Intentions of nurses and nursing students to tell the whole truth to patients and family members

Evaluation of Guilan University of Medical Sciences medical interns' attitudes regarding breaking bad news to patients based on the SPIKES model, 2020 to 2022

BACKGROUND

Bad news may be defined as "any information which adversely and seriously affects an individual's view of his or her future." It seems necessary for physicians to use a specific method to break the bad news to patients properly. Due to the importance of this skill and its effects on patient's hope and motivation to continue his treatment process, in this study, we evaluate the interns of Guilan University of Medical Sciences' attitude to breaking bad news (BBN) to the patients based on strategy for BBN, perception of condition or seriousness, invitation from the patient to give information, knowledge: giving medical facts, explore emotions, and sympathize (SPIKES) model in 2020-2022.

MATERIALS AND METHODS

In this cross-sectional study in Iran, 153 Guilan University of Medical Sciences interns were selected as a census sample in 2020-2022. A self-administered questionnaire collected the information with standard tests confirming its reliability and validity. The collected data were described and analyzed using Statistical Package for the Social Sciences (SPSS) 16. The Chi-square test was used to measure the statistical relationship between the demographic variables and the entire questionnaire. Also, a one-way analysis of variance (ANOVA) test was used to measure the relationship between the average age and the scores obtained from the four main areas and the entire questionnaire. A statistical level of less than 0.05 was considered significant.

RESULTS

43.1% of the interns were men, and 56.9% were women. The mean attendance age was 26.12 ± 1.32, the minimum age was 23, and the maximum was 33. Only 8.5% of the interns in this study had been taught about BBN, and most participants announced that they feel pressure and anxiety when BBN to patients. The attitude of interns in this study was not satisfying in all four parts of the study: individual preference (54.2% of participants showed poor attitude), preparing environmental conditions for BBN (60.8% of participants showed poor attitude), how to break bad news (52.3% of participants showed poor attitude), and the things that are done after BBN (52.9% of participants showed poor attitude).

CONCLUSION

Based on the results, the attitude of the interns who had participated in this study was not satisfactory. Due to the importance of this communication skill to reduce physician anxiety and best control patients' reactions, managing courses in the undergraduate curriculum seems necessary.

Who breaks bad news: Doctors, family caregivers or cancer patients? A qualitative study in Southern China

This qualitative study was conducted among the family caregivers of cancer patients treated in a hospital in Shenzhen, southern China, to elucidate the truth-telling process. Thirteen participants were recruited, and the data were thematically analyzed. The five major themes are as follows: Who discloses the truth to cancer patients? How do patients react to being informed of their true condition? What happens to cancer patients after they learn the truth? What are the impacts of family relationships and Chinese culture on truth telling? How do cancer patients behave after learning the truth?

Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients

OBJECTIVES

We aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis.

METHODS

We conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis.

RESULTS

Doctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient's "right to know" and respecting the family's interest in protecting the patient.

CONCLUSIONS

Doctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient's "right to know." Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China's cultural value of family decision-making.

PRACTICE IMPLICATIONS

Future training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.

Modeling Psychologists’ Ethical Intention

At the core of all therapeutic and medical practice lies ethics. By applying an expanded Ajzen’s Theory of Planned Behavior formulation, the present investigation tested a model for explaining psychologists’ intention to behave ethically. In the pretest, dual relationships and money conflicts were seen as the most prevalent dilemmas. A total of 395 clinical psychologists filled out questionnaires containing either a dual relationship dilemma describing a scenario where a psychologist was asked to treat a son of a colleague or a money-focused dilemma where he or she was asked to treat a patient unable to pay for the service. Results obtained from applying the expanded Ajzen’s model to each dilemma, generally, supported the study hypotheses. In particular, attitudes were seen as the most important predictor in both dilemmas followed by a morality component, defined here as the commitment of the psychologist to the patient included here as an additional predictor in the model. The expanded model provided a better understanding of ethical intention. Practical implications were also discussed.

Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice

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.