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Terrasson J, Rault A, Seigneur É, Doz F, Dolbeault S, Brédart A. [Announcing treatment resistance in pediatric oncology: A qualitative study of nurses' experiences]. Bull Cancer 2022; 109:1154-1161. [PMID: 35985866 DOI: 10.1016/j.bulcan.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The announcement of treatment resistance is a key moment in the management of children treated for cancer. Although nurses are present at various stages of this announcement, few studies have examined their role and experience. This study proposes to enhance understanding of the experience of nurses at this time of the pediatric cancer trajectory in France. METHOD A qualitative study was conducted in two pediatric oncology departments. Semi-structured research interviews were conducted with seven pediatric nurses (five women) with an average age of 36.9 years. RESULTS Nurses report not being systematically present during announcements of treatment resistance but being present with the families before and after these announcements. Nurses described their role at this point in the management process as multifaceted. The emotional burden associated with these announcements is significant: nurses must manage their own emotions when faced with the discovery of resistance to treatment, those of the families, and must often answer difficult questions about the prognosis or end of life. In this context, teamwork is an important support. DISCUSSION Better awareness and recognition of the role of nurses and the associated emotional burden would enable them to fully carry out their missions.
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Affiliation(s)
- Johanna Terrasson
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France.
| | - Aude Rault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France
| | - Étienne Seigneur
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France
| | - François Doz
- Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; Institut Curie, UMR 144 CNRS, 75005 Paris, France
| | - Sylvie Dolbeault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université Paris-Saclay, centre de recherche en épidémiologie et santé des populations (CESP), U1018, Inserm, 94807 Villejuif, France
| | - Anne Brédart
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université de Paris, laboratoire psychopathologie et processus de santé, 92100 Boulogne-Billancourt, France
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2
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Walker L, Sivell S. Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2081-2088. [PMID: 35193783 DOI: 10.1016/j.pec.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques. METHODS BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis. RESULTS Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure. CONCLUSION Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central. PRACTICE IMPLICATIONS BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.
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Affiliation(s)
- Louise Walker
- Cardiff University, Wales, UK; Greys Hospital, Private Bag 9001, Pietermaritzburg 3200, KwaZulu Natal, South Africa.
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
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3
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Rayan A, Hussni Al-Ghabeesh S, Qarallah I. Critical Care Nurses’ Attitudes, Roles, and Barriers Regarding Breaking Bad News. SAGE Open Nurs 2022; 8:23779608221089999. [PMID: 35434304 PMCID: PMC9008854 DOI: 10.1177/23779608221089999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
This study examines critical care nurses’ attitudes, roles, experience, education, and barriers regarding breaking the bad news. A descriptive, cross-sectional design was used in this study. A convenience sample of 210 critical care nurses completed the study. Most of the critical care nurses contributed to breaking bad news and they were involved in different roles in this process and they had a positive attitude regarding breaking bad news. In this study, (75.2%) of the participants reported that they did not receive any specific training regarding breaking bad news. In addition, nurses face various barriers when breaking bad news. Critical care nurses’ involvement in breaking bad news should be encouraged. Most barriers to BBN were negatively associated with nurses’ roles, attitudes, and experiences during BBN. Administrators should promote the involvement of critical care nurses in breaking bad news and strengthen them through addressing the challenges they face in the process of BBN.
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Affiliation(s)
- Ahmad Rayan
- Zarqa University, Faculty of Nursing. Zarqa, Jordan
| | | | - Islam Qarallah
- Master program in Faculty of Nursing, Al-Zaytoonah University of Jordan and work as critical care nurse in Royal medical services. Amman, Jordan
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4
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McBrien B. Assessment and management of metastatic bone cancer in emergency departments. Emerg Nurse 2021; 29:20-25. [PMID: 33231019 DOI: 10.7748/en.2020.e2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
A cancer diagnosis in emergency departments (EDs) is often associated with advanced or metastatic cancer. Patients with bone metastases have a complex range of physical and psychological needs. Meeting the needs of patients with cancer is an important part of the role of emergency nurses, but evidence suggests that they often do not feel adequately prepared to provide effective care for this patient group. This article uses a case study of a patient who presented to an ED with metastatic cancer in his right lower limb, to provide an overview of bone metastases, including the relevant anatomy, pain management and psychological support. The article also outlines the signs and symptoms of bone metastases and discusses patient assessment, symptom management and available treatments.
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Affiliation(s)
- Barry McBrien
- Emergency Department, Tallaght University Hospital, Dublin, Ireland
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5
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Rupp SK, Stengel A. Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer-A Systematic Review. Front Psychiatry 2021; 12:656929. [PMID: 34276435 PMCID: PMC8280526 DOI: 10.3389/fpsyt.2021.656929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Gastric cancer (GC) is one of the leading causes of death worldwide. It is associated with several disease-related impairments contributing to the psycho-social burden of those patients, such as deterioration of well-being and overall quality of life (QOL). The aim of this study is to present the wide range of factors potentially impacting patients' overall well-being and possible preventive interventions. Methods: This systematic review was conducted in October 2020 with a search in the PubMed, MedLine, PsycInfo, and Google Scholar databases. We used the keywords "gastric cancer," "gastric neoplasm," and each of them combined with "quality of life," "depression," and "anxiety" to identify all relevant articles reporting about potential impact factors influencing the overall well-being of patients suffering from gastric cancer. Results: Finally, 125,490 articles were found, of which 125,431 were excluded in several steps of screening. Inclusion criteria were studies carried out on human ≥18 years of age, studies in English or German language, clinical trials, registry-based studies, cohort studies, population-based studies, and certain titles and abstracts. After screening for eligibility 35 potential factors influencing overall well-being in patients with GC were identified and classified into 9 important categories: genetic condition, treatment method, blood markers, nutritional status, daily living, state of health, mental state, supportive care, and alternative treatment. Conclusion: Since various factors are involved in the development of patients' overall well-being, timely treatment of psycho-social impairments by physicians and psychologists is of enormous importance. Preventing psycho-social burden by improving patients' QOL should be of high importance in the treatment regimen of patients with GC.
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Affiliation(s)
- Sophia Kristina Rupp
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Section Psychooncology, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Hsu TH, Li IC, Fang CK, Tang WR, Lin CT. A preliminary study of the effectiveness of cancer communication skills training for interdisciplinary staff. Jpn J Clin Oncol 2020; 49:734-742. [PMID: 31063193 DOI: 10.1093/jjco/hyz065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/27/2019] [Accepted: 04/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies have emphasized that the disclosure of a diagnosis and prognosis is the doctor's responsibility, but little attention has been given to the importance of interdisciplinary cooperation. OBJECTIVE Therefore, this study examined and compared the effectiveness of cancer communication skills training (CST) for doctors and interdisciplinary staff in Taiwan. METHODS This study utilized a quasi-experimental design. The participants were 124 oncology professionals who participated in cancer CST. These 124 professionals included a group of 65 doctors and a group of 59 interdisciplinary professionals, both of which received the same CST. After the participants have received CST, the changes in their disease disclosure skills were evaluated. RESULTS Significant pretest-posttest differences were observed in the overall truth-telling scores for both groups (doctors: t = 6.94, P < 0.001; interdisciplinary professionals: t = 7.71, P < 0.001) and in different constructs. However, in many items, the doctors demonstrated no progress after receiving the training (P > 0.05), whereas the interdisciplinary professionals demonstrated significant progress (P < 0.05). In particular, the doctors' scores for 'disclosing information in a monotonous tone' showed significant retrogression (P < 0.05). There were no significant differences in the overall truth-telling scores of the two groups with regard to pre- and post-CST (P > 0.05 and P > 0.05, respectively), and there were also no significant differences in the four sub-scales' scores. CONCLUSION The CST for interdisciplinary professionals improved their cooperation and communication skills.
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Affiliation(s)
- Tsui-Hsia Hsu
- School of Nursing, National Yang-Ming University, Taiwan.,Health Promotion Administration, Ministry of Health and Welfare
| | - I-Chuan Li
- School of Nursing, National Yang-Ming University, Taiwan
| | - Chun-Kai Fang
- Department of Psychiatry and Suicide Prevention Center.,Department of Medicine, Mackay Medical College, New Taipei.,Mackay Memorial Hospital, Taipei.,Taiwan Psycho-Oncology Society
| | - Woung-Ru Tang
- Taiwan Psycho-Oncology Society.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan
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7
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Newman AR, Callahan MF, Lerret SM, Oswald DL, Weiss ME. Pediatric Oncology Nurses' Experiences With Prognosis-Related Communication. Oncol Nurs Forum 2019; 45:327-337. [PMID: 29683123 DOI: 10.1188/18.onf.327-337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine nurses' experiences of prognosis-related communication (PRC) with parents of children with cancer. SAMPLE & SETTING Cross-sectional, correlational study in the pediatric oncology setting involving 316 members of the Association of Pediatric Hematology/Oncology Nurses. METHODS & VARIABLES Online survey regarding individual nurse factors, PRC, interprofessional collaboration, moral distress, and perceived quality of care. RESULTS Nurses strongly agreed that prognostic disclosure is critical for decision making, but they are challenged in determining their role. Nurses with more years of experience and training in PRC, those working in an outpatient setting, and those with higher levels of nurse-physician collaboration reported more positive experiences with PRC. Positive experiences with PRC and collaboration were significantly associated with higher nurse-perceived quality of care and reduced nurse moral distress. IMPLICATIONS FOR NURSING Nurses should work to be active participants in the process of PRC by collaborating with physician colleagues. When nurses sense that prognostic discussions have been absent or unclear, they should feel confident in approaching physician colleagues to ensure parent understanding and satisfaction with communication.
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8
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Klint K, Sjöland H, Axelsson ÅB. Revealed by degrees: Patients' experience of receiving information after in-hospital cardiac arrest. J Clin Nurs 2018; 28:1517-1527. [PMID: 30589946 DOI: 10.1111/jocn.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/16/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of receiving information about the event after having a cardiac arrest in hospital. BACKGROUND In Sweden, approximately 2,600 people per year experience cardiac arrest in hospital. After a cardiac arrest, the patient is entitled to receive information about what has occurred. This information must be provided in a way that does not do the patient more harm than good. In order to provide information to patients in a satisfactory manner for them, knowledge about how patients react to information in this situation is valuable. DESIGN We used a qualitative approach with interviews and content analysis. METHODS Twenty patients participated in face-to-face interviews analysed by content analysis. Consolidated criteria for reporting qualitative studies were used. RESULTS The analysis resulted in three categories: Getting the information gradually, Understanding information received and Seeking clarity. The subcategories that emerged were as follows: Indirect information, Short and direct information, Explanatory information, Lack of information, Unsatisfactory information, Hard-to-understand information, Insight, Unanswered questions, Hard-to-formulate questions, Requesting information and Searching independently for knowledge. CONCLUSIONS The patients needed gradual and repeated information during their hospitalisation, and repeated information was continually required after their discharge from hospital. Whether or how the information was given varied. The patients' experience was that they sometimes lacked opportunities for conversation and asking questions, while they also found it hard to formulate questions. Patients who have a cardiac arrest in hospital appear to have similar information needs to patients whose cardiac arrest takes place outside the hospital context. RELEVANCE TO CLINICAL PRACTICE Information on the patient's cardiac arrest should be given in gradual stages, according to the patient's needs. The information needs to be repeated during the hospital stay and after discharge. Healthcare professional should gain insight into patients' responses and create information that is adapted to the individual.
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Affiliation(s)
- Kjell Klint
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helen Sjöland
- Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Åsa B Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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9
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The child doesn't hear? On breaking bad news as perceived by parents and audiologists. Int J Pediatr Otorhinolaryngol 2018; 112:113-120. [PMID: 30055719 DOI: 10.1016/j.ijporl.2018.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The object of this study was to explore how parents experienced receiving the news of their child's hearing loss, and how audiologists experienced the situation of conveying the diagnosis, in order to examine improvements to the current process. METHOD A questionnaire regarding different aspects of breaking the news was developed. 48 Arabic and Hebrew speaking parents of hearing impaired children answered the questionnaire. A similar questionnaire was filled out by 31 audiologists. RESULTS Findings demonstrate parents' general satisfaction with the manner in which the diagnosis was delivered. According to the parents' reports, receiving the diagnosis evoked negative feelings of fear, depression and difficulty believing the diagnosis. Parents' feelings were influenced by their cultural background, such as their ethnic identity, religious practice and difficulties due to language barriers. The audiologists described concern and anxiety when breaking bad news, but they felt they were able to present the diagnosis. The audiologists felt that they were not trained in this aspect, and the ability was acquired through experience. Both parents and audiologists agreed that the audiologist should be the professional to deliver the diagnosis. All emphasized sensitivity and professionalism as necessary qualities. Whereas audiologists were of the opinion that the most important information to transmit was the type of hearing loss, the parents were most interested in discussing their feelings, the rehabilitation process, and talking to other parents. CONCLUSIONS Overall, results reveal that breaking bad news of a child's hearing loss has been done fairly well. Due to the parents' reports of the need for emotional support, it is suggested that audiologists receive further training and adjust to personal and cultural differences. Recommendations include establishing an appropriate setting and ensuring that an interpreter is available when necessary. Further emotional support may be provided through establishment of a family support network.
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10
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The Differences in Preference for Truth-telling of Patients With Cancer of Different Genders. Cancer Nurs 2018; 41:320-326. [DOI: 10.1097/ncc.0000000000000513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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.
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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
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Banerjee SC, Manna R, Coyle N, Penn S, Gallegos TE, Zaider T, Krueger CA, Bialer PA, Bylund CL, Parker PA. The implementation and evaluation of a communication skills training program for oncology nurses. Transl Behav Med 2018; 7:615-623. [PMID: 28211000 DOI: 10.1007/s13142-017-0473-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Many nurses express difficulty in communicating with their patients, especially in oncology settings where there are numerous challenges and high-stake decisions during the course of diagnosis and treatment. Providing specific training in communication skills is one way to enhance the communication between nurses and their patients. We developed and implemented a communication skills training program for nurses, consisting of three teaching modules: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging interactions with families. Training included didactic and experiential small group role plays. This paper presents results on program evaluation, self-efficacy, and behavioral demonstration of learned communication skills. Three hundred forty-two inpatient oncology nurses participated in a 1-day communication skills training program and completed course evaluations, self-reports, and pre- and post-standardized patient assessments. Participants rated the training favorably, and they reported significant gains in self-efficacy in their ability to communicate with patients in various contexts. Participants also demonstrated significant improvement in several empathic skills, as well as in clarifying skill. Our work demonstrates that implementation of a nurse communication skills training program at a major cancer center is feasible and acceptable and has a significant impact on participants' self-efficacy and uptake of communication skills.
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Affiliation(s)
- Smita C Banerjee
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Ruth Manna
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Nessa Coyle
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Stacey Penn
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Tess E Gallegos
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Talia Zaider
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Carol A Krueger
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Philip A Bialer
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.,Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
| | - Patricia A Parker
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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13
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Rosenberg AR, Starks H, Unguru Y, Feudtner C, Diekema D. Truth Telling in the Setting of Cultural Differences and Incurable Pediatric Illness: A Review. JAMA Pediatr 2017; 171:1113-1119. [PMID: 28873121 PMCID: PMC5675758 DOI: 10.1001/jamapediatrics.2017.2568] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Navigating requests from parents or family caregivers not to disclose poor prognosis to seriously ill children can be challenging, especially when the requests seem culturally mediated. Pediatric clinicians must balance obligations to respect individual patient autonomy, professional truth telling, and tolerance of multicultural values. OBSERVATIONS To provide suggestions for respectful and ethically appropriate responses to nondisclosure requests, we used a hypothetical case example of a Middle Eastern adolescent patient with incurable cancer and conducted an ethical analysis incorporating (1) evidence from both Western and Middle Eastern medical literature and (2) theories of cultural relativism and justice. While Western medical literature tends to prioritize patient autonomy and corresponding truth telling, the weight of evidence from the Middle East suggests high variability between and within individual countries, patient-physician relationships, and families regarding truth-telling practices and preferences. A common reason for nondisclosure in both populations is protecting the child from distressing information. Cultural relativism fosters tolerance of diverse beliefs and behaviors by forbidding judgment on foreign societal codes of conduct. It does not justify assumptions that all individuals within a single culture share the same values, nor does it demand that clinicians sacrifice their own codes of conduct out of cultural respect. We suggest some phrases that may help clinicians explore motivations behind nondisclosure requests and gently confront conflict in order to serve the patient's best interest. CONCLUSIONS AND RELEVANCE It is sometimes ethically permissible to defer to family values regarding nondisclosure, but such deferral is not unique to cultural differences. Early setting of expectations and boundaries, as well as ongoing exploration of family and health care professional concerns, may mitigate conflict.
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Affiliation(s)
- Abby R. Rosenberg
- Seattle Children’s Hospital, Cancer and Blood Disorders Center, Seattle, Washington2Seattle Children’s Research Institute, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington3Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Helene Starks
- Seattle Children’s Research Institute, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington3Department of Pediatrics, University of Washington School of Medicine, Seattle4Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle
| | - Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children’s Hospital at Sinai, Baltimore, Maryland6Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Chris Feudtner
- Department of Medical Ethics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania8Departments of Pediatrics, Ethics, and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Douglas Diekema
- Seattle Children’s Research Institute, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington3Department of Pediatrics, University of Washington School of Medicine, Seattle4Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle
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14
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Chircop D, Scerri J. Being diagnosed with cancer: The experiences of patients with non-Hodgkin's lymphoma. J Clin Nurs 2017; 26:4899-4904. [DOI: 10.1111/jocn.13967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Daren Chircop
- Department of Nursing; Faculty of Health Sciences; University of Malta; Msida Malta
| | - Josianne Scerri
- Department of Mental Health; Faculty of Health Sciences; University of Malta; Msida Malta
- Kingston University and St George's, University of London; London UK
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15
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Nurses' Perceptions of Diagnosis and Prognosis-Related Communication: An Integrative Review. Cancer Nurs 2017; 39:E48-60. [PMID: 27035358 DOI: 10.1097/ncc.0000000000000365] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disclosure of diagnostic and prognostic information has become the standard in the United States and increasingly around the world. Disclosure is generally identified as the responsibility of the physician. However, nurses are active participants in the process both intentionally and inadvertently. If not included in initial discussions regarding diagnosis and prognosis, the nurse may find it challenging to openly support the patient and family. OBJECTIVE The aim of this study is to synthesize published literature regarding nurses' perceptions and experiences with diagnosis and prognosis-related communication. METHODS The Whittemore and Knafl method guided the integrative review process. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Health Sciences in ProQuest, PubMed, and Web of Science were used to review the literature from 2000 to 2015. Constant comparison methods were used to analyze the data and develop themes. RESULTS Thirty articles met all of the inclusion criteria and were included in this review. Several themes emerged from the data, including the nurse's role in the process of diagnosis and prognosis-related communication, barriers and difficulties related to communication, and positive and negative outcomes. CONCLUSIONS Nurses play an integral role in the process of diagnostic and prognostic disclosure. Further exploration of both physician and patient perceptions of the nurse's role are needed. Interprofessional training regarding diagnosis and prognosis-related communication is essential to promote collaboration and better empower nurses in this process. IMPLICATIONS FOR PRACTICE Nurses should aim to purposefully partner with physician colleagues to plan and participate in diagnostic and prognostic discussions. Nurses should identify opportunities to improve their knowledge, understanding, and comfort with challenging conversations.
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Kugimoto T, Katsuki R, Kosugi T, Ohta A, Sato H. Significance of Psychological Stress Response and Health-related Quality of Life in Spouses of Cancer Patients When Given Bad News. Asia Pac J Oncol Nurs 2017; 4:147-154. [PMID: 28503648 PMCID: PMC5412153 DOI: 10.4103/2347-5625.204494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). Methods: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.
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Affiliation(s)
| | - Ryo Katsuki
- Deptartment of Anesthesiology, NHO Ureshino Medical Center, Ureshino, Japan
| | - Toshifumi Kosugi
- Deptartment of Palliative Care, Saga-ken Medical Center, Koseikan, Saga, japan
| | | | - Hidetoshi Sato
- Department of Comprehensive Community-based Palliative Care, Faculty of Medicine, Saga University Hospital, Saga University, Saga, Japan
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Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs 2017; 73:1632-1645. [PMID: 28072478 DOI: 10.1111/jan.13252] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
AIMS The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news. BACKGROUND The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN The study used a descriptive survey design involving self-reported written accounts and framework analysis. METHODS Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014. FINDINGS Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news. CONCLUSION The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jean Buchanan
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Mary Tod
- School of Nursing and Midwifery, The University of Sheffield, UK
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Tang WR, Hong JH, Rau KM, Wang CH, Juang YY, Lai CH, Fujimori M, Fang CK. Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices. Psychooncology 2016; 26:999-1005. [DOI: 10.1002/pon.4257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Kun-Ming Rau
- Department of Hematology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Hsu Wang
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chien-Hong Lai
- Department of Hematology; Chang Gung Memorial Hospital; Keelung Taiwan
| | - Maiko Fujimori
- Center for Suicide Prevention, National Institute of Mental Health; National Center for Neurology & Psychiatry; Tokyo Japan
| | - Chun-Kai Fang
- Department of Psychiatry, Suicide Prevention Center & Hospice and Palliative Care Center; MacKay Memorial Hospital; Taipei Taiwan
- Department of Medicine; MacKay Medical College; New Taipei Taiwan
- Department of Thanatology and Health Counseling; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
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Abstract
“Necessary evils” require employees to psychologically or physically harm others to produce a perceived greater good. Employees can also help others during necessary evils tasks by providing assistance and support to those harmed. Through an inductive, qualitative study of human resources employees’ experiences carrying out downsizing, we explore how the perception of helping the person one has harmed relates to the harm-doer’s ability to withstand the challenges of having to carry out necessary evils. Our research culminates in a theoretical model showing that (a) seven kinds of stressors were associated with participants’ involvement in necessary evils tasks, (b) these stressors triggered a series of negative personal outcomes (negative self-focused emotions, emotional exhaustion, and intention to turnover), and (c) perceived prosocial impacts ameliorated these negative personal outcomes. We discuss the implications our findings for research and practice, address limitations of our study, and offer ideas for future research.
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Affiliation(s)
| | | | - Rick Cotton
- University of Victoria, British Columbia, Canada
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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.
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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
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Role, perspective and knowledge of Iranian critical care nurses about breaking bad news. Aust Crit Care 2015; 29:77-82. [PMID: 26256781 DOI: 10.1016/j.aucc.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 05/24/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the issue of caring critically ill patients, nurses are involved in the process of breaking bad news in critical care units, while little research has been conducted on this challenging issue. OBJECTIVES The purpose of this study was to determine the role, perspective and knowledge of Iranian critical care nurses regarding breaking bad news. METHODS This descriptive study was conducted on a sample of 160 nurses working in critical care units of hospitals affiliated to Tehran University of Medical Sciences. Stratified and quota sampling methods were used. The data collection tool was a four-part questionnaire with validity and reliability confirmed via content validity and test-retest, respectively. RESULTS The study showed that most critical care nurses were involved in breaking bad news, with different roles. The majority of participants (91.2%) had a positive attitude towards involvement of nurses in breaking bad news. In this study, 78.8% of nurses had moderate knowledge about how to break bad news, and only a few had good level of knowledge (16.2%). CONCLUSION According to the findings, while critical care nurses took different roles in the process of breaking bad news and they had positive attitude towards participation in this process, yet their knowledge about this process was inadequate. Thus, designing educational programmes to enhance critical care nurses' knowledge and skills in this area seems necessary.
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Abstract
Patient empowerment is a patient-centered approach to care in which healthcare providers nurture patients' innate abilities to self-manage and incorporate patient goals for therapy into the overall management plan. Standard care of chronic myeloid leukemia (CML) requires lifelong medication with oral therapy and regular follow-up. The success of CML treatment, therefore, depends on a high degree of patient involvement and motivation, as well as strong collaboration between patients and healthcare providers. Oncology nurses can support patients with CML from the time of diagnosis to the end of treatment to ensure they maintain high levels of involvement in their care. At the author's center, patients who most actively collaborate with their physicians in treatment decisions take personal responsibility for the quality of their care and show good adherence to treatment. In the current article, the author discusses the potential effect of patient response to cancer diagnosis on clinical outlook and describes strategies in place at the cancer center to ensure that patients diagnosed with CML have the best chance at keeping their cancer under control.
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Newman AR, Helft PR. Reliability and Validity of a Tool to Assess Oncology Nurses' Experiences With Prognosis-Related Communication. Oncol Nurs Forum 2014; 42:64-73. [DOI: 10.1188/15.onf.64-73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schook RM, Linssen C, Festen J, Schramel FM, Lammers E, Zaanen P, Postmus PE. Website visitors asking questions online to lung cancer specialists: what do they want to know? Interact J Med Res 2013; 2:e15. [PMID: 23919980 PMCID: PMC3742407 DOI: 10.2196/ijmr.1749] [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: 02/01/2011] [Accepted: 06/03/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2003 the Dutch Lung Cancer Information Centre (Longkanker Informatie Centrum) launched a website containing information on lung cancer accessible to anyone. OBJECTIVE Our study aim was to inventorize the information needs of the visitors of this website by analyzing the questions they asked the lung cancer specialists in the websites interactive section "Ask the Physician". METHODS The first 2000 questions posted up until May 2006 have been classified by visitors' wish, type of required information, identity, gender, and phase during treatment course. RESULTS Our results show that 1893 (1158/1893, 61%) of the questions were asked by a loved one/caregiver and (239/1893 13%) by patients. 1 out of 3 questions was asked by a daughter/grand-daughter. Most questions concerned specific information on lung cancer and lung cancer course (817/1893, 43%). The most inquired specific information topics were therapy side effects, diagnostics, general information on lung cancer, and regular therapy. Furthermore, questioners wanted to verify their own doctor's information (122/1893, 6%), a diagnosis (267/1893, 14%), and a prognosis (204/1893, 11%). CONCLUSIONS Lung cancer patients and their caregivers asked the most questions in the interactive website section. The most frequently requested information was more detailed information. These include specific information on lung cancer (regular therapy, diagnostics, and disease symptoms), verification of what the doctor has said, diagnosis, and prognosis. Most of the requested information could have been obtained from treating specialists, indicating that current information supply to lung cancer patients and their caregivers may not be matching their needs sufficiently. The further implementation of an online dialogue with lung cancer specialists might be a solution.
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Affiliation(s)
- Romane M Schook
- VU University Medical Center, Department of Pulmonary Diseases, Amsterdam, Netherlands.
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Attitudes, beliefs and perceptions regarding truth disclosure of cancer-related information in the Middle East: a review. Palliat Support Care 2012; 11:69-78. [PMID: 23171758 DOI: 10.1017/s1478951512000107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this review is to evaluate the current status concerning attitudes, beliefs and/or practices of patients, family members, health professionals and/or caregivers regarding truth disclosure about a cancer diagnosis in the Greater Middle East countries. A search was done via MedLine for all publications related to this review objective. 55 publications were included emanating from Egypt, Iran, Israel, Jordan, Kuwait, Lebanon, Palestine Pakistan, Saudi Arabia, Turkey, and United Arab Emirates. In the Greater Middle East region, a diagnosis of cancer is still mixed with social stigma and misperceptions related to incurability. Physicians conserve a truth disclosure policy in which from one side they respect some of the historical and cultural misperceptions about cancer and accordingly, tell the truth about cancer to one of the family members and from another side acknowledge the patients' right to know the truth and tend to disclose it for him(or her) when possible. Family members and caregivers' attitudes, perceptions and beliefs about telling the truth to the patient seem to be in favor of concealment. Discrepant results concerning physicians' and patients' evaluation of the quality of truth disclosure exist in the literature. Education programs in breaking bad news are lacking in many countries. Finally, the most important and common problem affecting truth disclosure to a patient suffering from cancer is the lack of codes and legislations concerning the patients' rights in an informed consent. Studies, legislations and training programs are needed in this domain in Middle Eastern societies.
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Tabak N, Itzhaki M, Sharon D, Barnoy S. Intentions of nurses and nursing students to tell the whole truth to patients and family members. J Clin Nurs 2012; 22:1434-41. [PMID: 23134310 DOI: 10.1111/j.1365-2702.2012.04316.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate the intentions of nurses and nursing students to telling the truth to patients and families, based on the Theory of Planned Behavior which examines intention to perform behaviours. BACKGROUND In recent decades, the perception that patients have a moral and legal right to truthful and reliable information has become dominant. However, the study of telling the truth to non-oncology patients has received scant attention and little is known about the intention of nurses and nursing students to tell the truth. DESIGN A cross-sectional design. METHODS We used a scenario-based questionnaire, illustrating eight different situations in which nurses/nursing students are asked to tell the truth to a patient or family member regarding a devastating disease with which the patient is afflicted. Data were analysed using the Mann-Whitney U-test and ridge regression. RESULTS The sample included 150 participants, 110 registered nurses and 40 third year nursing students, with a response rate of 87%. The results show that nurses and nursing students intend to tell the whole truth even if this is not easy for them. Nurses more than students think that it is important to tell the whole truth and intend to do so. Head nurses tend to tell the truth more than staff nurses. For nurses, the components of the Theory of Planned Behaviour predicted intention to tell the truth, whereas among students subjective norms were the only predictor of intention. CONCLUSION The Theory of Planned Behaviour is a powerful predictor of nurse intention to tell the whole truth to patients and their families. Students perceive social pressure as the most important incentive of their intention to tell the truth. RELEVANCE TO CLINICAL PRACTICE Nurses and nursing students should receive additional training in dealing with various situations involving truth telling.
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Affiliation(s)
- Nili Tabak
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tang WR, Fang JT, Fang CK, Fujimori M. Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice. Psychooncology 2012; 22:1605-10. [PMID: 22962020 DOI: 10.1002/pon.3174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/01/2012] [Accepted: 08/16/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Truth telling or transmitting bad news is a problem that all doctors must frequently face. The purpose of this cross-sectional study was to investigate if medical students' opinions of truth telling differed from their observations of attending physicians' actual clinical practice. METHODS The subjects were 275 medical clerks/interns at a medical center in northern Taiwan. Data were collected on medical students' opinions of truth telling, their observations of physicians' clinical practice, students' level of satisfaction with truth telling practiced by attending physicians, and cancer patients' distress level when they were told the truth. RESULTS Students' truth-telling awareness was significantly higher than the clinical truth-telling practice of attending physicians (p<0.001), and the means for these parameters had a moderate difference, especially in three aspects: method, emotional support, and providing additional information (p<0.001). Regardless of this difference, students were satisfied with the truth telling of attending physicians (mean ± SD=7.33 ± 1.74). However, our data also show that when cancer patients were informed of bad news, they all experienced medium to above average distress (5.93 ± 2.19). CONCLUSIONS To develop the ability to tell the truth well, one must receive regular training in communication skills, including experienced attending physicians. This study found a significant difference between medical students' opinions on truth telling and attending physicians' actual clinical practice. More research is needed to objectively assess physicians' truth telling in clinical practice and to study the factors affecting the method of truth telling used by attending physicians in clinical practice.
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Affiliation(s)
- Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Kumar M, Goyal S, Singh K, Pandit S, Sharma D, Verma AK, Rath G, Bhatnagar S. Breaking bad news issues: a survey among radiation oncologists. Indian J Palliat Care 2011; 15:61-6. [PMID: 20606858 PMCID: PMC2886220 DOI: 10.4103/0973-1075.53533] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice. Materials and Methods: We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients. Results: Most responders had an oncology experience of three to seven years (20/35). Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer. Conclusion: Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.
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Affiliation(s)
- Milind Kumar
- Department of Radiotherapy, Dr. BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India
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Abstract
Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.
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Affiliation(s)
- Tonia C Onyeka
- Department of Anesthesia, Pain and Palliative Care Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
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Fukui S, Ogawa K, Yamagishi A. Effectiveness of communication skills training of nurses on the quality of life and satisfaction with healthcare professionals among newly diagnosed cancer patients: a preliminary study. Psychooncology 2010; 20:1285-91. [PMID: 20737411 DOI: 10.1002/pon.1840] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 07/17/2010] [Accepted: 07/19/2010] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The importance of effective communication skills to sustain the cancer patient quality of life (QOL) and their satisfaction with healthcare professionals is well documented. This study aims to assess the effectiveness of communication skills training (CST) of nurses for patient QOL and their satisfaction with healthcare professionals just after being diagnosed with cancer. METHODS This is a secondary analysis of a randomized controlled trial. Eight nurses, who mainly provide psychological and informational support for patients soon after they were informed of their cancer diagnosis by physicians at a cancer screening center, were randomly assigned to an experimental group attending a CST program (four nurses) or to a control group (four nurses). Eighty-nine patients with gastric, colorectal, or breast cancer were supported and assessed by either group of nurses during the study period. The effectiveness for patient QOL and their satisfaction with healthcare professionals was assessed by administering the Short Form-8 Health Survey (SF-8) and a single-item VAS three times (1 week after diagnosis: T1; 1 month after diagnosis: T2; and 3 months after diagnosis: T3). RESULTS Repeated measures analysis of variance showed a group-by-time significant increase of the mental aspects of SF-8 (F=3.48; P=0.03) and satisfaction with the nurse (F=3.18; p=0.04). CONCLUSIONS Our findings underscore the importance of CST for healthcare professionals to improve the QOL of patients as well as their satisfaction with these professionals.
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Affiliation(s)
- Sakiko Fukui
- Graduate School of Nursing, The Japanese Red Cross University, Tokyo, Japan.
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Warnock C, Tod A, Foster J, Soreny C. Breaking bad news in inpatient clinical settings: role of the nurse. J Adv Nurs 2010; 66:1543-55. [PMID: 20492016 DOI: 10.1111/j.1365-2648.2010.05325.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of an exploration of the role of the nurse in the process of breaking bad news in the inpatient clinical setting and the provision of education and support for nurses carrying out this role. BACKGROUND The term 'breaking bad news' is mostly associated with the moment when negative medical information is shared with a patient or relative. However, it can also be seen as a process of interactions that take place before, during and after bad news is broken. Little research has been conducted exploring the role of the nurse in the process of breaking bad news in the inpatient clinical setting. METHODS A questionnaire was developed using Likert scales and open text questions. Data collection took place in 2007. Fifty-nine inpatient areas took part in the study; 335 questionnaires were distributed in total and 236 were completed (response rate 70%). RESULTS Nurses engaged in diverse breaking bad news activities at many points in care pathways. Relationships with patients and relatives and uncontrolled and unplanned events shaped the context in which they provided this care. Little formal education or support for this work had been received. CONCLUSION Guidance for breaking bad news should encompass the whole process of doing this and acknowledge the challenges nurses face in the inpatient clinical area. Developments in education and support are required that reflect the challenges that nurses encounter in the inpatient care setting.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Abstract
Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research.
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Affiliation(s)
- Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.
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Fukui S, Ogawa K, Ohtsuka M, Fukui N. A randomized study assessing the efficacy of communication skill training on patients' psychologic distress and coping. Cancer 2008; 113:1462-70. [DOI: 10.1002/cncr.23710] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Li JY, Liu C, Zou LQ, Huang MJ, Yu CH, You GY, Jiang YD, Li H, Jiang Y. To tell or not to tell: attitudes of Chinese oncology nurses towards truth telling of cancer diagnosis. J Clin Nurs 2008; 17:2463-70. [DOI: 10.1111/j.1365-2702.2007.02237.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jones RA, Taylor AG, Bourguignon C, Steeves R, Fraser G, Lippert M, Theodorescu D, Mathews H, Kilbridge KL. Family interactions among African American prostate cancer survivors. FAMILY & COMMUNITY HEALTH 2008; 31:213-20. [PMID: 18552602 PMCID: PMC2810541 DOI: 10.1097/01.fch.0000324478.55706.fe] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Prostate cancer affects African Americans at a higher rate than any other ethnic group in the United States. Prostate cancer does not only affect the man with the disease but also affects those individuals who are closest to him, such as his family and friends. Open communication is valuable in coping with stressors that are affiliated with chronic illnesses. This article focuses on family and friend social support of men with prostate cancer. Data analysis revealed that support from family members and friends plays an important role in how men cope with their treatment and recovery from prostate cancer.
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Affiliation(s)
- Randy A Jones
- School of Nursing, University of Virginia, Charlottesville, VA 22908, USA.
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