The experience of speech-language therapists and audiologists when delivering bad news: A qualitative analysis

Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis

OBJECTIVE

To provide an overview of healthcare practitioners' experiences of breaking bad news.

METHOD

Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis.

RESULTS

Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised.

CONCLUSIONS

Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged.

PRACTICE IMPLICATIONS

Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.

Healthcare professionals' involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study

PURPOSE

Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical¹ healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK.

MATERIALS AND METHODS

19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis.

RESULTS

Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised.

CONCLUSIONS

BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future.Implications for rehabilitationBreaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions.Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them.Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided.Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task.Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.

SPICES: Disclosure Practices to Help Caregivers Digest a Diagnosis of Developmental Language Disorder

PURPOSE

Recent studies of the experiences of caregivers of children with language disorders have suggested that speech-language pathologists (SLPs) are not clearly and effectively providing caregivers with a comprehensible diagnostic term for their child's difficulties. Since the work of the CATALISE consortium, there has been a mounting consensus around the use of the term developmental language disorder (DLD) to identify primary, persistent language problems beginning in childhood. Thanks to the increasing unification of SLPs around the term DLD, the time is ripe to directly address clinical practices in delivering a diagnosis to caregivers in ways they can understand, retain, and use to build connection and drive advocacy efforts.

CONCLUSIONS

In this tutorial, the authors review the SPIKES model, used by physicians to structure diagnostic disclosure conversations. Drawing upon research examining caregiver experiences of receiving a range of developmental diagnoses, we have adapted the SPIKES model to meet the needs of SLPs and their clients. The authors present the SPICES model for planning and executing sensitive and effective disclosure of a DLD diagnosis.

Students' Reflections During Training Workshops on Communication and Information Exchange in Audiology Consultations: An Exploratory Qualitative Study

PURPOSE

This clinical focus article outlines various communication challenges and scenarios related to information giving encountered by a group of audiology students, as reflected on during a series of communication skills workshops.

METHOD

We held two online training workshops during which students reflected on their clinical communication experiences and asked questions related to clinical scenarios. Third-year audiology students from a South African university participated in the workshops (17 in the first, 15 in the second). We analyzed these reflections using thematic analysis.

RESULTS

Students' reflections related to four themes: (a) balancing information giving, (b) managing shared decision making, (c) managing linguistic differences, and (d) relating bad news. The first theme was heavily prioritized in students' reflections. Providing students with time to practice skills introduced in the initial communication skills workshop enabled further reflection in the subsequent workshop. We discuss these themes using specific examples raised by students.

CONCLUSIONS

Our findings suggest that students first need to master basic information giving skills before they can move on to more advanced skills such as managing shared decision making, linguistic differences, and relating bad news. This study confirms that reflective skills need to be developed with students in an explicit manner, rather than as part of a hidden curriculum. Our approach to providing communication training and encouraging reflection on clinical experiences offers a starting point for clinical educators to support students in developing these skills.

Prognostication in post-stroke aphasia: Perspectives of people with aphasia on receiving information about recovery

Many people with aphasia (language impairment post-stroke) want to know their prognosis for recovery, yet current understanding of their experience of receiving prognoses is limited. Such insight is necessary to inform clinical practice in formulating and delivering aphasia prognoses, especially given the psycho-emotional distress and secondary adverse effects on recovery associated with conversations about prognosis. We sought an in-depth understanding of the perspectives of people with aphasia in relation to receiving prognoses post-stroke, with the aim of informing an evidence-based approach to aphasia prognostication in clinical practice. Semi-structured interviews, facilitated by communication support strategies, were conducted one-to-one with eight people with aphasia (ranging from mild to very severe) 3-12 months post-stroke. Reflexive thematic analysis was used to analyse the qualitative data, yielding two over-arching themes: (1) How would you know without knowing me?; (2) I need to know, but I don't want to know. Our findings illustrate issues of mistrust within the patient-clinician relationship, and complex emotions relating to hope and post-stroke adjustment. The present insight into the lived experience of receiving aphasia prognoses highlights the need for focused consideration of personal definitions of normalcy, measures for fostering trust, and the role of prognostic uncertainty.