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Rafiei M, Mohammadi Z, Mohamadirizi S. Clinical nurses' experiences about "breaking bad news" during the COVID-19 pandemic: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:247. [PMID: 39309994 PMCID: PMC11414847 DOI: 10.4103/jehp.jehp_417_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/30/2023] [Indexed: 09/25/2024]
Abstract
BACKGROUND Nurses have the most contact with COVID-19 patients and their families, while it is unclear how nurses react when they give bad news during pandemic disaster, particularly in the cultural and social context of Iran. So, our main purpose was to explore the experiences of clinical nurses about breaking bad news (BBN) in the context of the COVID-19 epidemic era. MATERIALS AND METHOD The study was a qualitative content analysis approach. Data were collected by the purposive sampling method through in-depth interviews with 13 nurses in Isfahan University of Medical Sciences. The method of data analysis was conventional qualitative content analysis. RESULTS The participants of this study were 13 nurses. The work experience range was from 2 to 18 years, and in terms of education, one of them was Ph.D., eight had a bachelor's degree education, and four had a master's degree in nursing. Qualitative data of content analysis were obtained in four main categories such as nurses' avoidance of BBN, considering the patient's and family's beliefs in BBN, nurses' unpreparedness to deliver bad news during the pandemic crisis, and surrender of the patient and family members in the face of the COVID-19 bad news. CONCLUSION The results of the research showed that due to probability of occurrence of pandemic in the futureand also the nature of the nursing profession, so nurses should be familiar with the correct ways of BBN and existing protocols on crisis conditions and cultural and religious context of the society to provide a high quality of care for patients and their families.
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Affiliation(s)
- Malihe Rafiei
- Master of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zakieh Mohammadi
- Master of Critical Care Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahla Mohamadirizi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Pruski M, Rodger D, Hurford JE. Disclosing the undisclosed: are radiographers and healthcare scientists required to communicate a provisional diagnosis when asked? JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109417. [PMID: 38955477 DOI: 10.1136/jme-2023-109417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 06/15/2024] [Indexed: 07/04/2024]
Abstract
Patients need to be given the relevant information to be able to give informed consent, which might require the disclosure of a provisional diagnosis. Yet, there is no duty to give information to a patient if that patient is aware that this information exists but chooses not to request it. Diagnostic radiographers and healthcare scientists are often responsible for ensuring that patients have given informed consent for the investigations they undertake, but which were requested by other clinicians. Here we examine if they have a duty to disclose a patient's provisional diagnosis made by a referring clinician if the patient asks for this information as part of the informed consent process to a diagnostic investigation. We first consider aspects of UK law, professional guidance and salient ethical principles, emphasising that while professional codes of practice highlight the need to act in the patient's best interest, they do not require giving patients information they do not require for the examination or have not requested. We then propose that diagnostic radiographers and healthcare scientists placed in such a position use a 'minimally necessary disclosure' framework. This framework fulfils their commitment to their patient and the principle of veracity, while respecting the boundaries of their professional duties. The framework ensures that enough detail is given to the patient for them to be able to give informed consent, while shouldering the diagnostic professional from making a full disclosure, which is the duty of the referring clinician.
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Affiliation(s)
- Michal Pruski
- Department of Medical Physics and Clinical Engineering, Cardiff and Vale University Health Board, Cardiff, UK
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Daniel Rodger
- Institute of Health and Social Care, London South Bank University, London, UK
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Wei Q, Zhou H, Hou X, Liu X, Chen S, Huang X, Chen Y, Liu M, Duan Z. Current status of and barriers to the treatment of advanced-stage liver cancer in China: a questionnaire-based study from the perspective of doctors. BMC Gastroenterol 2022; 22:351. [PMID: 35871649 PMCID: PMC9310466 DOI: 10.1186/s12876-022-02425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Liver cancer is a severe public health problem worldwide, and it creates a relatively higher disease burden in China than in the Western world. Despite achieving notable progress in China, potential differences in some aspects of medical services for liver cancer may persist across different regions and hospitals. This warrants serious consideration of the actual status of and barriers to liver cancer treatment. We intended to explore the present status of and obstacles in liver cancer treatment especially for advanced-stage liver cancer. Methods In February 2021, a national multicenter cross-sectional study was conducted among 1500 doctors from 31 provinces of mainland China using a self-administered online questionnaire. Participants completed the questionnaire about their general information, perspectives on the current status of liver cancer treatment, and expectations for future treatment. Chi-square and logistic regression analyses were performed to explore the differences associated with the regions, doctors’ professional ranks, and hospital levels. Results Treatment conditions, medications, and treatment strategies were inconsistent across different economic regions and hospital of different levels. With respect to obstacles in treatment, 76.6% of the doctors were unsatisfied with the current treatment for liver cancer. Important factors that influenced their satisfaction with the treatment for liver cancer included early diagnosis and the disclosure of true conditions to patients. Conclusions There persists differences in the treatment of liver cancer in China, besides barriers to treatment. More attention should be paid to the detection and treatment of liver cancer and the propagation of novel progress among doctors in underdeveloped areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02425-4.
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Porter AS, Woods C, Stall M, Velrajan S, Baker JN, Mack JW, Kaye EC. Oncologist approaches to communicating uncertain disease status in pediatric cancer: a qualitative study. BMC Cancer 2022; 22:1109. [PMCID: PMC9620648 DOI: 10.1186/s12885-022-10190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Most patients with cancer and their caregivers desire honest, clear prognostic communication, yet oncologists often disclose prognosis inconsistently. Prognostic communication becomes even more challenging when disease progression is unclear or equivocal. Presently, oncologist approaches for discussing uncertain disease findings are poorly understood. Methods In this prospective, longitudinal study, we audio-recorded serial disease reevaluation conversations between children with high-risk cancer, their families, and their primary oncologists over 24 months and conducted content analysis at recorded timepoints when oncologists categorized disease progression as equivocal. Results Of the 265 medical discussions recorded across the illness course for 33 patient-parent dyads, a total of 40 recorded discussions took place at equivocal timepoints, comprising > 500 min of medical dialogue. Prognosis talk encompassed < 3% of dialogue and was absent in nearly half of equivocal discussions (17/40, 42.5%). Curability statements were identified in only two conversations. Inductive content analysis of dialogue revealed four distinct patterns for communicating equivocal disease status: (1) up-front reassurance, (2) softening the message, (3) describing possible disease progression without interpretation, (4) expressing uncertainty without discussing the bigger picture. Conclusion Oncologists rarely discuss prognosis with children with high-risk cancer and their families at timepoints when disease progression is not definitive. Formal guidance is needed to better support oncologists in navigating uncertainty while sharing honest, person- and family-centered information about prognosis. Supplementary information The online version contains supplementary material available at 10.1186/s12885-022-10190-6.
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Affiliation(s)
- Amy S. Porter
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Cameka Woods
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Melanie Stall
- grid.267313.20000 0000 9482 7121The University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Justin N. Baker
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA
| | - Jennifer W. Mack
- grid.65499.370000 0001 2106 9910Dana-Farber Cancer Institute, Boston, MA USA ,grid.2515.30000 0004 0378 8438Boston Children’s Hospital, Boston, MA USA
| | - Erica C. Kaye
- grid.240871.80000 0001 0224 711XSt. Jude Children’s Research Hospital, Memphis, TN USA ,grid.240871.80000 0001 0224 711XDivision of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 1121, 38105 Memphis, TN USA
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Hart JL. Deception, honesty, and professionalism: a persistent challenge in modern medicine. Curr Opin Psychol 2022; 47:101434. [DOI: 10.1016/j.copsyc.2022.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
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Alsirafy SA, Abdel-Aziz HI, Abdel-Aal HH, El-Sherief WA, Farag DE. Not Telling Patients Their Cancer Diagnosis in Egypt: Is It Associated With Less Anxiety and Depression and Better Quality of Life? JCO Glob Oncol 2022; 8:e2200080. [PMID: 35728012 PMCID: PMC9232364 DOI: 10.1200/go.22.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In many countries, including Egypt, it is still believed that not telling patients their cancer diagnosis is associated with less psychological morbidity. This study was conducted to explore whether not telling Egyptian patients their cancer diagnosis is associated with less anxiety and depression and better quality-of-life (QoL) or not. METHODS A cross-sectional observational study was conducted in two Egyptian cancer care facilities and included 292 adult patients with cancer of whom 197 (67%) were aware of their diagnosis and 95 (33%) were unaware. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression and the Functional Assessment of Cancer Therapy-General 7 questionnaire to assess QoL. RESULTS Patients unaware of their cancer diagnosis were significantly more likely to be less educated, with no family history of cancer, interviewed within 6 months of cancer diagnosis, diagnosed with a cancer other than breast and colorectal cancer, in a poorer performance status, and with no history of anticancer treatment. There was no significant difference between unaware and aware patients in the scores of HADS-Anxiety (median [interquartile range (IQR)] = 6 [3-11] and 7 [4-11], P = .203), HADS-Depression (median [IQR] = 8 [4-12] and 8 [4-11], P = .64), and Functional Assessment of Cancer Therapy-General 7 (median [IQR] = 16 [12-20] and 16 [11-21], P = .754). In multiple regression analysis with adjustment, diagnosis unawareness did not associate significantly with anxiety, depression, and QoL (P = .394, .662, and .845, respectively). CONCLUSION The results of the current study confirm that not telling adult patients their cancer diagnosis is not associated with less anxiety and depression nor better QoL. The awareness of diagnosis in patients with cancer is not associated with more anxiety and depression or worse quality of life.![]()
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Affiliation(s)
- Samy A. Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hadeer I. Abdel-Aziz
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
- Damietta Cancer Center, Damietta, Egypt
| | - Hesham H. Abdel-Aal
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wessam A. El-Sherief
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dina E. Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Konteti V, Wu V, Smith B, Ramesh Y. An Editorial Review of Prognostic Awareness and Considerations for the Clinical Setting. Clin Oncol (R Coll Radiol) 2022; 34:376-378. [DOI: 10.1016/j.clon.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
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Cochrane A, Gallagher P, Dunne S. "You just need to learn": A qualitative study on the information needs of family caregivers of people with lung cancer. Eur J Oncol Nurs 2021; 56:102082. [PMID: 34871938 DOI: 10.1016/j.ejon.2021.102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Lung cancer caregivers often face considerable duties and responsibilities yet frequently feel unprepared for this role. The current study is the first to purposefully explore the information needs of family caregivers throughout the lung cancer trajectory. METHODS Semi structured interviews were conducted with nine lung cancer caregivers (7 female) including those bereaved within five years. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Four main themes emerged: 1) "He knew that I'd ask questions, you see": Information-gathering during appointments; 2) "You can't really ask that with mum there": Discordant information needs between caregiver and the person with lung cancer; 3) "Trying to get the answers": Seeking information beyond the hospital; 4) "It took a while to kind of get into": Learning to adjust to changing roles and circumstances. CONCLUSIONS Lung cancer caregivers need reliable information to feel competent in their new roles and responsibilities. In the current study, there were a number of areas in which information was lacking, including those related to treatment, side effects, care services and symptom management. The provision of appropriate and timely information to lung cancer caregivers can ensure they feel supported in their roles and responsibilities. This will in turn benefit lung cancer survivors by ensuring that they understand information in consultations with oncology nurses and other health professionals and receive appropriate support from their caregivers that enhances their quality of life along the cancer trajectory.
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Affiliation(s)
- Andreanne Cochrane
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Pamela Gallagher
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Simon Dunne
- School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland.
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Rost M, Mihailov E. In the name of the family? Against parents' refusal to disclose prognostic information to children. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:421-432. [PMID: 33847853 PMCID: PMC8349339 DOI: 10.1007/s11019-021-10017-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 06/12/2023]
Abstract
Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland.
| | - Emilian Mihailov
- Institute for Biomedical Ethics, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
- Research Centre in Applied Ethics, Faculty of Philosophy, University of Bucharest, Bucharest, Romania
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Chang T, Darshani S, Manikavasagam P, Arambepola C. Knowledge and attitudes about end-of-life decisions, good death and principles of medical ethics among doctors in tertiary care hospitals in Sri Lanka: a cross-sectional study. BMC Med Ethics 2021; 22:66. [PMID: 34039321 PMCID: PMC8152188 DOI: 10.1186/s12910-021-00631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Competent end-of-life care is an essential component of total health care provision, but evidence suggests that it is often deficient. This study aimed to evaluate the knowledge and attitudes about key end-of-life issues and principles of good death among doctors in clinical settings. METHODS A cross-sectional study was conducted among allopathic medical doctors working in in-ward clinical settings of tertiary care hospitals in Sri Lanka using a self-administered questionnaire with open- and close-ended questions as well as hypothetical clinical scenarios. Univariate and logistic regression analysis were used to identify the independent factors associated with knowledge and attitudes. RESULTS Of the responders who had not been a caregiver for a terminally ill relative (n = 390), 57.9% were men with a mean age of 36.5 years (SD = 8.2). Compared to undergraduate (65.6%; n = 256), only 27.4% (n = 107) had received end-of-life care training at postgraduate level. Only 65.9% of doctors favoured disclosing terminal prognosis to patients; 27.7% of doctors were aware of advance directives; 14.6% were aware of the correct time of death when certifying brain death; 70.3% felt more comfortable in withholding than withdrawing life-sustaining treatment; 61.3% were aware of do-not-attempt cardiopulmonary resuscitation (DNACPR) decisions while 26.7% felt reluctant to administer it; 15.1% thought that all life-sustaining therapy should be withdrawn with a DNACPR decision; and only17.9% were able to name the four principles of medical ethics while 57.9% could not name a single. Participants scored a mean of 9.2 (SD = 3.9) of a maximum 14 points when tested on principles of a 'good death'. Doctors who had pursued postgraduate studies were more likely to be aware of breaking bad news (adjusted-Odds-Ratio:1.99; 95%CI = 1.19-3.32), advance directives (adjusted-OR: 4.15; 95%CI = 2.49-6.94), aware of certifying the correct time of death (adjusted-OR:2.37; 95%CI = 1.33-4.2) and less reluctant to make DNACPR decisions (adjusted-OR:1.74; 95%CI = 1.13-2.68). Doctors who had worked in ICU were more comfortable withholding than withdrawing treatment (adjusted-OR:1.99; 95%CI = 1.2-3.31). CONCLUSIONS Knowledge and attitudes about end-of-life care, good death and principles of medical ethics among doctors in Sri Lanka were suboptimal. Structured training of end-of-life care needs to be integrated within curricula and in-service training.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - Saumya Darshani
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Pavithra Manikavasagam
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Welsch K, Gottschling S. Wishes and Needs at the End of Life–Communication Strategies, Counseling, and Administrative Aspects. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:303-312. [PMID: 34180804 PMCID: PMC8289964 DOI: 10.3238/arztebl.m2021.0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/19/2020] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Managing the last phase of life properly, i.e., taking care that a patient's wishes are respected at the end of life and beyond, is very important and can relieve the patient and his or her family of unnecessary burdens. METHODS This review is based on guidelines, reviews, meta-analyses, selected publications, and the authors' own experiences from everyday clinical practice. RESULTS Most patients want frank information from their physicians about their condition at all times over the course of their treatment, from the moment of diagnosis to the end of their life. This has no lasting adverse effects, but rather enables patients to take decisions that are appropriate to their stage of disease. Early integration in palliative care can improve patients' quality of life, symptom control, and mood. In helping to manage the last phase of life, the physician often serves as a provider of impulses, or else determines which other types of professional should counsel or support the patient. Patients should be enabled to issue directives that reflect their wishes, as well as to choose representatives who are allowed to speak for them. Consideration should also be given to the patient's emotional legacy, e.g., letters or video messages with personal content. CONCLUSION In the care of patients with life-limiting diseases, more attention should be paid to the management of the last phase of life. Palliative-care physicians can take over this task from other medical disciplines, and early integration in palliative care is recommended.
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Affiliation(s)
- Katja Welsch
- Centre of Palliative Care and Pediatric Pain,Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar
| | - Sven Gottschling
- Centre of Palliative Care and Pediatric Pain,Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar
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Melis P, Galletta M, Aviles Gonzalez CI, Contu P, Jimenez Herrera MF. Experiencing communication related to knowing the cancer diagnosis and prognosis: A multi-perspective interpretative phenomenological study. Eur J Oncol Nurs 2021; 51:101904. [PMID: 33578333 DOI: 10.1016/j.ejon.2021.101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 12/12/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To understand the phenomenon of communication related to knowing the diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses. METHODS Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) -who were linked by a carer-cared relationship-were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants' narratives. RESULTS Two overarching themes were identified: The first theme "the «what is it?» and the «what will happen to me?»" illustrates the two different paths of communication of diagnosis and prognosis. The second theme "Matching and mismatching in identifying the others as speakers" shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions. CONCLUSIONS Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses' perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
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Affiliation(s)
- Paola Melis
- Departament d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | | | - Paolo Contu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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Wu J, Wang Y, Jiao X, Wang J, Ye X, Wang B. Differences in practice and preferences associated with truth-telling to cancer patients. Nurs Ethics 2020; 28:272-281. [PMID: 32959721 DOI: 10.1177/0969733020945754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Doctors should disclose the diagnosis to patients according to the principle of autonomy. However, not disclosing the diagnosis and prognosis to cancer patients remains common in mainland China. OBJECTIVE The study explored the experiences and attitudes of patients with cancer, family members, and the medical staff in truth-telling. RESEARCH DESIGN A quantitative survey with three closed-ended questionnaires was conducted. PARTICIPANTS In all, 137 patients with cancer, 134 family members caring for cancer cases, and 54 medical staff were surveyed. Descriptive statistics were used to summarize all characteristics, and the chi-square test was performed to analyze group differences in attitudes toward cancer disclosure. ETHICAL CONSIDERATIONS This study was approved by the Committee on Ethics of Biomedicine Research, at the Second Military Medical University (HJEC-2018-YF-001). Informed consent was obtained from all participants prior to study commencement. FINDINGS A total of 59.8% of patients were informed about their diagnosis within 1 week, and 19.7% inferred theirs. The medical staff preferred to prioritize family members in informing about patient diagnosis while 77.4% of patients preferred to be told the whole truth at the time of initial diagnosis. More patients than family members and medical staff wanted the patients to be informed about the diagnosis (p < 0.001). A significant difference was found between the patients and family members regarding who should tell the patients. DISCUSSION The willingness of patients in knowing the truth was underestimated by their family members as well as the medical staff. Guessing the truth indirectly may exert negative effects on the patients, and not telling the truth is inappropriate in patients who want to be informed. CONCLUSION Disclosure of a cancer diagnosis is a complex process involving medical practice, as well as a range of cultural, ethical, and legal factors. The medical staff should first assess each patient's willingness in truth-telling and inform about disease diagnosis with respect. Emotional support and comfort from family members are encouraged. Anyone in the patient's care team, especially nurses, could be integrated in the process of truth-telling.
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Affiliation(s)
- Jing Wu
- Naval Medical University, China
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Nasrabadi AN, Joolaee S, Navab E, Esmaeili M, Shali M. White lie during patient care: a qualitative study of nurses' perspectives. BMC Med Ethics 2020; 21:86. [PMID: 32883258 PMCID: PMC7470607 DOI: 10.1186/s12910-020-00528-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Keeping the patients well and fully informed about diagnosis, prognosis, and treatments is one of the patient's rights in any healthcare system. Although all healthcare providers have the same viewpoint about rendering the truth in treatment process, sometimes the truth is not told to the patients; that is why the healthcare staff tell "white lie" instead. This study aimed to explore the nurses' experience of white lies during patient care. METHODS This qualitative study was conducted from June to December 2018. Eighteen hospital nurses were recruited with maximum variation from ten state-run educational hospitals affiliated to Tehran University of Medical Sciences. Purposeful sampling was used and data were collected by semi-structured interviews that were continued until data saturation. Data were classified and analyzed by content analysis approach. RESULTS The data analysis in this study resulted in four main categories and 11 subcategories. The main categories included hope crisis, bad news, cultural diversity, and nurses' limited professional competences. CONCLUSION Results of the present study showed that, white lie told by nurses during patient care may be due to a wide range of patient, nurse and/or organizational related factors. Communication was the main factor that influenced information rendering. Nurses' communication with patients should be based on mutual respect, trust and adequate cultural knowledge, and also nurses should provide precise information to patients, so that they can make accurate decisions regarding their health care.
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Affiliation(s)
- A Nikbakht Nasrabadi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq, Tehran, 141973317, Iran
| | - S Joolaee
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq, Tehran, 141973317, Iran.,Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center for Evaluation & Outcome Sciences (CHEOS), University of British Columbia, Vancouver, Canada
| | - E Navab
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq, Tehran, 141973317, Iran
| | - M Esmaeili
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq, Tehran, 141973317, Iran
| | - M Shali
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq, Tehran, 141973317, Iran.
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15
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Ghoshal A, Salins N, Damani A, Chowdhury J, Chitre A, Muckaden MA, Deodhar J, Badwe R. To Tell or Not to Tell: Exploring the Preferences and Attitudes of Patients and Family Caregivers on Disclosure of a Cancer-Related Diagnosis and Prognosis. J Glob Oncol 2020; 5:1-12. [PMID: 31770048 PMCID: PMC6882506 DOI: 10.1200/jgo.19.00132] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To understand the preferences and attitudes of patients and family caregivers on disclosure of cancer diagnosis and prognosis in an Indian setting. METHODS Overall, 250 adult patients with cancer and 250 family caregivers attending the outpatients of a tertiary cancer hospital for the first time were recruited purposively. The mean ages of patients and caregivers were 49.9 years (range, 23-80 years) and 37.9 years (range, 19-67 years), respectively. Separately, they completed prevalidated, close-ended preference questions and were interviewed for open-ended attitude questions. RESULTS A total of 250 adult patients (response rate, 47.17% overall, 73.2% in men, and 26.8% in women) and 250 family caregivers (response rate, 40.65% overall, 84.0% in men, and 16.0% in women) participated. Significant differences were observed in the preference to full disclosure of the name of illness between patients (81.2%) and caregivers (34.0%) and with the expected length of survival between patients (72.8%) and caregivers (8.8%; P < .001). The patients felt that knowing a diagnosis and prognosis may help them be prepared, plan additional treatment, anticipate complications, and plan for future and family. The caregivers felt that patients knowing a diagnosis and prognosis may negatively affect the future course of illness and cause patients to experience stress, depression, loss of hope, and confidence. CONCLUSION Patients with cancer preferred full disclosure of their diagnoses and prognoses, whereas the family caregivers preferred nondisclosure of the same to their patients. This novel information obtained through a large study with varied participants from different parts of the country will help formulate communication strategies for cancer care.
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Affiliation(s)
| | | | | | | | - Arundhati Chitre
- Ramniranjan Jhunjhunwala College of Arts, Science, and Commerce, Mumbai, India
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16
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Testoni I, Wieser MA, Kapelis D, Pompele S, Bonaventura M, Crupi R. Lack of Truth-Telling in Palliative Care and Its Effects among Nurses and Nursing Students. Behav Sci (Basel) 2020; 10:E88. [PMID: 32403378 PMCID: PMC7287675 DOI: 10.3390/bs10050088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
Unclear communication of inauspicious prognoses may disorientate both patients and their relatives, drastically jeopardizing the planning of palliative care. This paper considers the issue of truth-telling in the communicative problems of nurses and students of nursing with terminally ill patients. The fundamental objective is the analysis of the difficulties related to the lack of truth-telling and how it might impact their professional and personal lives. A qualitative study was realized, involving 47 participants, both nurses (25) and nursing students (22), working in palliative care units or in associations of volunteers for the assistance of oncological patients. The exploration was focused on the way they relate to patients who are not aware of their real health conditions and their consequences. Particular attention was paid to their opinions concerning what could be done in order to manage such problematic situations in the near future.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied psychology (FISPPA), University of Padova, 35131 Padova, Italy; (I.T.); (S.P.)
- Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | | | - Dafni Kapelis
- Palliative Care Department, ULSS n. 8 Asolo, 31011 Treviso, Italy;
| | - Sara Pompele
- Department of Philosophy, Sociology, Pedagogy and Applied psychology (FISPPA), University of Padova, 35131 Padova, Italy; (I.T.); (S.P.)
| | | | - Robert Crupi
- NewYork-Presbyterian Queens, New York, NY 11355, USA;
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17
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Su T, He C, Li X, Xiao L, He J, Bai Y, Tang Y. Association between early informed diagnosis and survival time in patients with lung cancer. Psychooncology 2020; 29:878-885. [PMID: 32266740 DOI: 10.1002/pon.5360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/07/2020] [Accepted: 02/10/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As a malignant tumor with high mortality, lung cancer (LC) often causes great trauma to patients, and a series of negative emotions and a heavy psychological burden accompanies poor prognosis. Whether or not to inform the patients of their condition has always been a controversial topic in the medical community. This retrospective cohort study investigated the association between early informed diagnosis and survival time in patients with LC. METHODS A total of 29 825 patients with LC were enrolled between October 2002 and December 2016. The potential factors influencing LC survival were registered, including knowing their cancer diagnosis status, age, gender, pathological type, clinical stage, surgical history, hospital grade, and patient occupation. All participants were followed up every 6 months until June 2017. RESULTS In June 2017, 23.1% of the participants still survived. Their median survival time (MST) was 11.20 months (95% confidence interval [CI], 10.98-11.43). Generally, patients that knew their cancer diagnosis had longer MST than those who did not (18.33 months vs 8.77 months, P < .001). By stratified analysis, patients that knew their cancer diagnosis had longer survival time in each subgroup (P < .001, all subgroups). Cox regression analysis showed that knowing their cancer diagnosis was an independent influencing factor for survival in patients with LC (hazard ratio, 0.826; 95% CI, 0.802-0.851; P < .001). CONCLUSIONS Knowing their cancer diagnosis contributed to longer survival time in patients with LC, providing clear evidence that medical staff and patients' families should fully disclose cancer diagnoses to patients.
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Affiliation(s)
- Tong Su
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Chen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Xiaopan Li
- Department of Cancer Prevention and Vital Statistics, Center for Disease Control and Prevention, Shanghai, China.,Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Lei Xiao
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Jingwen He
- College of Psychology, The Second Military Medical University, Shanghai, China
| | - Yonghai Bai
- Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yunxiang Tang
- College of Psychology, The Second Military Medical University, Shanghai, China.,Department of Medical Psychology, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
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18
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Aghaei MH, Vanaki Z, Mohammadi E. Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients. Indian J Palliat Care 2020; 26:86-94. [PMID: 32132791 PMCID: PMC7017707 DOI: 10.4103/ijpc.ijpc_181_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/02/2019] [Indexed: 01/04/2023] Open
Abstract
Aim Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. Methods In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. Results Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. Conclusion Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.
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Affiliation(s)
- Mir Hossein Aghaei
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zohreh Vanaki
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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19
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Torishima M, Urao M, Nakayama T, Kosugi S. Negative recollections regarding doctor-patient interactions among men receiving a prostate cancer diagnosis: a qualitative study of patient experiences in Japan. BMJ Open 2020; 10:e032251. [PMID: 31964666 PMCID: PMC7044962 DOI: 10.1136/bmjopen-2019-032251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore the negative recollections of prostate cancer patients regarding the attitudes and language used by the doctors in delivering their diagnoses in Japan, in order to improve patient-centred communication. DESIGN AND SETTING This is a qualitative secondary analysis of the prostate cancer narrative data from the Database of Individual Patients' Experiences-Japan archives. A thematic analysis was conducted regarding negative recollections of doctors' words/attitudes when delivering a cancer diagnosis. Recruitment was based on maximum variation sampling. Participants were recruited from medical institutions, patient associations and through media advertisements. PARTICIPANTS Men with a diagnosis of prostate cancer (n=51). FINDINGS Of the 51 participants, 17 had negative recollections of the doctors' words/attitudes during the delivery of the cancer diagnosis. After thematic analysis, 11 categories emerged: 'Surprised by the abrupt disclosure of the diagnosis', 'Displeased by the direct disclosure of the diagnosis to the patient in the absence of family members', 'Unable to accept the doctor's negative words in the explanations', 'Unable to understand the doctor's technical jargon', 'Distrust due to failure in diagnosis based on previous examinations', 'Aggrieved at the doctor's unwillingness to allow questions', 'Dissatisfied with explanations involving facts only', 'Indignant over the unexpected disclosure of life expectancy', 'Unable to accept the doctor's blame for the delay in the initial hospital visit', 'Uncomfortable with the usage of inappropriate metaphors' and 'Pessimistic thoughts despite optimistic explanations'. CONCLUSIONS It is clear that patients have recollections of a variety of negative experiences regarding the words/attitudes of their doctors at the time they received their prostate cancer diagnosis. Thus, the use of narrative data would facilitate the appropriate application of commonly used guidelines for the delivery of cancer diagnoses tailored to individual patients in clinical practice.
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Affiliation(s)
- Masako Torishima
- Clinical Genetics Unit, Kyoto University Hospital, Kyoto, Sakyo-ku, Japan
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Sakyo-ku, Japan
| | - Michiko Urao
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Sakyo-ku, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Sakyo-ku, Japan
| | - Shinji Kosugi
- Clinical Genetics Unit, Kyoto University Hospital, Kyoto, Sakyo-ku, Japan
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Sakyo-ku, Japan
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20
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Jorge R, Teixeira A, Calanzani N, Nunes R, Sousa L. Older people's preferences for prognostic information in a situation of serious illness with less than a year to live. CIENCIA & SAUDE COLETIVA 2019; 24:4313-4324. [PMID: 31664403 DOI: 10.1590/1413-812320182411.02022018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/16/2018] [Indexed: 11/21/2022] Open
Abstract
This study aimed to determine the preferences of community-dwelling older people about information disclosure regarding poor prognosis, the likely symptoms and problems, and the care options available in a situation of serious illness with less than a year to live; and to identify factors associated with a preference for information disclosure regarding poor prognosis. The Brazilian version of the Preferences and Priorities for End of Life Care (PRISMA) questionnaire was administered face-to-face to 400 older people, living in the city of Belo Horizonte, Minas Gerais, Brazil. The main results indicated that 74.0% preferred to be informed that they had limited time left, 89.3% wished to be informed about symptoms and problems, and 96.3% about available care options. The factors associated with preferences for information about poor prognosis were: gender (women: OR = 0.446, 95% CI: 0.269-0.738) and choosing the least preferred place to die (home of a relative or friend: OR = 2.423, 95% CI: 1.130-5.198. These results show that most older people want to be informed in an advanced illness situation with less than a year to live. Health care professionals need to be prepared to anticipate news about poor prognosis and the disease.
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Affiliation(s)
- Rafaela Jorge
- Programa Doutoral em Geriatria e Gerontologia, Departamento de Educação e Psicologia, Universidade de Aveiro. Campus Universitário de Santiago. 3810-193. Aveiro, Portugal.
| | - Andreia Teixeira
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS). Porto, Portugal
| | - Natália Calanzani
- Instituto Usher de Ciências da Saúde da População e Informática, Centro de Ciências da Saúde da População, Universidade de Edimburgo. Edimburgo Reino Unido
| | - Rui Nunes
- Faculdade de Medicina da Universidade do Porto. Porto, Portugal
| | - Liliana Sousa
- Departamento de Educação e Psicologia, Centro de Investigação em Tecnologias e Serviços de Saúde (Cintesis.ua), Universidade de Aveiro. Aveiro, Portugal
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21
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Anuk D, Özkan M, Kizir A, Özkan S. The characteristics and risk factors for common psychiatric disorders in patients with cancer seeking help for mental health. BMC Psychiatry 2019; 19:269. [PMID: 31481035 PMCID: PMC6724340 DOI: 10.1186/s12888-019-2251-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the adverse effects of cancer diagnoses and treatments on mental health are known, about less than 10% of patients are estimated to be referred to seek help. The primary purpose of this study was to obtain the baseline information on patients with cancer seeking help for mental health who presented for the first time to the psycho-oncology outpatient clinic, and to identify risk factors that may provide clues healthcare practitioners in recognizing those needing psychological help in oncology practice. METHODS We reviewed the charts of 566 patients with cancer who were referred to the psycho-oncology outpatient clinic over a two-year period. The study includes the socio-demographic data, illness characteristics, psychiatric characteristics, psychiatric diagnoses, and treatment recommendations for these patients. RESULTS The incidence of diagnoses of psychiatric disorders was 97.5%. The distributions of psychiatric diagnoses were as follows: any kind of adjustment disorders, mood disorders, anxiety disorders, organic brain syndrome, personality disorders, delusional disorder, and insomnia. Recurrence of cancer, other chronic medical illnesses, a history of psychiatric disorders, poor social support, and low income comprised the common significant risk factors for adjustment disorders, mood disorders, and anxiety disorders. These risk factors were also seen to be significant in the regression analysis in terms of sex. CONCLUSION This study identifies the distribution of psychiatric disorders, the risk factors for specific psychiatric disorders, and draws attention to the fact that there are serious delays in patients seeking psychiatric help and in the referrals of oncologists for psychological assessment. Identifying risk factors and raising oncologists' awareness toward risk factors could help more patients gain access to mental health care much earlier.
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Affiliation(s)
- Dilek Anuk
- Department of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390, Istanbul, Turkey.
| | - Mine Özkan
- 0000 0001 2166 6619grid.9601.eDepartment of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Ahmet Kizir
- 0000 0001 2166 6619grid.9601.eDepartment of Radiation Oncology, Institute of Oncology, Istanbul University, 34390 Istanbul, Capa Turkey
| | - Sedat Özkan
- 0000 0001 2166 6619grid.9601.eDepartment of Consultation Liaison Psychiatry, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Capa, 34390 Istanbul, Turkey
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22
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de Camargos MG, Paiva BSR, de Almeida CSL, Paiva CE. What Is Missing for You to Be Happy? Comparison of the Pursuit of Happiness Among Cancer Patients, Informal Caregivers, and Healthy Individuals. J Pain Symptom Manage 2019; 58:417-426.e4. [PMID: 31195075 DOI: 10.1016/j.jpainsymman.2019.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/14/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT After cancer diagnosis, personal value priorities may change in a way that would transform such values and how life is perceived by cancer patients and their caregivers, including happiness and its pursuit. OBJECTIVES The objective of the study was to analyze and compare what cancer patients, informal caregivers, and healthy population believe that would make them happy. METHODS A qualitative content analysis was performed on the responses to a single question: "What is missing for you to be happy?" Narratives of cancer patients (n = 242, face-to-face interview), informal caregivers (n = 125, face-to-face interview), and healthy participants (n = 1,671, recruited through social media, online survey) were analyzed. Word clouds were created for each group of participants. Contents were identified and frequencies were compared among participants by means of chi-square and Fisher's exact tests. RESULTS Overall, participants were pursuing better health (n = 288, 14.1%), better interpersonal relationships (n = 456, 22.4%), money (n = 412, 20.2%), and work-related aspects (n = 481, 23.6%). Cancer patients and informal caregivers sought better health and cure more often than when compared to healthy people (P < 0.001). Among cancer patients, survivors' profile tended to be similar to that of the healthy population concerning what they need to be happy. Unexpectedly, "cure" (22.7%) was more frequent among participants with incurable cancer. CONCLUSION Regardless of the group they were in, participants sought happiness in what they considered to be important to their lives, but it was something they did not have at the time of the interview. Psychoeducational and cognitive-behavioral strategies focused on how to deal with life expectations among people facing cancer are awaited.
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Affiliation(s)
- Mayara Goulart de Camargos
- Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Carlos Eduardo Paiva
- Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
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23
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Campagne DM. [Cancer: Communicating the diagnosis and prognosis]. Semergen 2019; 45:273-283. [PMID: 30638638 DOI: 10.1016/j.semerg.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022]
Abstract
The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.
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Affiliation(s)
- D M Campagne
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, España.
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24
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Li Y, Wan M, Luo X, Li J, Wang H, Wei D, Feng H. The impact of informing diagnosis on quality of life in patients with cancer: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12320. [PMID: 30212976 PMCID: PMC6155951 DOI: 10.1097/md.0000000000012320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cancer is the second leading cause of death globally. More millions new cancer cases are diagnosed, and millions persons died due to cancer each year. There are different attitudes on disclosure of diagnosis to the patients with cancer. The current systematic reviews are qualitative, and indicate that there is limited evidence on the association between awareness of diagnosis and quality of life in patients with cancer. In this study, we aim to evaluate the effect of awareness of diagnosis on quality of life in patients with cancer by conducting a systematic review and meta-analysis. METHODS We will perform a comprehensive electronic search in the databases below: MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, WEB OF SCIENCE, Chinese Biomedical Literature database, WANFANG database, and China National Knowledge Infrastructure. The cohort studies focusing on the association between awareness of diagnosis and quality of life in patients with cancer will be included. The risk of bias for the included studies will be appraised using the Newcastle-Ottawa Scale tool for cohort study. We will pool the effect estimates from the included studies to quantitatively present the strength of the association of interest. RESULTS This study will present pooled effect estimates regarding the impact of informing diagnosis on quality of life in patients with cancer. CONCLUSION This is the first quantitative systematic review which tends to provide modest evidence on the association between informing diagnosis and quality of life in patients with cacner. PROSPERO REGISTRATION NUMBER CRD42017060073.
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Affiliation(s)
- Yabin Li
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Miao Wan
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xianggui Luo
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Jiao Li
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Hongxia Wang
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
| | - Dang Wei
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Haixia Feng
- Department of Neurological Rehabilitation, Rehabilitation Central Hospital of Gansu Province
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25
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Alzahrani AS, Alqahtani A, Alhazmi M, Gaafar R, Bajabir D, Alharbi IM, Alharbi AM, Kheshaifaty G, Alzahrani A. Attitudes of cancer patients and their families toward disclosure of cancer diagnosis in Saudi Arabia: a Middle Eastern population example. Patient Prefer Adherence 2018; 12:1659-1666. [PMID: 30214168 PMCID: PMC6126501 DOI: 10.2147/ppa.s176651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Particularly in the Middle East, few studies have explored the attitude of cancer patients and their families toward cancer diagnosis disclosure (CDD). This study was conducted to investigate the preference and attitude of a sample of cancer patients and their families in Saudi Arabia toward CDD. METHODS We constructed a questionnaire based on previous studies. The questionnaire assessed preference and attitude toward CDD. Participants were recruited from the King Abdullah Medical City, which has one of the largest cancer centers in Saudi Arabia. RESULTS Three hundred and four cancer patients and 277 of their family members participated in the study. The patient group preferred CDD more than the family group (82.6% vs 75.3%, P<0.05). This preference is especially more evident toward disclosure of detailed cancer information (status, prognosis, and treatment) (83.6% vs 59.9%, P<0.001). In a binary logistic regression, factors associated with preference toward CDD included having information about cancer (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.15-2.84) and being employed (OR, 1.77; 95% CI, 1-2.82) while being from the patient group was the only factor associated with preference toward detailed cancer information (OR, 3.25; 95% CI, 2.11-5.05). In terms of patient reaction after CDD, "fear" was the attitude expected by the family group more than the patient group (56.3% vs 70.4%, P<0.001) while "acceptance" was the attitude anticipated by the patient group more than the family group (38% vs 15.2%, P<0.001). CONCLUSION Patients preferred CDD and disclosure of related information, while their families were more inclined toward scarce disclosure. Family members seem to experience negative attitudes more than the patients themselves.
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Affiliation(s)
- Ahmad S Alzahrani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Abdullah Alqahtani
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Maher Alhazmi
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | - Doaa Bajabir
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | | | | | - Ghufran Kheshaifaty
- Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia,
| | - Aamer Alzahrani
- College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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26
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Gan Y, Zheng L, Yu NX, Zhou G, Miao M, Lu Q. Why do oncologists hide the truth? Disclosure of cancer diagnoses to patients in China: A multisource assessment using mixed methods. Psychooncology 2017; 27:1457-1463. [PMID: 28833916 DOI: 10.1002/pon.4545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE In the United States and most European countries, cancer diagnoses are disclosed to patients. In China, however, the trend toward full disclosure has progressed slowly. The present study aimed to explore attitudes toward truth-telling practice among physicians, patients, patients' family members, and the general population, and reasons for nondisclosure. METHODS We administered a short survey to 212 physicians, 143 patients with cancer, 413 family members of patients with cancer, and 1415 members of the general population. A MANOVA was performed to examine group differences in attitudes toward cancer disclosure. In addition, we interviewed 20 oncologists. Interview data were analyzed using NVivo10. After the interview, we administered another short survey to 143 patients with cancer. RESULTS Quantitative data indicated that physicians were the least, and patients the most, in favor of disclosure. Qualitative data among physicians and follow-up surveys among cancer patients revealed 5 reasons for the concealment of cancer diagnoses by physicians, including lack of awareness of patients' right to knowledge, cultural influences, insufficient medical resources and training, families' financial concerns, and the need to protect doctors from violence. CONCLUSION There is a discrepancy between the needs of patients and those in medical practice. These results deepen our understanding regarding the reasons for oncologists' attitudes toward nondisclosure.
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Affiliation(s)
- Yiqun Gan
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Lei Zheng
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Nancy Xiaonan Yu
- Department of Applied Social Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Guangyu Zhou
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Miao Miao
- School of Sociology, China University of Political Science and Law, Beijing, China
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
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Rajasooriyar C, Kelly J, Sivakumar T, Navanesan G, Nadarasa S, Sriskandarajah MH, Sabesan S. Breaking Bad News in Ethnic Settings: Perspectives of Patients and Families in Northern Sri Lanka. J Glob Oncol 2017; 3:250-256. [PMID: 28717767 PMCID: PMC5493221 DOI: 10.1200/jgo.2016.005355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The discussion of a cancer diagnosis and prognosis often is difficult. This study explored the expectations of Tamil-speaking patients with cancer and their families with respect to receiving their cancer diagnosis in northern Sri Lanka. Methods This exploratory, descriptive, qualitative study used semistructured interviews. Results Thematic analysis identified two major themes: communication and information seeking. The findings illustrate a discrepancy between patient preference for direct disclosure of the diagnosis and that of families. Ninety-five percent of patients wanted medical staff to disclose their cancer diagnosis, whereas only 45% of family members believed that the diagnosis should be disclosed to the patient rather than to the family. Conclusion Although patients and their family members’ views and expectations of the disclosure of diagnosis and prognosis differ, a majority of patients want to be told directly about their diagnosis rather than to learn of it from a relative. The findings are similar to the literature on other ethnic groups from Sri Lanka and studies from English-speaking developed countries. Therefore, the main questions are how to educate families and physicians about the benefits of open disclosure to patients and how to change culture. Results of this study along with a previous study call for the development of strategies and guidelines to improve societal views, educate patients and families, and train health professionals in the area of breaking bad news and discussing prognosis in the Sri Lankan setting.
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Affiliation(s)
- Chrishanthi Rajasooriyar
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Jenny Kelly
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Thanikai Sivakumar
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Gowcikan Navanesan
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Shahini Nadarasa
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Madona Hashanthy Sriskandarajah
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
| | - Sabe Sabesan
- and , Jaffna Teaching Hospital; , Tellipalai Trail Cancer Hospital, Jaffna; and , National Hospital of Sri Lanka; , Teaching Hospital, Karapitiya, Sri Lanka; and , Townsville Hospital and Health Service; and , James Cook University; and , The Townsville Hospital, Townsville, Queensland, Australia
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Yanwei L, Dongying L, Zhuchen Y, Ling L, Yu Z, Zhanyu P. A double-edged sword: Should stage IV non-small cell lung cancer patients be informed of their cancer diagnosis? Eur J Cancer Care (Engl) 2017; 26. [PMID: 28266089 DOI: 10.1111/ecc.12665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
Abstract
This study aimed to examine whether awareness of cancer diagnosis and prognosis among patients with stage IV lung cancer treated with first-line erlotinib vary with psychological distress and quality of life (QoL). This study was carried out at the Comprehensive treatment Department of Tianjin Cancer Hospital between August 2013 and September 2015 among patients ≥18 years-old and suffering from EGFR mutation-positive stage IV non-small cell lung cancer (NSCLC) treated with first-line erlotinib (150 mg/day; N = 137). The Hospital Anxiety and Depression Scale (HADS) was administered before (baseline) and after 12 weeks of treatment. QoL was assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire. Diagnosis and prognosis awareness was assessed by interview. Among patients, 21% reported to be fully aware of their disease; 41% were only aware of the diagnosis, not the stage; and 51% were not aware at all. Among patients, 63.5% reported elevated anxiety, 71.5% were depressed, and 75.2% had HADS score ≥15 (emotional distress). Patients who were totally and partly aware experienced improvements in HADS and FACT-L compared with baseline (all p < .05). Patients who were not aware scored better than the other patients for all FACT-L subscales from baseline to 12 weeks (all p < .05). Aware patients experienced improvements from baseline in HADS and FACT-L (all p < .05). Awareness of cancer diagnosis and stage was associated with initially high global distress and poorer QoL. Unaware patients exhibited better emotional distress and QoL during first-line therapy with erlotinib for EGFR mutation-positive advanced NSCLC.
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Affiliation(s)
- L Yanwei
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - L Dongying
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Y Zhuchen
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - L Ling
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Z Yu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - P Zhanyu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Ni YH, Alræk T. What circumstances lead to non-disclosure of cancer-related information in China? A qualitative study. Support Care Cancer 2016; 25:811-816. [PMID: 27832368 PMCID: PMC5266771 DOI: 10.1007/s00520-016-3464-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Withholding information from cancer patients is a common practice in many Asian countries, including China, Japan, and Singapore, as well as in some Western countries, such as Spain, Greece, and Italy. Much research has investigated why doctors withhold information from cancer patients generally, both in the West and the East, but little research has been done on specifically why Chinese doctors withhold such information. METHODS Three focus group interviews were conducted with a total of 16 oncologists in China. The interviews were recorded, transcribed, and translated. Qualitative data were analyzed using systematic text condensation. RESULTS The result of this study revealed numerous circumstances that can lead to non-disclosure of cancer-related information. Many of these circumstances have been described in previous studies about non-disclosure in other countries. We found two additional circumstances that have not been described in previous literature and might therefore expand our current knowledge about this phenomenon; they are contradiction between laws and fear for personal safety. CONCLUSION Numerous circumstances can lead to non-disclosure of cancer-related information. This study found two additional circumstances that might lead to non-disclosure. The findings of this study suggest further assessment and clarification about the laws that govern doctor-patient communication and that action should be taken to ensure safe working environments for Chinese oncologists.
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Affiliation(s)
- Yi Hu Ni
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, Kalfarveien 31, 5020, Bergen, Norway.
| | - Terje Alræk
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Institute of Health Sciences, Kristiania University College, PB 1190 Sentrum, 0107, Oslo, Norway
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31
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[Quality of diagnosis information given to terminal cancer patients]. ENFERMERIA CLINICA 2016; 26:344-350. [PMID: 27647557 DOI: 10.1016/j.enfcli.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
Abstract
AIM To determine the information that terminal cancer patients have about their diagnosis, identifying key words used, and quantifying the conspiracy of silence. METHOD A cross-sectional, analytical study was conducted by reviewing the hospice support team data base which contains the medical history and a semi-structured interview with terminal cancer patients in the first visit to the hospice. Demographic and socioeconomic data was collected, as well as relevant clinical information (diagnosis, prevalent symptoms, number of symptoms, patient functionality, QoL, information given, and words used). RESULTS Out of total of sample of 723 records, 77.87% (95% CI: 74.70-80.74) of the patients were properly informed about their diagnosis. The most used words were cancer in 26% of the patients, tumour in 51.59%, and for the remaining 10.65%, the word inflammation was used. Statistically significant differences of information were found between sexes, age, types of cancer, and hospital ward. CONCLUSIONS Terminal cancer patients have knowledge on their diagnosis, suggesting that the conspiracy of silence is present to a lesser extent. This knowledge is transmitted using different words and with euphemisms.
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Alsirafy SA, Abdel-Kareem SS, Ibrahim NY, Abolkasem MA, Farag DE. Cancer diagnosis disclosure preferences of family caregivers of cancer patients in Egypt. Psychooncology 2016; 26:1758-1762. [PMID: 27362334 DOI: 10.1002/pon.4206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 06/03/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family caregivers (FCs) of cancer patients are frequently seen as a barrier to honest communication with patients in Egypt. This study was conducted to investigate the attitude of FCs of cancer patients toward cancer diagnosis disclosure (CDD) and its determinants. METHODS A structured interview was used to assess the preferences of 288 FCs regarding CDD. RESULTS According to the FCs, 85% of patients were aware of their diagnosis. The majority (81%) of FCs preferred CDD to patients. In case they developed cancer, 92% of FCs wanted to know their diagnosis and 88% wanted to inform their families. In a univariate analysis, factors associated with FCs' negative attitude toward CDD to patients were as follows: patient's lower level of education (P = .001), patient's rural residence (P < .001), hematological malignancies (P < .001), FC's belief that the patient is unaware of diagnosis (P < .001), FC's unwillingness to know his/her own cancer diagnosis (P < .001), and FC's unwillingness to inform his/her family about his/her cancer diagnosis (P < .001). Only 2 factors predicted independently the negative attitude of FCs toward CDD, the FC's belief that the patient is unaware of diagnosis (P < .001), and the FC's unwillingness to know his/her own cancer diagnosis (P = .049). CONCLUSIONS The results suggest that the majority of FCs of Egyptian cancer patients prefer CDD to patients. The finding that the vast majority of FCs of aware patients preferred CDD suggests that the reaction of Egyptian patients to CDD is acceptable by FCs. Family caregivers with a negative attitude toward CDD may be reflecting their own fears.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Shady S Abdel-Kareem
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
- Port Said General Hospital, Port Said, Egypt
| | - Noha Y Ibrahim
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Abolkasem
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dina E Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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33
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Challenges to Practicing Sexual Medicine in the Middle East. Sex Med Rev 2016; 4:221-228. [DOI: 10.1016/j.sxmr.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/26/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022]
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34
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van Eechoud I, Grypdonck M, Leman J, Van Den Noortgate N, Deveugele M, Verhaeghe S. Balancing truth-telling: relatives acting as translators for older adult cancer patients of Turkish or northwest African origin in Belgium. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- I. van Eechoud
- Department of Social Work and Diversity & Intercultural Mediation of the University Hospital Ghent; Ghent Belgium
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - M. Grypdonck
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - J. Leman
- Department of Social Sciences; KULeuven; Leuven Belgium
| | | | - M. Deveugele
- Department of Family Practice and Primary Health Care; Ghent University; Ghent Belgium
| | - S. Verhaeghe
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Ghent Belgium
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Jeba J, Jacob A, Kandasamy R, George R. The patient who 'must not be told': demographic factors associated with collusion in a retrospective study in South India. Postgrad Med J 2016; 92:659-662. [PMID: 27099298 DOI: 10.1136/postgradmedj-2015-133850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/10/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with cancer need adequate information about diagnosis, treatment options, and possible outcomes and prognosis to make therapeutic decisions. In cultures where the family plays the dominant role in healthcare decisions, doctors are often requested to collude in withholding distressing information from the patient. This challenging situation has not been well studied and there is limited knowledge on the different factors that may contribute to collusion. OBJECTIVE To study the prevalence of collusion among adult cancer patients attending a palliative care outpatient clinic and the contributing factors. METHODS The healthcare records of 306 adult cancer patients who had visited the palliative care outpatient clinic at least three times with follow-up until death were retrospectively reviewed. Details on information shared and why it was not shared were retrieved from the documentation in the communication sheet in the patient chart. The prevalence, sociodemographic and clinical factors that could contribute to collusion in doctor-patient communication were studied. RESULTS Collusion was present in 40% of cases at the time of referral to the palliative care outpatient clinic (collusion regarding diagnosis in 18%; collusion regarding prognosis in 40%). Collusion was later addressed in 35%. Collusion was significantly higher among female patients (p=0.005), manual workers (p=0.035), those not accompanied by a spouse (p=0.000) and with no oncological treatment (p=0.001). CONCLUSIONS Collusion regarding diagnosis or prognosis is common among cancer patients referred for palliative care. It was more prevalent among female patients, manual workers, patients who had not received oncological treatment, and patients not accompanied by a spouse.
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Affiliation(s)
- Jenifer Jeba
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Annie Jacob
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ramu Kandasamy
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Reena George
- Palliative Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Ilan S, Carmel S. Patient communication pattern scale: psychometric characteristics. Health Expect 2015; 19:842-53. [PMID: 26172267 PMCID: PMC5034838 DOI: 10.1111/hex.12381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In western societies, a shared decision-making model for doctor-patient relationships calling for open and collaborative communication is recommended. Research focuses mainly on the doctor's communication patterns, while research on patient communication patterns is rare. The purpose of this study was to develop a tool for evaluating patient's communication patterns - the Patient Communication Pattern Scale (PCPS). METHODS Interviews based on structured questionnaires were conducted with 251 cancer patients. In addition to the 14-item PCPS, the questionnaire included questions regarding education, religiosity and desirability of control in general and over one's own health in particular, for validating the scale. RESULTS The PCPS was found to be a valid and reliable tool for evaluating patients' communication patterns. Confirmatory factor analysis supported the PCPS designed structure of five facets: (1) Information, (2) Clarification, (3) Initiation, (4) Preferences and (5) Emotions. CONCLUSION The PCPS is a reliable scale for evaluating patient communication patterns. The use of this scale can assist in promoting related research and in developing interventions for enhancing open and collaborative doctor-patient communication.
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Affiliation(s)
- Sara Ilan
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sara Carmel
- Head Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
The question "What is truth?" is one of the oldest questions in philosophy. Truth within the field of medicine has gained relevance because of its fundamental relationship to the principle of patient autonomy. To fully participate in their medical care, patients must be told the truth-even in the most difficult of situations. Palliative care emphasizes patient autonomy and a patient-centered approach, and it is precisely among patients with chronic, life-threatening, or terminal illnesses that truth plays a particularly crucial role. For these patients, finding out the truth about their disease forces them to confront existential fears. As physicians, we must understand that truth, similar to the complexity of pain, is multidimensional. In this article, we discuss the truth from three linguistic perspectives: the Latin veritas, the Greek aletheia, and the Hebrew emeth. Veritas conveys an understanding of truth focused on facts and reality. Aletheia reveals truth as a process, and emeth shows that truth is experienced in truthful encounters with others. In everyday clinical practice, truth is typically equated with the facts. However, this limited understanding of the truth does not account for the uniqueness of each patient. Although two patients may receive the same diagnosis (or facts), each will be affected by this truth in a very individual way. To help patients apprehend the truth, physicians are called to engage in a delicate back-and-forth of multiple difficult conversations in which each patient is accepted as a unique individual.
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Affiliation(s)
- Gerhild Becker
- Department of Palliative Care, Comprehensive Cancer Center, University Medical Center Freiburg, Freiburg, Germany
| | - Karin Jors
- Department of Palliative Care, Comprehensive Cancer Center, University Medical Center Freiburg, Freiburg, Germany.
| | - Susan Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
OBJECTIVES To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. DATA SOURCES Published articles, textbooks, reports, and clinical experience. CONCLUSION The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. IMPLICATIONS FOR NURSING PRACTICE Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.
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Huang SH, Tang FI, Liu CY, Chen MB, Liang TH, Sheu SJ. Truth-telling to patients' terminal illness: what makes oncology nurses act individually? Eur J Oncol Nurs 2014; 18:492-8. [PMID: 24907230 DOI: 10.1016/j.ejon.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Nurses encounter the challenge of truth-telling to patients' terminal illness (TTPTI) in their daily care activities, particularly for nurses working in the pervasive culture of family protectiveness and medical paternalism. This study aims to investigate oncology nurses' major responses to handling this issue and to explore what factors might explain oncology nurses' various actions. METHODS A pilot quantitative study was designed to describe full-time nurses' (n = 70) truth-telling experiences at an oncology centre in Taipei. The potential influencing factors of nurses' demographic data, clinical characteristics, and truth-telling attitudes were also explored. RESULTS Most nurses expressed that truth-telling was a physician's responsibility. Nevertheless, 70.6% of nurses responded that they had performed truth-telling, and 20 nurses (29.4%) reported no experience. The reasons for inaction were "Truth-telling is not my duty", "Families required me to conceal the truth", and "Truth-telling is difficult for me". Based on a stepwise regression analysis, nurses' truth-telling acts can be predicted based on less perceived difficulty of talking about "Do not resuscitate" with patients, a higher perceived authorisation from the unit, and more oncology work experience (adjusted R² = 24.1%). CONCLUSIONS Oncology care experience, perceived comfort in communication with terminal patients, and unit authorisation are important factors for cultivating nurses' professional accountability in truth-telling. Nursing leaders and educators should consider reducing nursing barriers for truth-telling, improving oncology nurses' professional accountability, and facilitating better quality care environments for terminal patients.
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Affiliation(s)
- Shu-He Huang
- School of Nursing, National Yang Ming University, Taipei, Taiwan; Department of Nursing, National Yang-Ming University Hospital, Taipei, Taiwan.
| | - Fu-In Tang
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
| | - Chang-Yi Liu
- Oncology Unit of O'Connor Hospital, San Jose, CA, USA.
| | - Mei-Bih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Te-Hsin Liang
- Department of Statistics of Information Science, Center for Statistical Consultation, Fu Jen Catholic University, Taipei, Taiwan.
| | - Shuh-Jen Sheu
- School of Nursing, National Yang Ming University, Taipei, Taiwan.
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Discordance between perceived and actual cancer stage among cancer patients in Korea: a nationwide survey. PLoS One 2014; 9:e90483. [PMID: 24817193 PMCID: PMC4015901 DOI: 10.1371/journal.pone.0090483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 02/03/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We assessed the accuracy of communication between doctors and patients by evaluating the consistency between patient perception of cancer stage and the medical records, and analyzed the most influential factors of incongruence among cancer patients at 10 cancer centers across Korea. METHODS Information was gathered from cancer patients at the National Cancer Center and nine regional cancer centers located in every province of Korea between 1 July 2008 and 31 August 2008. Data were analyzed using Pearson's χ2 test and multivariate logistic regression analysis. RESULTS The stages of cancer reported by the 1,854 patients showed a low degree of congruence with the stages given in medical records (k = 0.35, P<0.001). Only 57.1% of the patients had accurate knowledge of their cancer stage. In total, 18.5% underestimated their stage of disease, and the more advanced the cancer stage, the more likely they were to underestimate it, in order of local (14.2%), regional (23.7%), and distant (51.6%). Logistic regression analysis showed that congruence was lower in patients with cervical cancer (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.30-0.87), recurrence (OR = 0.64, 95% CI = 0.50-0.83), and treatment at the National Cancer Center (OR = 0.53, 95% CI = 0.39-0.72). CONCLUSION There are knowledge gaps between patients' perceived and actual stage of cancer. Patients with cervical cancer, recurrence, and who received treatment at a regional cancer center showed less understanding of their cancer stage.
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Tanzi S, Biasco G, Baile WF. Enhancing the Empathic Connection: Using Action Methods to Understand Conflicts in End-of-Life Care. J Patient Exp 2014; 1:14-19. [PMID: 28725796 DOI: 10.1177/237437431400100104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Empathy is a core feature of patient-centered care. It enables practitioners to better understand the patient and family concerns that are key to patient and family satisfaction, prevention of anxiety and depression, and provider empowerment. Current methods of teaching communication skills do not specifically focus on enhancing the ability to "stand in the patient's shoes" as a way of connecting with the patient and/or family experience and understanding feelings that may be a source of conflict with providers. In this paper, we present a model for deepening empathic understanding based upon action methods (role-reversal and doubling) derived from psychodrama and sociodrama. We describe these techniques and illustrate how they can be used to identify hidden emotions and attitudes and reveal that which the patient and family member may be thinking or feeling but be afraid to say. Finally, we present data showing that these methods were valuable to participants in enhancing their professional experience and skills.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Guido Biasco
- Academy of Sciences of Palliative Medicine, Bentivoglio, Bologna, Italy
| | - Walter F Baile
- Departments of Behavioral Science and Faculty and Academic Development, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Wang DC, Guo CB, Peng X, Su YJ. Psychological morbidity and health-related quality of life in patients with differing awareness of cancer diagnosis: a cross-sectional study. Psychooncology 2014; 23:975-80. [PMID: 24577849 DOI: 10.1002/pon.3512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 12/08/2013] [Accepted: 02/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Dian Can Wang
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Chuan Bin Guo
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Xin Peng
- Department of Oral and Maxillofacial Surgery; Peking University School and Hospital of Stomatology; Beijing China
| | - Yan Jie Su
- Department of Psychology; Peking University; Beijing China
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Sarafis P, Tsounis A, Malliarou M, Lahana E. Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Glob J Health Sci 2013; 6:128-37. [PMID: 24576372 PMCID: PMC4825228 DOI: 10.5539/gjhs.v6n2p128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/23/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. AIMS Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. METHOD Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. RESULTS There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.
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Affiliation(s)
- Pavlos Sarafis
- Faculty of Nursing, Technological Educational Institute of Sterea Ellada.
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Al-Amri AM. Future Saudi doctors and cancer patients agree cancer patients should be informed about their cancer. Asia Pac J Clin Oncol 2013; 9:342-8. [PMID: 23672291 DOI: 10.1111/ajco.12073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare attitudes of Saudi medical students and Saudi cancer patients towards disclosure of cancer information and to examine whether differences exist between students and patients, level of education or gender and region of residence. METHODS Data were collected from 384 students and 368 patients using a nine-question questionnaire on attitudes to cancer. RESULTS Almost all patients (98%) wanted to receive all the information should they get cancer compared with 93% of students (P = 0.001) and almost no patients and students wanted the information hidden (99 vs 98%, P = 0.273). If they became ill students were more likely to share information with their family and friends than patients. Fewer than 2% of patients did not want to know the benefits of chemotherapy compared to 3% of students, while 99% of patients wanted to know the side-effects compared to 93% of students (P = 0.095 and P = 0.001, respectively). Almost all patients and students (99 vs 98%) would refuse treatment without knowing their diagnosis (P = 0.401). Patients wanted to know the prognosis more than students (98 vs 92%; P = 0.001). In all, 99% of male students wanted their cancer diagnosis disclosed compared with women (98%; P = 0.615). Gender, education level, regions and age did not affect the desire of cancer patients to know their prognosis (P = 0.275, P = 0.664, P = 0.0314 and P = 0.164, respectively). CONCLUSION There was a consensus among cancer patients and medical students that cancer information, including diagnosis, treatment effects and prognosis, should be disclosed to patients.
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Affiliation(s)
- Ali M Al-Amri
- Department of Internal Medicine/Oncology, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
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Arabiat DH, Al Jabery M, Abdelkader RH, Mahadeen A. Jordanian mothers' beliefs about the causes of cancer in their children and their impact on the maternal role. J Transcult Nurs 2013; 24:246-53. [PMID: 23545695 DOI: 10.1177/1043659613481808] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Arab culture and Islamic beliefs contribute to values and practices regarding cancer. Mothers in Jordanian society are expected to be the primary caregivers to children. PURPOSE The purpose of this study was to explore Jordanian mothers' beliefs regarding the causes of cancer in their children and their impact on their role as mothers. DESIGN A descriptive, qualitative design was used. Individual interviews were conducted with Jordanian mothers (n = 51) of hospitalized children with cancer. RESULTS Causes of cancer were attributed to supernatural explanations and biomedical explanations. The impact of cancer on these mothers' lives varied. For some, their child's illness resulted in stronger family bonds, whereas for others, the families suffered a state of disequilibrium. CONCLUSIONS Cultural beliefs helped assign meaning to their children's illness. The maternal role of Jordanian women was partially fulfilled or inadequately performed, which in turn affected the functioning and coping abilities of the entire household.
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Chou WC, Hung YS, Kao CY, Su PJ, Hsieh CH, Chen JS, Liau CT, Lin YC, Liaw CC, Wang HM. Impact of palliative care consultative service on disease awareness for patients with terminal cancer. Support Care Cancer 2013; 21:1973-81. [DOI: 10.1007/s00520-013-1733-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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When clinicians telling the truth is de facto discouraged, what is the family’s attitude towards disclosing to a relative their cancer diagnosis? Support Care Cancer 2012; 21:1089-95. [DOI: 10.1007/s00520-012-1629-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
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Locatelli C, Piselli P, Cicerchia M, Repetto L. Physicians' age and sex influence breaking bad news to elderly cancer patients. Beliefs and practices of 50 Italian oncologists: the G.I.O.Ger study. Psychooncology 2012; 22:1112-9. [DOI: 10.1002/pon.3110] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/07/2022]
Affiliation(s)
| | - P. Piselli
- Department of Epidemiology; INMI “L. Spallanzani”; Rome; Italy
| | | | - L. Repetto
- UOC Oncology; Borea Hospital, Sanremo (IM); Italy
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de Pentheny O'Kelly C, Urch C, Brown EA. The impact of culture and religion on truth telling at the end of life. Nephrol Dial Transplant 2011; 26:3838-42. [DOI: 10.1093/ndt/gfr630] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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