steven C. Kirshblum, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
| | - Amanda L. Botticello
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Gina Benaquista DeSipio
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joyce Fichtenbaum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Akshat Shah
- Santa Clara Valley Medical Center, San Jose, CA, USA
| | | |
Collapse
|
16
|
|
17
|
Cushman DM, Thomas K, Mukherjee D, Johnson R, Spill G. Perceived Quality of Life With Spinal Cord Injury: A Comparison Between Emergency Medicine and Physical Medicine and Rehabilitation Physicians. PM R 2015; 7:962-969. [DOI: 10.1016/j.pmrj.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/03/2015] [Accepted: 03/07/2015] [Indexed: 11/17/2022]
|
18
|
Abbaszadeh A, Ehsani SR, begjani J, Kaji MA, Dopolani FN, Nejati A, Mohammadnejad E. Nurses' perspectives on breaking bad news to patients and their families: a qualitative content analysis. J Med Ethics Hist Med 2014; 7:18. [PMID: 25512837 PMCID: PMC4263382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/22/2014] [Indexed: 10/29/2022] Open
Abstract
Breaking bad news is quite often not done in an effective manner in clinical settings due to the medical staff lacking the skills necessary for speaking to patients and their families. Bad news is faced with similar reactions on the part of the news receiver in all cultures and nations. The purpose of this study was to explore the perspectives of Iranian nurses on breaking bad news to patients and their families. In this research, a qualitative approach was adopted. In-depth and semi-structured interviews were conducted with 19 nurses who had at least one year work experience in the ward, and content analysis was performed to analyze the data. Five major categories emerged from data analysis, including effective communication with patients and their families, preparing the ground for delivering bad news, minimizing the negativity associated with the disease, passing the duty to physicians, and helping patients and their families make logical treatment decisions. The results of this study show that according to the participants, it is the physicians' duty to give bad news, but nurses play an important role in delivering bad news to patients and their companions and should therefore be trained in clinical and communicative skills to be able to give bad news in an appropriate and effective manner.
Collapse
Affiliation(s)
- Abbas Abbaszadeh
- Professor, Department of Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Roghayeh Ehsani
- Department of Nursing, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamal begjani
- PhD candidate in Nursing, Department of Nursing Education, Islamic Azad University, Iranshahr Branch, Iranshahr, Iran
| | - Mohammad Akbari Kaji
- PhD candidate in Nursing, Isfahan University of Medical Sciences, and Young Researchers Club, Islamic Azad University, Isfahan Branch (Khoorasgan), Isfahan, Iran
| | | | - Amir Nejati
- Assistant Professor, Department of Emergency Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadnejad
- PhD candidate in Nursing, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Esmaeil Mohammadnejad, Address: First Floor, No. 9, Kavusi Alley, Urmia St, South Eskandari St, Tehran, Iran., , Tel: 98 21 66 93 66 26, Fax: 98 21 66 93 66 26
| |
Collapse
|
19
|
Litchke LG, Lloyd LK, Schmidt EA, Russian CJ, Reardon RF. Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study. Top Spinal Cord Inj Rehabil 2013; 18:264-72. [PMID: 23459144 DOI: 10.1310/sci1803-264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on health-related quality of life (HRQoL) in wheelchair rugby (WR) athletes. METHOD Twenty-four male WR athletes (22 with tetraplegia, 1 with a spastic cerebral palsy, and 1 with congenital upper and lower limb deformities) were matched by lesion level, completeness of injury, and rugby classification prior to being randomly assigned to 1 of 3 groups: (1) CPTR (n=8), (2) CFR (n=8), or (3) controls (CON, n=8). Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 (SF-36v2). Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises. RESULTS Sixteen participants completed the study (CPTR=4, CFR=5, CON=7). The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain (P = .038) and improvements in vitality (P = .028) for CFR versus CON. CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL (eg, vitality and bodily pain) in WR athletes. Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes.
Collapse
|
20
|
Sexton D. ‘As Good as it's Going to Get’. Bad News Conversations in Neurology: Challenges for Occupational Therapists. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13706169932860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: This exploratory study sought to answer the question, ‘What are the experiences of neurological occupational therapists when having bad news conversations with disabled people regarding likely levels of long-term disability?’. Method: The study design was a retrospective qualitative method within a phenomenological methodology. Convenience sampling was used to identify occupational therapists working with neurologically impaired adults. Ten semi-structured interviews using a topic guide were conducted. Ethical approval was granted by the Faculty Research Ethics Committee. Findings: Participants had bad news conversations prior to discharge and there was a functional focus. Four approaches to these conversations emerged: collaboration, being direct, avoidance and using a client-centred approach. Strategies included use of pre-discharge home visit, goal setting, using others, maintaining hope and communication skills. The participants agreed that this task has an emotional cost. Conclusion: Bad news conversations are an important and sometimes difficult clinical task that can have an impact on the quality of the therapeutic relationship. Little has been documented regarding occupational therapists' conversations relating to living with long-term disability. This study has underlined the importance of addressing this task in undergraduate education and also in the supervision of junior occupational therapists.
Collapse
|
21
|
Cordesse V, Jametal T, Guy C, Lefebvre S, Roussel M, Ruggeri J, Schimmel P, Holstein J, Meininger V. [Analysis of clinical pathway in changing and disabling neurological diseases]. Rev Neurol (Paris) 2013; 169:476-84. [PMID: 23623808 DOI: 10.1016/j.neurol.2012.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/12/2012] [Accepted: 12/05/2012] [Indexed: 12/13/2022]
Abstract
Neurological diseases are characterized by the complexity of care and by a constant and changing disability. More and more frequently, their impact on the clinical pathway remains unknown. Seven postgraduate rehabilitation students (Master coordination du handicap, université Pierre-et-Marie-Curie, Paris) reconstructed the clinical pathway of 123 patients with various neurological diseases: multiple sclerosis, Alzheimer disease, amyotrophic lateral sclerosis, spinal trauma, Parkinson disease and brain tumors. There was a significant correlation between disease duration and the number of specialists involved in care, the number of prescribed drugs and the number of short-term hospitalizations; there was no correlation with age. This result suggests that with time an increasing number of complications related to the initial neurological disease developed. Hospitalization in rehabilitation units was highly correlated with the degree of disability and also with the help received by the patients during the course of their disease. This result suggests that these hospitalizations were a direct consequence of burn out among relatives. General practitioners (GP) were highly involved only during the initial part of the pathway, and their involvement rapidly declined thereafter, suggesting a probable relation with the specificities and the complexity of care for neurological diseases which induces a progressive transfer of responsibilities from the GP to the hospital. Social care was always incomplete and occurred too late during the course of the disease. The feeling by the patients that their care pathway was chaotic was highly correlated with the quality of the information given to the patient at the time of the announcement of their disease. This study confirms that cares for neurological diseases is highly specific and that expert centers and coordination networks are in a key position to ensure an efficient care pathway.
Collapse
Affiliation(s)
- V Cordesse
- Réseau SLA Île-de-France, bâtiment clinique médicale, hôpital de la Salpêtrière, 47/83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Adeleye AO, Fatiregun AA. Is breaking of bad news indeed unacceptable to native Africans? A cross-sectional survey of patients in a Nigerian neurosurgical service. Acta Neurol Scand 2013; 127:175-80. [PMID: 22712437 DOI: 10.1111/j.1600-0404.2012.01694.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Breaking of bad news is anecdotally deemed to be culturally unacceptable, even intolerable, to native Africans. We sought whether this hypothesis could be formulated among a cohort of patients who had difficult diagnoses given them in a Nigerian neurosurgical service. MATERIALS AND METHODS A semi-structured, interviewer-administered questionnaire was used in a cross-sectional survey among a consecutive cohort of patients on their opinion and preferences regarding the full disclosure of the grave prognoses of their difficult neurosurgical diagnoses. RESULTS A total of 109 patients, 74 (67.9%) males, were sampled over a one-and-half-year period. They were mainly young adults, mean age of 40.2 (SD 14.2) years; more than half of them, 56%, had only basic literacy education, but the majority, 99.1%, declared themselves to have serious religious commitments. Less than 3% of the study participants chose not to receive their medical bad news whilst the majority who preferred to have the full disclosure of their medical diagnosis wanted their relations around during the process in 88%, and indeed, 91% would not be happy to be kept in the dark by their knowing relations. Finally, whilst the majority (98%) did not see the prospects of getting any governmental support, hope in God (88%) and family support (40%) were the means by which they expected to cope with the realities of their new futures. CONCLUSIONS This data-driven study showed that contrary to anecdotal belief breaking bad news was not intolerable to a cohort of native Nigerian-African patients in a neurosurgical practice.
Collapse
Affiliation(s)
- A. O. Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine; University of Ibadan; Ibadan; Nigeria
| | - A. A. Fatiregun
- Department of Epidemiology, Medical Statistics and Environmental Health, College of Medicine; University of Ibadan; Ibadan; Nigeria
| |
Collapse
|
23
|
Shimizu K, Ogura H, Irisawa T, Nakagawa Y, Kuwagata Y, Shimazu T. Communicating by electrolarynx with a blind tetraplegic spinal cord injury patient on mechanical ventilation in the ICU. Spinal Cord 2013; 51:341-2. [PMID: 23357929 DOI: 10.1038/sc.2012.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Single-subject case. OBJECTIVES To describe the atypical presentation of communication with a blind tetraplegic spinal cord injury patient on a respirator using an electrolarynx. SETTING Critical care center in Osaka, Japan. METHODS A 53-year-old blind man with tetraplegic spinal cord injury was admitted to our center. It was difficult for him to express his desires and to communicate with others about his severe condition and other details of his care. We began to use an electrolarynx to communicate with this patient because he could move his mouth. RESULTS With use of the electrolarynx, the patient gradually became better able to speak fluently by electrolarynx on the first day of use. The electrolarynx allowed us and his family to communicate with him. He was pleased with the improvement in communication. CONCLUSION An electrolarynx is a useful method for communicating with blind tetraplegic spinal cord injury patients on mechanical ventilation.
Collapse
Affiliation(s)
- K Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Chang CL, Park BK, Kim SS. Conversational analysis of medical discourse in rehabilitation: a study in Korea. J Spinal Cord Med 2013; 36:24-30. [PMID: 23433331 PMCID: PMC3555101 DOI: 10.1179/2045772312y.0000000051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The purpose of this study is to conduct an analysis of actual communicative behaviors, including nonverbal ones, between physicians and patients in rehabilitation. DESIGN Sixteen videotaped physician-patient interactions in a rehabilitation center in Korea were transcribed. And three coders placed utterances in transcripts into categories while watching the videotapes. RESULTS Consistent with results of previous studies, patient active communicative behaviors varied considerably depending on individual patients. The findings revealed that, on average, patients' active communicative behaviors were less than 9% of patients' total utterances. In particular, almost half of the patients (N = 7) did not even ask one single question. The results also showed that physicians' empathic communicative acts averaged less than 3% of physicians' total utterances. In addition, among physicians' nonverbal behaviors, eye-contact showed significant correlation with physician empathic listening and supportive talks. CONCLUSIONS The findings of this study indicated a considerable lack of empathic communicative behaviors of physicians in Korea. This might have led to infrequent use of active communicative behaviors by patients. In addition, the importance of physician's partnership for enhancement of active communicative behaviors of patients was demonstrated. To better serve patients, physicians who wish to improve their communication should first identify components of their empathic communicative behaviors that need improvement and then attempt to refine their skills.
Collapse
Affiliation(s)
- Chulhun Ludgerus Chang
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea
| | | | | |
Collapse
|
25
|
Feng SQ, Kong XH, Liu Y, Ban DX, Ning GZ, Chen JT, Guo SF, Wang P. Regeneration of spinal cord with cell and gene therapy. Orthop Surg 2012; 1:153-63. [PMID: 22009833 DOI: 10.1111/j.1757-7861.2009.00018.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Transplantation of fetal spinal cord cells (FSCC) can promote regeneration of injured spinal cord, while Schwann cells (SC) and some growth factors have a similar effect. However, the synergistic effects and optimal combination of these modalities have not yet been evaluated. In the current study, the efficiency of cell therapy of FSCC and/or SC, with/without growth factors (nerve growth factor [NGF] and brain-derived neurotrophic factor [BDNF]) was examined, with the aim of establishing an optimized protocol for spinal cord injury. METHODS One hundred and twenty adult rats were randomly divided into six groups with 20 rats in each group. One week after the thoracic spinal cord injury model had been created, the rats were treated with different therapeutic modalities: Dulbecco's modified Eagles medium (DMEM) in Group I, FSCC in Group II, FSCC plus SC in Group III, FSCC plus SC over-expressing NGF in Group IV, FSCC plus SC over-expressing BDNF in Group V, and FSCC plus SC over-expressing both NGF and BDNF in Group VI. Subsequently, the rats were subjected to behavioral tests once a week after injury, while histology, immunohistochemistry and electron microscopy were performed at one and three month post-operation. RESULTS Both SC and FSCC promoted regeneration of spinal cord injury when used separately, while a combination of the two types of cell resulted in better recovery than either alone. Both growth factors (NGF and BDNF) enhanced the outcomes of cell therapy, while synergistic effects meant that a combination of each individual component (group VI) achieved the best results according to locomotion scale, histology and immunoreactivity in the injured cords. CONCLUSION SC, NGF and BDNF can enhance the outcome of FSCC therapy, while the combination of FSC with SC, NGF and BDNF is possibly the optimal protocol for clinical treatment of acute spinal cord injury.
Collapse
Affiliation(s)
- Shi-qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Ditunno JF, Cardenas DD, Formal C, Dalal K. Advances in the rehabilitation management of acute spinal cord injury. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:181-95. [PMID: 23098713 DOI: 10.1016/b978-0-444-52137-8.00011-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aggressive assessment and management of the secondary complications in the hours and days following spinal cord injury (SCI) leads to restoration of function in patients through intervention by a team of rehabilitation professionals. The recent certification of SCI physicians, newly validated assessments of impairment and function measures, and international databases agreed upon by SCI experts should lead to documentation of improved rehabilitation care. This chapter highlights recent advances in assessment and treatment based on evidence-based classification of literature reviews and expert opinion in the acute phase of SCI. A number of these reviews are the product of the Consortium for Spinal Cord Medicine, which offers clinical practice guidelines for healthcare professionals. Recognition of and early intervention for problems such as bradycardia, orthostatic hypotension, deep vein thrombosis/pulmonary embolism, and early ventilatory failure will be addressed although other chapters may discuss some issues in greater detail. Early assessment and intervention for neurogenic bladder and bowel function has proven effective in the prevention of renal failure and uncontrolled incontinence. Attention to overuse and disuse with training and advanced technology such as functional electrical stimulation have reduced pain and disability associated with upper extremity deterioration and improved physical fitness. Topics such as chronic pain, spasticity, sexual dysfunction, and pressure sores will be covered in more detail in additional chapters. However, the comprehensive and integrated rehabilitation by specialized SCI teams of physicians, nurses, therapists, social workers, and psychologists immediately following SCI has become the standard of care throughout the world.
Collapse
Affiliation(s)
- John F Ditunno
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
27
|
Kim HR, Shin HI. When is it appropriate to deliver a prognosis to Korean persons with acute spinal cord injury? Disabil Rehabil 2011; 34:1396-403. [PMID: 22149015 DOI: 10.3109/09638288.2011.637605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE In cases of complete spinal cord injury (SCI), which has a poor probability of recovery, the timely delivery of a prognosis may be crucial to help patients adapt to their situation. The study aimed to help for choose the appropriate time for delivering a prognosis to persons with SCI. METHOD Three hundred and four members of the Korean SCI Association with complete SCI were surveyed regarding the time at which their prognosis was communicated and their views about the appropriate time for prognosis delivery. Demographic and injury characteristics were also collected. Respondents' experience and opinions on prognosis communication were analysed to assess potential associations with demographic and injury profiles. RESULTS Participants' opinions regarding the time of prognosis delivery varied. Many respondents (44.1%) reported that the appropriate time would be within 1 month postinjury, whereas the others felt it should occur either between 1 and 3 months (29.3%) or more than 3 months (10.2%). The comparison of time of prognosis communication with the opinions showed that most would have preferred an earlier delivery of prognosis than they had experienced. CONCLUSIONS Our findings provide insight to physicians on the appropriate time for delivering a prognosis to individuals with complete SCI.
Collapse
Affiliation(s)
- Hye-Ri Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Republic of Korea
| | | |
Collapse
|
28
|
Abstract
How to deliver bad news to patients is a crucial part of medical practice. Many neurological diseases are incurable, progressive and result in physical or cognitive disabilities, which pose special challenges in the process of communication. Information about diagnosis, therapy and prognosis should be given in an appropriate setting and tailored to the patient's needs and cognitive level of functioning. Support and advice to the family and a team-oriented approach in the follow-up of neurological patients are of high importance. Patient autonomy, truth disclosure expectations and the access to other sources of information is important aspects that influence communication. There is a need for a special and continuous focus on communication in the education of neurologists with regard to the specific needs of this field. Attention should be given to the consequences of neurological disease as well as to therapy and prognosis.
Collapse
Affiliation(s)
- A Storstein
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|