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Zarezadeh MR, Mirzaei S, Mirjalili SMJ, Nasiriani K. The effect of guided group reflection on the ability and convenience of breaking bad news in pre-hospital emergency staff. BMC Health Serv Res 2024; 24:1175. [PMID: 39363286 PMCID: PMC11451198 DOI: 10.1186/s12913-024-11604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/18/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Bad news refers to any information that create negative changes in a person's understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. METHODS This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. RESULTS The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). CONCLUSION According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.
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Affiliation(s)
- Mohammad Reza Zarezadeh
- Nursing and Midwifery Care Research Center, Non- Communicable Diseases Research Institute, Shahid Sadougi University of Medical Sciences, Yazd, Iran
| | - Samaneh Mirzaei
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Khadijeh Nasiriani
- Department of Nursing, Nursing and Midwifery Care Research Center, Spiritual Health Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Canosa HG. Brazilian PENSA protocol: practical guide to difficult communication. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240674. [PMID: 39292091 DOI: 10.1590/1806-9282.20240674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/09/2024] [Indexed: 09/19/2024]
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Polivka L, Delcour C, Dufresne H, Bartoli S, Bataille P, Bekel L, Bonigen J, Deladrière E, Dimarcq S, Felix A, Havas C, Le Goff H, Levy M, Riback E, Welfringer-Morin A, Houdouin V, Hadj-Rabia S, Bodemer C, Faye A, Melki I. Breaking bad news: an active learning method for medical students. BMC MEDICAL EDUCATION 2024; 24:994. [PMID: 39267024 PMCID: PMC11391681 DOI: 10.1186/s12909-024-05821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/25/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Breaking bad news is one of the most difficult aspects of communication in medicine. The objective of this study was to assess the relevance of a novel active learning course on breaking bad news for fifth-year students. METHODS Students were divided into two groups: Group 1, the intervention group, participated in a multidisciplinary formative discussion workshop on breaking bad news with videos, discussions with a pluri-professional team, and concluding with the development of a guide on good practice in breaking bad news through collective intelligence; Group 2, the control group, received no additional training besides conventional university course. The relevance of discussion-group-based active training was assessed in a summative objective structured clinical examination (OSCE) station particularly through the students' communication skills. RESULTS Thirty-one students were included: 17 in Group 1 and 14 in Group 2. The mean (range) score in the OSCE was significantly higher in Group 1 than in Group 2 (10.49 out of 15 (7; 13) vs. 7.80 (4.75; 12.5), respectively; p = 0.0007). The proportion of students assessed by the evaluator to have received additional training in breaking bad news was 88.2% (15 of the 17) in Group 1 and 21.4% (3 of the 14) in Group 2 (p = 0.001). The intergroup differences in the Rosenberg Self-Esteem Scale and Jefferson Scale of Empathy scores were not significant, and both scores were not correlated with the students' self-assessed score for success in the OSCE. CONCLUSION Compared to the conventional course, this new active learning method for breaking bad news was associated with a significantly higher score in a summative OSCE. A longer-term validation study is needed to confirm these exploratory data.
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Affiliation(s)
- Laura Polivka
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France.
| | - C Delcour
- Department of Obstetrical-Gynecology, Robert-Debré Hospital, AP-HP, Paris Cité University, Paris, EU, France
| | - H Dufresne
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - S Bartoli
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert-Debré, AP-HP, Paris Cité University, Paris, EU, France
| | - P Bataille
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - L Bekel
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - J Bonigen
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - E Deladrière
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - S Dimarcq
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - A Felix
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert-Debré, AP-HP, Paris Cité University, Paris, EU, France
- Department of General Pediatrics, RAISE Antilles-Guyane, Martinique University Hospital, Fort-de France, EU, France
| | - C Havas
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - H Le Goff
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - M Levy
- Paediatric Intensive Care Unit, Robert-Debré Hospital, AP-HP, Paris Cité University, Paris, EU, France
| | - E Riback
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - A Welfringer-Morin
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - V Houdouin
- Department of Pediatric Pulmonology and Pediatric Cystic Fibrosis Center, Robert-Debré Hospital, AP-HP, Paris Cité University, Paris, EU, France
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris Cité University, 149 rue de Sèvres, Paris, EU, 75015, France
| | - A Faye
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert-Debré, AP-HP, Paris Cité University, Paris, EU, France
| | - I Melki
- General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Robert-Debré, AP-HP, Paris Cité University, Paris, EU, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, EU, F-33000, France
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O'Connell C, Kavanaugh MS, Cummings C, Genge A. How to break the news in amyotrophic lateral sclerosis/motor neuron disease: practical guidelines from experts. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-10. [PMID: 39258740 DOI: 10.1080/21678421.2024.2397517] [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: 04/04/2024] [Revised: 07/29/2024] [Accepted: 08/17/2024] [Indexed: 09/12/2024]
Abstract
In amyotrophic lateral sclerosis/motor neuron disease (ALS/MND), it is necessary to communicate difficult news during the initial diagnosis and throughout the disease trajectory as the condition progresses. However, delivering difficult news to people with ALS/MND is an emotionally demanding task for healthcare and allied health professionals-one for which many feel ill-prepared because of limited training in this area. Ineffective communication of difficult news damages the patient-provider relationship and negatively impacts patient quality of life (QoL). To address this issue, we developed the A-L S-PIKES protocol based on available literature and our extensive clinical experience. It provides easy-to-follow, stepwise guidelines to effectively deliver difficult news to people with ALS/MND (PALS) that includes: Advance Preparation (preparing for the discussion logistically and emotionally); Location & Setting (creating a comfortable setting that fosters rapport); Patient's Perceptions (assessing PALS' understanding and perception of their condition); Invitation (seeking PALS' permission to share information); Knowledge (sharing information in a clear, understandable manner); Emotion/Empathy (addressing emotions with empathy and providing emotional support); and Strategy & Summary (summarizing the discussion and collaboratively developing a plan of action). A-L S-PIKES provides practical guidelines on how to prepare for and conduct these challenging conversations. It emphasizes effective communication tailored to the individual needs of PALS and their families, empathy, sensitivity, and support for PALS' emotional well-being and autonomy. The aim of A-L S-PIKES is to both enhance skills and confidence in delivering difficult news and to improve the QoL of PALS and their families. Future studies should systematically evaluate the feasibility and effectiveness of A-L S-PIKES to establish its utility in clinical practice.
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Affiliation(s)
- Colleen O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada
- Physical Medicine & Rehabilitation, Dalhousie University, Faculty of Medicine, Fredericton, Canada
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Cathy Cummings
- International Alliance of ALS/MND Associations (Northampton, England), Coldwater, Canada
| | - Angela Genge
- Clinical Research Unit, Montreal Neurological Institute, Montreal, Canada, and
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Yousuf AAAA, Stewart DC, Kane T, Soltani A, Al-Khal A, Sethi A. Health professionals' views and experiences of breaking bad news in the Eastern Mediterranean Region: a scoping review. Front Med (Lausanne) 2024; 11:1440867. [PMID: 39290389 PMCID: PMC11407430 DOI: 10.3389/fmed.2024.1440867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Breaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization's (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals' experiences in delivering bad news within the WHO's Eastern Mediterranean Region. Methods This scoping review was conducted according to the Joanna Brigg Institute's scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to "breaking bad news" and "health professionals" was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO's Eastern Mediterranean Region. Results Out of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants. Conclusion The scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO's Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.
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Affiliation(s)
| | | | - Tanya Kane
- QU Health, Qatar University, Doha, Qatar
| | | | - Abdullatif Al-Khal
- QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
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Mohd Desa SNF, Doss JG, Kadir K, Ch'ng LL, Kok TC, Jelon MA, Yahya MR, Parumo R, Chong SMY, Shim CK. An insight into clinicians' practices in breaking bad news of oral cancer diagnosis. Int J Oral Maxillofac Surg 2024; 53:717-723. [PMID: 38637182 DOI: 10.1016/j.ijom.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia. An exploratory sequential mixed-methods study design was used. A qualitative study was conducted among 12 clinicians to gather relevant information regarding their practices in BBN of oral cancer diagnosis using a descriptive-interpretive approach. The themes that emerged were preparation for BBN, BBN setting, communication, emotional aspects, and summarizing the session. These themes were used to develop a questionnaire with 34 items. In the quantitative study, this questionnaire was sent to 87 clinicians who had experienced BBN of oral cancer diagnosis in the past 5 years; the response rate was 100%. An arbitrary cut-off score between the third and fourth quartiles was set to distinguish 'good' and 'poor' practice in BBN among the clinicians. The data analysis was performed using IBM SPSS Statistics version 23.0. Overall, at least two-thirds of the clinicians had good practices in BBN of oral cancer diagnosis. The clinicians' designation (oral and maxillofacial surgery consultant/specialist vs dental officer) and BBN experiences were factors associated with their practices in BBN of oral cancer diagnosis.
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Affiliation(s)
- S N F Mohd Desa
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Periodontology and Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - J G Doss
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia; Oral Cancer Research and Coordinating Centre (OCRCC), Universiti Malaya, Kuala Lumpur, Malaysia.
| | - K Kadir
- Oral Cancer Research and Coordinating Centre (OCRCC), Universiti Malaya, Kuala Lumpur, Malaysia; Department of Oral and Maxillofacial and Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - L L Ch'ng
- Oral and Maxillofacial Surgery Department, Hospital Seberang Jaya, Seberang Jaya, Perai, Pulau Pinang, Malaysia
| | - T C Kok
- Oral and Maxillofacial Surgery Department, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - M A Jelon
- Oral and Maxillofacial Surgery Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - M R Yahya
- Oral and Maxillofacial Surgery Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - R Parumo
- Oral and Maxillofacial Surgery Department, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - S M Y Chong
- Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah, Klang, Selangor, Malaysia
| | - C K Shim
- Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia
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Cardoso AF, Rosendo I, Santiago L, Neto J, Cardoso D. Protocols for breaking bad news in health care: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00334. [PMID: 39039825 DOI: 10.11124/jbies-23-00404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVE This scoping review will map the available evidence on communication protocols for breaking bad news to adult patients and their families in health care. INTRODUCTION Breaking bad news to adult patients and their families is a challenging task for health care professionals. To address these challenges, communication protocols have been developed to support health care professionals in breaking bad news in a compassionate and effective manner while respecting each patient's individuality. INCLUSION CRITERIA This scoping review will consider all studies that focus on communication protocols (original or adapted versions) to break bad news to adult patients and/or their families (adults) in any health care context, regardless of the approach (face-to-face, telephone, video, or other). Quantitative, qualitative, and mixed methods studies, systematic reviews, and text and opinion papers will be considered for inclusion in this review. METHODS This review will be conducted in accordance with the JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished evidence in English, Spanish, and Portuguese. The databases to be searched include CINAHL Plus Complete (EBSCOhost), MEDLINE (PubMed), Academic Search Complete, Psychology and Behavioral Sciences Collection, Scopus, and Web of Science Core Collection. Gray literature will also be searched for. Two independent reviewers will independently perform study selection and data extraction. Data will be extracted using a data extraction tool developed by the reviewers. Any disagreements that arise between the reviewers will be resolved through discussion or with an additional reviewer. Data will be presented in tabular and narrative format. DETAILS OF THE REVIEW CAN BE FOUND IN OPEN SCIENCE FRAMEWORK https://osf.io/s6ru7/.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Inês Rosendo
- USF Coimbra Centro, Coimbra, Portugal
- Faculty of Medicine of University of Coimbra, University of Coimbra Coimbra, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Luiz Santiago
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), University of Coimbra, Coimbra, Portugal
| | - Joana Neto
- Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Krieger T, Jozwiak L, Ebersbach G, Suess T, Falkenburger B, Feige T, Eggers C, Warnecke T, Scholl W, Schmidt-Heisch C, Folkerts AK, Kalbe E, Seven ÜS. Exploring the lived experiences of individuals with Parkinson's disease and their relatives: insights into care provision experiences, disease management support, self-management strategies, and future needs in Germany (qualitative study). BMC Neurol 2024; 24:208. [PMID: 38890614 PMCID: PMC11184701 DOI: 10.1186/s12883-024-03696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) significantly impacts the health-related quality of life of affected individuals and their relatives. In order to support the affected individuals and their families in coping with PD, it is essential to offer comprehensive information about their experiences. A comprehensive understanding of their lived experiences with the disease, the healthcare system, applied self-management strategies and their needs is considered crucial for developing a PD support program. Therefore, we aimed to explore the lived experiences and support needs of individuals with PD and their relatives in Germany. METHODS This non-interventional, qualitative study conducted an explorative status quo and needs assessment. It generated knowledge through semi-structured focus groups and interviews with individuals with PD at various disease stages and their relatives. The interviews were digitally recorded, transcribed verbatim, and analysed using content analysis. RESULTS Fifty-two individuals with PD and 29 relatives participated in eight focus groups and 13 paired and 13 individual interviews. Four themes with corresponding subthemes emerged: (1) experiences, revealing individuals' experiences around their diagnosis and with disease-specific care provision; (2) management support offers, clarifying who provides support and the type of support offered; (3) self-management, including comprehensibility, meaningfulness and manageability; and (4) future needs, differentiating between deficits and needs. Most participants expressed a sense of abandonment when obtaining self-management strategies and mastering their lives with PD, often referred to as 'life 2.0'. They identified the lack of structured and adequate provision of information, system orientation and social awareness. CONCLUSIONS In Germany, there is an urgent need for a comprehensive PD care program that addresses the needs of individuals with PD and their relatives from the start of their care trajectory. It could assist individuals in gaining a comprehensive understanding of the disease, obtaining self-management strategies, building a support network, and becoming experts in self-managing their disease. Moreover, it may positively influence their care trajectory and reduce burdens, such as overburdening, fear of progression, and health anxiety. TRIAL REGISTRATION German Clinical Studies Register ( https://www.drks.de/DRKS00030090 , No. DRKS00030090, Date of registration: 15.12.2022).
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Affiliation(s)
- Theresia Krieger
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Leonie Jozwiak
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Ebersbach
- Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Thorsten Suess
- Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Björn Falkenburger
- Department of Neurology, University of Technology Dresden, Dresden, Germany
| | - Tim Feige
- Department of Neurology, University of Technology Dresden, Dresden, Germany
| | - Carsten Eggers
- Knappschaftskrankenhaus Bottrop, Department of Neurology, Bottrop, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Munster, Munster, Germany
| | | | | | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Mariano L, Nicosia L, Sorce A, Pesapane F, Coppini V, Grasso R, Monzani D, Pravettoni G, Mauri G, Venturini M, Pizzamiglio M, Cassano E. Radiologists' Communicative Role in Breast Cancer Patient Management: Beyond Diagnosis. Healthcare (Basel) 2024; 12:1145. [PMID: 38891220 PMCID: PMC11172385 DOI: 10.3390/healthcare12111145] [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: 03/25/2024] [Revised: 05/20/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
In the landscape of cancer treatment, particularly in the realm of breast cancer management, effective communication emerges as a pivotal factor influencing patient outcomes. This article delves into the nuanced intricacies of communication skills, specifically spotlighting the strategies embraced by breast radiologists. By examining the ramifications of communication on patient experience, interdisciplinary collaboration, and legal ramifications, this study underscores the paramount importance of empathetic and comprehensive communication approaches. A special emphasis is placed on the utilization of the SPIKES protocol, a structured method for conveying sensitive health information, and the deployment of strategies for navigating challenging conversations. Furthermore, the work encompasses the significance of communication with caregivers, the integration of artificial intelligence, and the acknowledgement of patients' psychological needs. By adopting empathetic communication methodologies and fostering multidisciplinary collaboration, healthcare practitioners have the potential to enhance patient satisfaction, promote treatment adherence, and augment the overall outcomes within breast cancer diagnosis. This paper advocates for the implementation of guidelines pertaining to psychological support and the allocation of sufficient resources to ensure the provision of holistic and patient-centered cancer care. The article stresses the need for a holistic approach that addresses patients' emotional and psychological well-being alongside medical treatment. Through thoughtful and empathetic communication practices, healthcare providers can profoundly impact patient experiences and breast cancer journeys in a positive manner.
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Affiliation(s)
- Luciano Mariano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (L.M.); (F.P.); (M.P.); (E.C.)
| | - Luca Nicosia
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (L.M.); (F.P.); (M.P.); (E.C.)
- Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
| | - Adriana Sorce
- Postgraduation School in Radiodiagnostics, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Filippo Pesapane
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (L.M.); (F.P.); (M.P.); (E.C.)
| | - Veronica Coppini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.C.); (R.G.); (D.M.); (G.P.)
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.C.); (R.G.); (D.M.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.C.); (R.G.); (D.M.); (G.P.)
- Laboratory of Behavioral Observation and Research on Human Development, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.C.); (R.G.); (D.M.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (L.M.); (F.P.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (L.M.); (F.P.); (M.P.); (E.C.)
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Lackie K, Miller S, Brown M, Mireault A, Helwig M, Beatty L, Picketts L, Stilwell P, Houk S. Interprofessional collaboration between health professional learners when breaking bad news: a scoping review of teaching approaches. JBI Evid Synth 2024; 22:1071-1102. [PMID: 38328948 DOI: 10.11124/jbies-22-00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The objective of this scoping review was to examine teaching approaches used to teach interprofessional health professional learners how to break bad news collaboratively. INTRODUCTION When breaking bad news, health professionals must be equipped to deliver it skillfully and collaboratively; however, the literature shows that this skill receives little attention in program curricula. Consequently, health professionals can feel inadequately prepared to deliver bad news, which may lead to increased burnout, distress, and compassion fatigue. INCLUSION CRITERIA Studies that describe teaching approaches used to teach learners how to break bad news collaboratively were considered for inclusion. Studies must have included 2 or more undergraduate and/or postgraduate learners working toward a professional health or social care qualification/degree at a university or college. Studies including lay, complementary and alternative, or non-health/social care learners were excluded. Due to the primary language of the research team, only English articles were included. METHODS The JBI 3-step process was followed for developing the search. Databases searched included MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Education Resource Complete (EBSCOhost), and Social Work Abstracts (EBSCOhost). The initial search was conducted on February 11, 2021, and was updated on May 17, 2022. Title and abstract screening and data extraction were completed by 2 independent reviewers. Disagreements were resolved through discussion or with a third reviewer. Results are presented in tabular or diagrammatic format, together with a narrative summary. RESULTS Thirteen studies were included in the scoping review, with a range of methodologies and designs (pre/post surveys, qualitative, feasibility, mixed methods, cross-sectional, quality improvement, and methodological triangulation). The majority of papers were from the United States (n=8; 61.5%). All but 1 study used simulation-enhanced interprofessional education as the preferred method to teach interprofessional cohorts of learners how to break bad news. The bulk of simulations were face-to-face (n=11; 84.6%). Three studies (23.1%) were reported as high fidelity, while the remainder did not disclose fidelity. All studies that used simulation to teach students how to break bad news utilized simulated participants/patients to portray patients and/or family in the simulations. The academic level of participants varied, with the majority noted as undergraduate (n=7; 53.8%); 3 studies (23.1%) indicated a mix of undergraduate and graduate participants, 2 (15.4%) were graduate only, and 1 (7.7%) was not disclosed. There was a range of health professional programs represented by participants, with medicine and nursing equally in the majority (n=10; 76.9%). CONCLUSIONS Simulation-enhanced interprofessional education was the most reported teaching approach to teach interprofessional cohorts of students how to break bad news collaboratively. Inconsistencies were noted in the language used to describe bad news, use of breaking bad news and interprofessional competency frameworks, and integration of interprofessional education and simulation best practices. Further research should focus on other interprofessional approaches to teaching how to break bad news; how best to incorporate interprofessional competencies into interprofessional breaking bad news education; whether interprofessional education is enhancing collaborative breaking bad news; and whether what is learned about breaking bad news is being retained over the long-term and incorporated into practice. Future simulation-specific research should explore whether and how the Healthcare Simulation Standards of Best Practice are being implemented and whether simulation is resulting in student satisfaction and enhanced learning.
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Affiliation(s)
- Kelly Lackie
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Stephen Miller
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marion Brown
- School of Social Work, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Amy Mireault
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Melissa Helwig
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Lorri Beatty
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leanne Picketts
- Centre for Collaborative Clinical Learning and Research, Dalhousie University, Halifax, NS, Canada
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Shauna Houk
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Krieger T, Dittmer K, Reinert D, Hömberg M, Tepe A, Hamm I, Vitinius F. Study protocol OKRA: orientation compass for the preparing, delivering and following up on breaking bad news conversations in paediatric oncology. BMJ Paediatr Open 2024; 8:e002473. [PMID: 38823801 PMCID: PMC11149114 DOI: 10.1136/bmjpo-2023-002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/25/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION In paediatric oncology, 'breaking bad news'-BBN-like cancer diagnosis is perceived as particularly challenging. Enabling a trialogue between children with their relatives and health professionals requires profound communication skills. Lacking the skills, experience or adequate support tools might result in negative consequences for both paediatric oncologists as BBN transmitters and BBN receivers as children with cancer and their relatives.In contrast to oncology for adults, multiperspective studies that explore BBN experience and specific support needs are rare, especially in Germany. Systematically developed and practically piloted support instruments, which address the specific needs of paediatric oncology, are missing. OBJECTIVE To systematically design and mature in practice an orientation compass for preparing, delivering and following up on BBN conversations in paediatric oncology-so-called Orientierungskompass zur Übermittlung schwerwiegender Nachrichten in der Kinderonkologie (OKRA). METHODS AND ANALYSIS OKRA is based on a QUAL-quant mixed study design, comprising two phases. Four groups will contribute (1) experts through personal experience (representatives for children receiving BBN and their parents), (2) medical care providers and representatives of national medical societies, (3) ambulant psychosocial/psychological support providers and (4) researchers. In phase 1, multiperspective knowledge is generated through a participatory group Delphi that involves in-depth interviews, focus group discussions and questionnaires. This process culminates in formulating theses for a high-quality BBN process (output phase 1). In phase 2, based on the theses, a pilot orientation compass is designed. Through iterative cycles with the participatory action research method, this instrument will be piloted in three paediatric oncological settings and consequently optimised. ETHICS AND DISSEMINATION OKRA was approved on 19 September 2023 by the ethics committee of the Medical Faculty of the University of Cologne (No. 23-1187). After project completion, the OKRA compass will be distributed to multidisciplinary paediatric oncology teams throughout Germany. TRIAL REGISTRATION NUMBER DRKS00031691.
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Affiliation(s)
- Theresia Krieger
- Medical Psychology | Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne and Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Faculty of Medicine, Department of Medical Psychology, Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne and University Hospital Cologne, Cologne, Germany
| | - David Reinert
- Faculty of Medicine, Department of Medical Psychology, Neuropsychology and Gender Studies & Centre for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne and University Hospital Cologne, Cologne, Germany
| | - Marc Hömberg
- Department of Paediatric Oncology and Haematology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Andrea Tepe
- Foundation for Children with Cancer with Affiliated Parent-House, Cologne, Germany
| | - Isabel Hamm
- Department of Psychosomatics and Psychotherapy, University of Cologne and Faculty of Medicine, Cologne, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University of Cologne and Faculty of Medicine, Cologne, Germany
- Department of Psychosomatic Medicine, Robert Bosch Hospital, Stuttgart, Germany
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Falvo L, Bona A, Heniff M, Cooper D, Moore M, Doos D, Sarmiento E, Hobgood C, Ahmed R. How to HEEAL: A Patient and Peer-Centric Simulation Curriculum for Medical Error Disclosure. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11394. [PMID: 38567116 PMCID: PMC10985053 DOI: 10.15766/mep_2374-8265.11394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024]
Abstract
Introduction Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop. Methods This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure. Results Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05). Discussion This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.
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Affiliation(s)
- Lauren Falvo
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Anna Bona
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Melanie Heniff
- Associate Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Dylan Cooper
- Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | - Malia Moore
- Assistant Professor, Department of Emergency Medicine, Indiana University School of Medicine
| | | | - Elisa Sarmiento
- Biostatistician II, Department of Emergency Medicine, Indiana University School of Medicine
| | - Cherri Hobgood
- Professor, Department of Emergency Medicine, Penn State College of Medicine; Adjunct Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine; Founder, Center for Leadership Life
| | - Rami Ahmed
- Professor, Department of Emergency Medicine, Indiana University School of Medicine
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Zemlin C, Nourkami-Tutdibi N, Schwarz P, Wagenpfeil G, Goedicke-Fritz S. Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students. BMC MEDICAL EDUCATION 2024; 24:134. [PMID: 38347593 PMCID: PMC10863240 DOI: 10.1186/s12909-024-05096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND It is a crucial task for physicians to deliver life threatening information to patients (breaking bad news; BBN). Many aspects influence these conversations on both sides, patients, and doctors. BBN affects the patient-physician relationship, patients' outcome, and physicians' health. Many physicians are still untrained for this multi-facetted task and feel unprepared and overburdened when facing situations of BBN. Therefore, any faculties should aim to integrate communication skills into their medical curricula as early as possible. The SPIKES protocol is an effective framework to deliver BBN. Aim of this study is to evaluate the feasibility and obstacles of a BBN seminar and its acceptance and learning curve among undergraduate medical students. METHODS 158 2nd year undergraduate medical students attended a compulsory BBN seminar. The task was to deliver a cancer diagnosis to the patient within a patient - physician role-play in a gyneco-oncological setting before and after a presentation of the SPIKES protocol by the lecturer. The students evaluated important communication skills during these role-plays respectively. Self-assessment questionnaires were obtained at the beginning and end of the seminar. RESULTS Most students indicated that their confidence in BBN improved after the seminar (p < 0.001). They like the topic BBN to be part of lectures (76%) and electives (90%). Communication skills improved. Lecturer and seminar were positively evaluated (4.57/5). CONCLUSION The seminar significantly increased confidence and self-awareness in delivering life-threatening news to patients among undergraduate medical students. Important learning aspects of BBN and communication skills could be delivered successfully to the participants within a short time at low costs. The integration of communication skills should be implemented longitudinally into medical curricula starting before clinical education to increase the awareness of the importance of communication skills, to decrease anxiety, stress, and workload for future doctors and- most importantly- to the benefit of our patients.
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Affiliation(s)
- Cosima Zemlin
- Department of Gynecology and Obstetrics, Faculty of Medicine, Saarland University, Homburg, Germany
| | | | - Pascal Schwarz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Saarland University, Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Sybelle Goedicke-Fritz
- Department of General Pediatrics and Neonatology, Saarland University, Homburg, Germany.
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Sánchez AR, Beltrán MJM, Arribas Marín JM, de la Torre-Montero JC, Gil BB, García MDCM, Ribeiro ASF. The Communication of Bad News in Palliative Care: The View of Professionals in Spain. Am J Hosp Palliat Care 2024; 41:26-37. [PMID: 36943176 DOI: 10.1177/10499091231163323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Communication is one of the central axes around which end-of-life care revolves in the context of palliative care. Communication of bad news is reported as one of the most difficult and stressful tasks by palliative care professionals. Therefore, the aim of this study is to identify aspects related to the communication of bad news in palliative care in Spain. METHODS Descriptive cross-sectional study. An ad hoc questionnaire was designed and sent by e-mail to all palliative care teams in Spain. RESULTS Overall, 206 professionals (102 nurses, 88 physicians and 16 psychologists) completed the questionnaire. A total of 60.2% considered their communication of bad news skills to be good or very good. This was related to older age, experience in both the profession and palliative care, and to having received specific postgraduate training (P < .001). Around 42.2% perform communication of bad news with the patient first, which is associated with lower skill (P = .013). About 78.15% of the professionals do not use any specific protocol. CONCLUSION This study suggests that patients access palliative care with little information about their diagnosis and prognosis. The barriers identified in the communication of bad news are the lack of specific education and training in protocol management, the difficult balance between hope and honesty, the young age of the patient, and the family.
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Affiliation(s)
- Antonio Ramos Sánchez
- Escuela de Enfermería y Fisioterapia San Juan de Dios, Universidad Pontificia Comillas, Ciempozuelos, Spain
| | | | - Juan Manuel Arribas Marín
- Escuela de Enfermería y Fisioterapia San Juan de Dios, Universidad Pontificia Comillas, Ciempozuelos, Spain
| | | | - Beatriz Blanco Gil
- Equipo de Soporte de Atención Paliativa Domiciliaria de Villalba, Área Noroeste, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, Spain
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Alhabter AM, Qureshi AZ, Ullah S. Ethical and Legal Aspects of Telerehabilitation in Saudi Arabia. Int J Telerehabil 2023; 15:e6569. [PMID: 38162935 PMCID: PMC10754236 DOI: 10.5195/ijt.2023.6569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Organizations have their own policies and procedures to govern operational aspects of health care facilities. With the advent of telemedicine, there has been a growing trend in providing telehealth practices without formally exploring the ethical and legislative aspects. The potential use of electronic and digital services in telerehabilitation can influence various ethical and legal factors, such as confidentiality, consent. and negligence. Thus, establishing clear strategies in this regard is necessary. Ethical and legal aspects of healthcare are influenced by cultural, religious, and legislative rulings of a state. At the same time, the multidimensional scope of rehabilitation in a health system has its own challenges. This narrative review intends to highlight the importance of incorporating the ethical and legislative framework in the telerehabilitation process in Saudi Arabia. A summary of various aspects in-line with unique local attributes is included, which can also help to facilitate regional telerehabilitation services in the Arab World.
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Affiliation(s)
- Ahmed Mushabbab Alhabter
- Medical Affairs, King Faisal Medical City Abha, Saudi Arabia, Mailing Address: King Faisal Medical City, Al Andalus Abha 62521 Saudi Arabia
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine & Rehabilitation, King Fahad Medical City Riyadh, Saudi Arabia, Mailing Address: Rehabilitation Hospital, King Fahad Medical City, Sulaymania Riyadh 11525 Saudi Arabia
| | - Sami Ullah
- Department of Physical Medicine & Rehabilitation, King Fahad Medical City Riyadh, Saudi Arabia, Mailing Address: Rehabilitation Hospital, King Fahad Medical City, Sulaymania Riyadh 11525 Saudi Arabia
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Habib MH, Saraiya B, Davis MP. Breaking bad news: during the holiday season. BMJ Support Palliat Care 2023; 13:442-444. [PMID: 35177431 DOI: 10.1136/bmjspcare-2022-003558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
Breaking bad news can be a difficult process. This can further be complicated when such news needs to be delivered around the holiday season. Here, we discuss such a case, and provide recommendations on breaking bad news around the holiday season.
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Affiliation(s)
- Muhammad Hamza Habib
- Department of Medicine, Division of Medical Oncology, Supportive and Palliative Care, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Biren Saraiya
- Department of Medicine, Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Mellar P Davis
- Department of Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
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Mitchell A. How to break bad news. Emerg Nurse 2023; 31:17-21. [PMID: 37337434 DOI: 10.7748/en.2023.e2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 06/21/2023]
Abstract
RATIONALE AND KEY POINTS Breaking bad news is a fundamental yet challenging aspect of the role of healthcare professionals, including nurses. This article provides a step-by-step framework that nurses can use when delivering bad news and having challenging conversations with patients and/or families. • Preparation is important to ensure that challenging conversations are carried out in a suitable physical environment and with family members and/or friends present as appropriate. • Using a framework can aid nurses when undertaking challenging conversations, ensuring that all necessary aspects of the process are incorporated. • Nurses need to manage the expectations of patients and family members and respond appropriately to their emotional reactions. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article may help you to deliver bad news using a step-by-step framework in your practice. • How you can use the information in this article to communicate effectively and address emotional distress when breaking bad news.
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Affiliation(s)
- Aby Mitchell
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, England
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Jain V, Ravi A, Thakur V, Mishra A, Dhamor D, Khare S. Breaking bad news: Awareness and practice of the SPIKES protocol among general surgery residents at a tertiary care institute in northern India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:320-322. [PMID: 38759986 DOI: 10.25259/nmji_950_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Background In general surgery, a clinician is commonly required to break bad news. However, training in communication is not a part of the formal curriculum either in medical school or in surgical residency and there is a paucity of data on awareness of the SPIKES (Setting up the interview, Perception, Invitation, Knowledge sharing, Emotion, Strategy and Summary) protocol among practising surgeons and residents in India. Methods We did a cross-sectional study in the Department of General Surgery at our institution. Junior residents were invited to take part in a one-on-one interview. Descriptive statistics were used to describe the findings of the study. Comparison for categorical data was done using Fisher exact test or chi-square test (whichever was applicable). Results A total of 82 residents with mean (SD) age of 27 (2.5) years (range 23-37 years) participated in the study. Only 31 (37.8%) had ever received training for breaking bad news, though 80 (97.6%) had broken bad news at least once. Twenty-one (26.3%) participants had a bad experience while breaking bad news. Seventy-seven (93.9%) participants felt the need for training in breaking bad news and 76 of them were willing to attend the same. Although the complete SPIKES protocol was followed only by 25 (31.3%) residents, 46 (56.1%) felt that it was practically possible to follow the SPIKES protocol. Conclusion Resident doctors in general surgery face situations of breaking bad news and adherence to the SPIKES protocol is poor. Formal training at every level may enhance their communication skills and enable better healthcare delivery.
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Affiliation(s)
- Vibhu Jain
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Ashwitha Ravi
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Vipul Thakur
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Aniket Mishra
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Devesh Dhamor
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| | - Siddhant Khare
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Eigner DR, Breitreiter K, Carmack T, Cox S, Downing R, Robertson S, Rodan I. 2023 AAFP/IAAHPC feline hospice and palliative care guidelines. J Feline Med Surg 2023; 25:1098612X231201683. [PMID: 37768060 PMCID: PMC10812026 DOI: 10.1177/1098612x231201683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.
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Affiliation(s)
| | | | - Tyler Carmack
- Caring Pathways USA, Hampton Roads Veterinary Hospice, Virginia Beach, VA, USA
| | - Shea Cox
- BluePearl Pet Hospice, Mars Veterinary Health, Temecula, CA, USA
| | - Robin Downing
- The Downing Center for Animal Pain Management, Windsor, CO, USA
| | | | - Ilona Rodan
- Cat Behavior Solutions, Cat Care Clinic, Madison, WI, USA
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Sobczak K, Trzciński M, Kotłowska A, Lenkiewicz J, Lenkiewicz O, Przeniosło J, Plenikowski J. Delivering Bad News: Emotional Perspective and Coping Strategies of Medical Students. Psychol Res Behav Manag 2023; 16:3061-3074. [PMID: 37576446 PMCID: PMC10417753 DOI: 10.2147/prbm.s421995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose The aim of our study was to analyze students' emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN). Patients and Methods 291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience - whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA). Results Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy. Conclusion The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Trzciński
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Agata Kotłowska
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Oliwia Lenkiewicz
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Julia Przeniosło
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Plenikowski
- Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gdańsk, Poland
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21
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Nnate DA, Nashwan AJ. Emotional Intelligence and Delivering Bad News in Professional Nursing Practice. Cureus 2023; 15:e40353. [PMID: 37456491 PMCID: PMC10339355 DOI: 10.7759/cureus.40353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Delivering bad news often impacts nurses' emotional well-being and relationships with patients. However, most practice models do not offer a sufficient solution to the distress and reduced job satisfaction that may thus arise. This paper offers a critique of theoretical frameworks for breaking bad news in clinical settings, with the aim of highlighting the inadequate evidence available to guide nursing practice with regard to managing the emotional burden of breaking bad news. Firstly, the concept of emotional intelligence is introduced, followed by an overview of the impact of delivering bad news on the psychological well-being of healthcare workers. Several models for delivering bad news in clinical practice were then presented to emphasise the lack of evidence regarding ways of mitigating the burden associated with breaking bad news. Key components of emotional intelligence are highlighted to increase awareness of this factor among nurses and enable them to improve their interpersonal skills to mitigate the impact of breaking bad news. Enabling nurses to develop emotional self-awareness before utilising these frameworks will likely lead to increased nurse retention rates and improve reflective practice and communication skills, which could, in turn, strengthen nurse-patient relationships and subsequent care planning.
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Affiliation(s)
- Daniel A Nnate
- Urgent Care Division, Countess of Chester NHS Foundation Trust, Chester, GBR
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22
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Jabali O, Shubietah ARM, Ktaifan M, Zakaria Z, Abumohsen H. Perspectives of Palestinian Healthcare Workers on Factors Affecting the Families' Acceptance of News of Death: A Cross-Sectional Study. Cureus 2023; 15:e39001. [PMID: 37323303 PMCID: PMC10263072 DOI: 10.7759/cureus.39001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction In a healthcare setting, communication is essential for every aspect of care. The ability to break bad news to patients and families is one of the most crucial talents in a medical professional's communication toolkit. This study aims to investigate the factors affecting the family's acceptance of death news in Palestinian medical facilities. Methods A survey was constructed and distributed to participants through Palestinian medical social media groups. Palestinian medical health professionals who had reported at least one death (N=136) were included. Associations and correlations were calculated. P-values of < 0.05 were considered significant. Results We found that death is more likely to be accepted by the family if it's reported by an experienced staff member (p-value= 0.031) or a member who was involved in the cardiopulmonary resuscitation (CPR) of the deceased person (Adjusted odds ratio (AOR) = 19.335, p-value = 0.046). The medical ward staff is also more likely to achieve family acceptance (AOR = 6.857, p-value= 0.020). However, no evidence was found to support the claim that adhering to the SPIKES model increases the likelihood of family acceptance of death news (p-value= 0.102). Death of young people and unexpected death are less likely to be accepted (p-value < 0.05). Conclusion Families are less likely to accept unexpected death or the death of young members. Thus, reporting such deaths (mostly in the emergency department) should be done with greater care. We suggest letting experienced staff members or those who were involved in CPR report the death news in such situations.
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Affiliation(s)
- Oqab Jabali
- Research, An-Najah National University, Language Center, Faculty of Humanities, Nablus, PSE
| | - Abdalhakim R M Shubietah
- Medicine and Surgery, Darwish Nazzal Government Hospital, Palestinian Ministry of Health, Qalqilya, PSE
| | - Mahfouz Ktaifan
- Research, An-Najah National University, College of Medicine and Health Siences, Department of Medicine, Nablus, PSE
| | - Zaid Zakaria
- Medicine and Surgery, Palestinian Ministry of Health, Rafidia Government Surgical Hospital, Nablus, PSE
| | - Haytham Abumohsen
- Medicine and Surgery, Tubas Government Hospital,Palestinian Ministry of Health, Tubas, PSE
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White SJ, Stubbe M. Patient Responses to Diagnosis in Surgeon-Patient Consultations. HEALTH COMMUNICATION 2023; 38:608-617. [PMID: 34496683 DOI: 10.1080/10410236.2021.1965278] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons' accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis.
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Affiliation(s)
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, University of Otago
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24
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Miller EM, Porter JE, Barbagallo MS. Patient and family members' experiences with language and environment when receiving bad news: A qualitative exploratory study. Palliat Support Care 2023:1-7. [PMID: 36718557 DOI: 10.1017/s1478951522001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Receiving bad news about one's health can be devastating, yet little is known about how the therapeutic nature of the environment where bad news is delivered affects the experience. The current study aimed to explore how patients and their families were affected by the language and the built, natural, social, and symbolic environments when receiving bad news, through the Therapeutic Landscapes theoretical framework. METHODS Patients diagnosed with a life-limiting illness living in regional Victoria who had a hospital admission within 24 months and a diagnostic/prognostic conversation were invited to participate, as well as a family member who witnessed the conversation. Participants were recruited through social media and snowballing, resulting in 14 online semi-structured interviews being conducted between November 2021 and March 2022, audio-recorded, and transcribed verbatim. Reflexive thematic analysis was used to develop the themes. RESULTS Fourteen semi-structured interviews were conducted with women aged between 30 and 77 years. Interviews lasted between 45 and 120 minutes, with an average of 69 minutes, and were conducted online or via mobile phone. Four central themes were developed: "Hearing bad news for the first time," "Preferences for having hard conversations," "Creating a sense of safety for ongoing care," and "The therapeutic nature of the ward." SIGNIFICANCE OF RESULTS This body of work will help inform practice and future policy regarding bad news delivery and the design and aesthetics of environments where bad news is delivered. It is essential that bad news is delivered within a quiet, calm, and emotionally safe environment within a supportive therapeutic relationship.
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Affiliation(s)
- Elizabeth M Miller
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
| | - Joanne E Porter
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
| | - Michael S Barbagallo
- Collaborative Evaluation & Research Group (CERG), Federation University Australia, Churchill, VIC, Australia
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25
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Goodlev E. Discussing Difficult News: Reframing Patient and Family Preferences Surrounding the Content and Style of Communication. Cancer Treat Res 2023; 187:45-52. [PMID: 37851218 DOI: 10.1007/978-3-031-29923-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Uncomfortable conversations transcend medicine across all sites of care and at all stages of a serious illness. From discussion of prognosis or prognostic uncertainty, to evaluation of competing treatment options, to disclosure of medical errors, to consideration of potentially toxic treatments, clinicians must approach such conversations with sensitivity to a patient's cognitive, emotional, spiritual, and cultural needs. Conversations small and large may be seen as "difficult" by a patient or their family, and there may be discordant views of the perceived "difficulty" of a conversation from the perspective of the medical team as compared to the patient or family.
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Affiliation(s)
- Eric Goodlev
- Department of Medicine, Section of Palliative Care, Einstein Medical Center Montgomery, East Norriton, PA, USA.
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26
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PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2023; 31:13. [PMID: 36513796 PMCID: PMC9747823 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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27
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Gholami M, Valiee S, Kamyari N, Vatandost S. Comparing the Performance of Emergency Department Personnel and Patients' Preferences in Breaking Bad News. Bull Emerg Trauma 2023; 11:146-153. [PMID: 37525650 PMCID: PMC10387337 DOI: 10.30476/beat.2023.98439.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023] Open
Abstract
Objective Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significant implications for patients' outcomes. Inadequate and inappropriate delivery of bad news can result in detrimental psychological and emotional effects. This study aimed to compare the performance of emergency department (ED) personnel and patients' preferences in BBN. Methods This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to the ED were included using quota sampling. Data were collected using a demographic questionnaire, a researcher-made questionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The data were analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant. Results The results showed that the majority of patients (69.6%) received bad news from nurses. Based on the conditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of 19, while the overall attitude score (59.66±7.66 out of 76) revealed patients' high tendency to receive bad news. There was a statistically significant difference between the total score of personnel performances and the total score of patients' attitudes (p=0.001). Conclusion The performance of ED personnel concerning patients' attitudes toward the method of BBN in the emergency department was not optimal. Therefore, it is recommended to implement appropriate training programs for medical professionals, especially physicians, and nurses, to enhance their communication skills and reduce the detrimental effects of inappropriate delivery of bad news in medical settings.
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Affiliation(s)
- Mohammad Gholami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sina Valiee
- Clinical Care Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Salam Vatandost
- Clinical Care Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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28
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Paul TK. Letter to the Editor: It Is Time to End "Warning Shots". J Palliat Med 2022; 25:1618. [PMID: 36318063 DOI: 10.1089/jpm.2022.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Trisha K Paul
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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29
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Mitchell A. Breaking bad news. Nurs Stand 2022; 37:43-49. [PMID: 35989552 DOI: 10.7748/ns.2022.e11898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 06/15/2023]
Abstract
Nurses are often faced with situations in their practice where they have to break bad news to patients and their families. Such conversations are complex and can be challenging for all parties. It is essential that nurses are equipped with the skills required to manage such situations effectively to ensure optimal outcomes and quality of care for patients and their families. This article discusses some of the barriers to breaking bad news effectively to patients and the communication skills required to engage in challenging conversations. It also describes two mnemonic protocols that can be used by nurses to structure challenging conversations with patients face to face and over the phone.
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Affiliation(s)
- Aby Mitchell
- senior lecturer in adult nursing, College of Nursing, Midwifery and Health, University of West London, Brentford, England
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30
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Meitar D, Karnieli-Miller O. Twelve tips to manage a breaking bad news process: Using S-P-w-ICE-S - A revised version of the SPIKES protocol. MEDICAL TEACHER 2022; 44:1087-1091. [PMID: 34057007 DOI: 10.1080/0142159x.2021.1928618] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The way it is managed has implications for all involved in the encounter: the patient, family members, and the news provider. Existing guidelines were developed mainly at the turn of the millennium and require updating based on identification of daily clinical needs and pedagogical challenges while teaching the current protocols. Furthermore, there is a need to provide an overview of BBN encounters as a process, rather than a subdivided event, to help practitioners adopt an approach that might serve them in their daily routines. This twelve tips article summarizes research and practical experience for handling BBN encounters, from their preparation, through delivering the news while attending patients and family members' needs, toward documenting the news, and critically reflecting on the interaction. The tips are structured and explained to serve both practitioners and medical educators.
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Affiliation(s)
- Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Kotłowska A, Przeniosło J, Sobczak K, Plenikowski J, Trzciński M, Lenkiewicz O, Lenkiewicz J. Influence of Personal Experiences of Medical Students on Their Assessment of Delivering Bad News. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12040. [PMID: 36231342 PMCID: PMC9565137 DOI: 10.3390/ijerph191912040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to identify which attitudes and emotions accompany latter-year medical students as they experience situations where bad news is communicated. METHODS A cross-sectional study was conducted using the computer-assisted web interview (CAWI) methodology in a group of 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Correlations were analyzed using Pearson's χ2 test. For the categorical variables, subject profiles were analyzed using K-means clustering. RESULTS Students' self-assessments of their competence in delivering bad news (DBN) differed depending on the type of experience they had with it. More than half of the students had observed a situation of DBN (63.6%) and as many as 26.5% of the participants had received bad news themselves. These two groups were less likely to declare a lack of DBN-related skills (43.4% and 33.4%, respectively) than others. In this study, 9% of the students had personally delivered bad news. Only 13.4% of these students rated their DBN skills as insufficient. They were also the least likely to express concern regarding high levels of stress (29.6%) and anxiety (48%). CONCLUSIONS The ability to personally deliver bad medical news to a patient was the most effective form of gaining experience in DBN. Being a bearer of bad news may help students develop their own strategies for coping with difficult emotions and develop their professional competences, leading to improved medical care and patient comfort.
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Affiliation(s)
- Agata Kotłowska
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Julia Przeniosło
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Krzysztof Sobczak
- Department of Sociology of Medicine and Social Pathology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan Plenikowski
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Trzciński
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Oliwia Lenkiewicz
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Julia Lenkiewicz
- Faculty of Medicine, Student Scientific Circle of Medical Communication at the Medical University of Gdansk, 80-210 Gdansk, Poland
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Karnieli-Miller O, Pelles S, Meitar D. Position paper: Teaching breaking bad news (BBN) to undergraduate medical students. PATIENT EDUCATION AND COUNSELING 2022; 105:2899-2904. [PMID: 35710469 DOI: 10.1016/j.pec.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Sharing new medical information that is perceived as seriously effecting people's lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency. The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students. The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients' and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients' care during these difficult, life-changing encounters, and physicians' well-being.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sharon Pelles
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dafna Meitar
- Mandel School for Educational Leadership, Jerusalem, Israel; Medical College of Wisconsin, Wisconsin, USA
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Dugas EN, Poirier M, Basque D, Bouhamdani N, LeBreton L, Leblanc N. Canadian clinical capacity for fetal alcohol spectrum disorder assessment, diagnosis, disclosure and support to children and adolescents: a cross-sectional study. BMJ Open 2022; 12:e065005. [PMID: 36041771 PMCID: PMC9438035 DOI: 10.1136/bmjopen-2022-065005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Canadian fetal alcohol spectrum disorder (FASD) guidelines encourage an age-specific interdisciplinary diagnostic approach. However, there is currently no standard-of-care regarding FASD diagnosis disclosure and few studies document Canadian FASD clinical capacity. Our objectives were to describe clinical capacity (defined as skills and resources) for FASD assessment, diagnosis, disclosure and support in Canada. DESIGN, SETTING AND PARTICIPANTS Data were drawn from the CanDiD study, a cross-sectional investigation of Canadian FASD clinical capacity. Forty-one clinics participated in the study. Data were collected in 2021 on the number and types of health professionals included in the assessment and diagnostic teams, the presence (or absence) of a minor patient when the FASD diagnosis is disclosed to parents/guardians, who is responsible for the diagnosis disclosure, the use of explanatory tools, and the types of support/counselling services available. The proportion of clinics that follow the Canadian interdisciplinary diagnostic guidelines by age group is described among participating clinics. RESULTS Overall, 21, 13 and 7 specialised FASD clinics were in Western/Northern, Central and Atlantic Canada, respectively. The number of referrals per year surpassed the number of diagnostic assessments completed in all regions. Approximately, 60% of clinics who diagnosed FASD in infants and preschool children (n=4/7 and 15/25, respectively) followed the interdisciplinary guidelines compared with 80% (n=32/40) in clinics who diagnosed school-aged children/adolescents. Diagnostic reporting practices were heterogeneous, but most used an explanatory tool with children/adolescents (67%), offered support/counselling (90-95%) and used case-by-case approach (80%) when deciding who would disclose the diagnosis to the child/adolescent and when. CONCLUSIONS Limited diagnostic capacity and lack of FASD resources across Canada highlights a critical need for continued FASD support. This study identifies gaps in assessment, diagnosis and reporting practices for FASD in children/adolescents across Canada.
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Affiliation(s)
- Erika N Dugas
- Vitalité Health Network, Moncton, New Brunswick, Canada
| | | | | | - Nadia Bouhamdani
- Vitalité Health Network, Moncton, New Brunswick, Canada
- University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, New Brunswick, Canada
| | - Laure LeBreton
- Vitalité Health Network, Moncton, New Brunswick, Canada
- University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada
| | - Nicole Leblanc
- Vitalité Health Network, Moncton, New Brunswick, Canada
- University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, New Brunswick, Canada
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Srivastava R, Srivastava S. Bibliometric Analysis of Indian Journal of Palliative Care from 1995 to 2022 using the VOSviewer and Bibliometrix Software. Indian J Palliat Care 2022; 28:338-353. [DOI: 10.25259/ijpc_30_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction:
The Indian Journal of Palliative Care (IJPC) is an open-source, interdisciplinary and peer-reviewed journal started in 1994 that publishes high-quality articles in the field of palliative care in India. The purpose of this study is to analyse the bibliometric data of its publications using bibliometric analysis to understand the key bibliometric factors affecting the journal and its contribution to the field of palliative care research.
Material and Methods:
A software-assisted bibliometric analysis of the IJPC was conducted. The dimensions database was used to mine the bibliometric data of the journal from 1995 to 2022. A total of 1046 records were analysed using the VOSviewer and Biblioshiny by Bibliometrix software.
Results:
The analysis represented a vivid and graphically elaborate picture of the journal. It gives insight into the most productive and influential authors, countries, affiliations, sources and documents along with a picture of the network among them.
Conclusion:
This study highlights a gradual upward trend in the annual production of the journal. A strong connection of the IJPC could be seen with leading journals publishing in the field of palliative care globally.
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Affiliation(s)
- Rajashree Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
| | - Shikha Srivastava
- Department of Psychology, School of Liberal Education, Galgotias University, Greater Noida, Uttar Pradesh, India,
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A Journey toward Immediate Denture: Overcoming Bitter Reality with Psychotherapy. Case Rep Dent 2022; 2022:3080039. [PMID: 35928397 PMCID: PMC9345724 DOI: 10.1155/2022/3080039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
The loss of teeth affects the aesthetics, function (mastication and speech), confidence, mental state, and the overall quality of life of an individual. Aggressive periodontitis is a destructive condition leading to loss of teeth at early stages of the disease. Individuals facing this inevitable condition of losing the teeth and replacement at a younger age experience formidable psychological distress. The prosthodontic procedure when supported with psychotherapeutic interventions can support the patient in accepting the prognosis and treatment. We report the scenario where psychological intervention was provided in a systematic manner adopting the SPIKES protocol for a 42-year-old man presenting with aggressive periodontitis.
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Edwards S, Keillor L, Sandison L, Millett A, Davies F. Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic. Arch Emerg Med 2022; 39:712-715. [PMID: 35863868 DOI: 10.1136/emermed-2020-210481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/15/2022] [Indexed: 11/04/2022]
Abstract
In many countries, the COVID-19 pandemic resulted in restricted hospital visiting by relatives.Staff have been forced to deliver unwelcome and bad news over the telephone. There are few training resources around how to do this. We created a bespoke training package consisting of a 15 min eLearning session and a 1-hour facilitated role-play session. Two simulated telephone calls to a professional actor posing as the relative were undertaken on a speakerphone. Following each simulated call, the actor gave feedback to the caller, focusing on the likely experience of a relative during these conversations. Elements specific to telephone conversations included ensuring the safety of the recipient to take the call (eg, not driving a car), ensuring they had adequate local support, and allowing a deliberate silence after delivering the bad news. Silence has a powerful impact, despite being uncomfortable. The opportunity to have written notes before calling and to offer a return call was seen as an opportunity for improving communication. We collated these experiences into a series of phrases found most useful and empathic by the actor and participants. A practical aide- mémoir was created from this learning that could be used to help deliver bad news quickly in the emergency department.
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Affiliation(s)
- Sarah Edwards
- Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lisa Keillor
- Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, UK.,Emergency Department, Queen's Medical Centre, Nottingham, UK
| | - Lorna Sandison
- Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, UK.,Emergency Department, Kettering General Hospital, Kettering, UK
| | - Abigail Millett
- Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ffion Davies
- Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, UK
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Walker L, Sivell S. Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2081-2088. [PMID: 35193783 DOI: 10.1016/j.pec.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques. METHODS BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis. RESULTS Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure. CONCLUSION Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central. PRACTICE IMPLICATIONS BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.
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Affiliation(s)
- Louise Walker
- Cardiff University, Wales, UK; Greys Hospital, Private Bag 9001, Pietermaritzburg 3200, KwaZulu Natal, South Africa.
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
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Cameron A, Pollock K, Wilson E, Burford J, England G, Freeman S. Scoping review of end-of-life decision-making models used in dogs, cats and equids. Vet Rec 2022; 191:e1730. [PMID: 35703328 DOI: 10.1002/vetr.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning. METHODS A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted. RESULTS A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these. CONCLUSIONS A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.
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Affiliation(s)
- Amelia Cameron
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care (NCARE), School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care (NCARE), School of Health Sciences, University of Nottingham, Nottingham, UK
| | - John Burford
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Gary England
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Sarah Freeman
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
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Tacy TA, Kasparian NA, Karnik R, Geiger M, Sood E. Opportunities to enhance parental well-being during prenatal counseling for congenital heart disease. Semin Perinatol 2022; 46:151587. [PMID: 35461701 DOI: 10.1016/j.semperi.2022.151587] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prenatal diagnosis of congenital heart disease (CHD) can be a life-altering and traumatic event for expectant parents. Parental anxiety, depression, and traumatic stress are common following a prenatal cardiac diagnosis and if untreated, symptoms often persist long-term. During prenatal counseling, parents must try to manage psychological distress, navigate uncertainty, process complex medical information, and make high-stakes medical decisions for their unborn child and their family. Physicians must deliver the diagnosis, describe the expected perinatal management plan, discuss short and long-term prognoses and introduce elements of uncertainty that may exist for the particular diagnosis. Physican training in these important skills is highly variable and many in our field acknowledge the need for improved guidance on best practices for counseling and supporting parents during pregnancy and early parenthood after prenatal diagnosis, while also sustaining physicians' own emotional well-being. We describe these challenges and the opportunities that exist to improve the current state of prenatal counseling in CHD.
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Affiliation(s)
- Theresa A Tacy
- Department of Pediatrics, Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Nadine A Kasparian
- Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, OU, USA
| | - Ruchika Karnik
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Miwa Geiger
- Department of Pediatrics, Division of Pediatric Cardiology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Sood
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Sobczak K. The "CONNECT" Protocol: Delivering Bad News by Phone or Video Call. Int J Gen Med 2022; 15:3567-3572. [PMID: 35392027 PMCID: PMC8979830 DOI: 10.2147/ijgm.s358723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has changed the principles of communication within the health-care setting. Communication skills as developed for use in the context of a direct and personal encounter have become insufficient. As a result, numerous health professionals came to believe they were not sufficiently prepared to deliver bad news in relation to medical care. The CONNECT protocol is a tool designed to help health-care professionals in the delivery of such messages. The name of the protocol is an acronym derived from C - context, O - organization, NN - near and niceties, E - emotions, C - counseling, T - taking care. The objective of the protocol is to improve the effectiveness of the delivery of bad news in relation to medical care by ensuring proper organization of the key elements of the encounter with the patient and/or their family.
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Affiliation(s)
- Krzysztof Sobczak
- Department of Sociology Medicine and Social Pathology, Medical University of Gdansk, Gdansk, Poland
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41
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Venkataramu VN, Ghotra HK, Chaturvedi SK. Management of psychiatric disorders in patients with cancer. Indian J Psychiatry 2022; 64:S458-S472. [PMID: 35602367 PMCID: PMC9122176 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Santosh K Chaturvedi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.,Leicestershire Partnership NHS Trust, Thurmaston, Leicestershire, UK E-mail:
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42
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Velez D, Gerberding A, Ahmeti M. SUNBURN: a protocol for delivering bad news in trauma and acute care surgery. Trauma Surg Acute Care Open 2022; 7:e000851. [PMID: 35224205 PMCID: PMC8830305 DOI: 10.1136/tsaco-2021-000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022] Open
Abstract
IntroductionThe delivery of bad news can be one of the most challenging tasks in surgery. There are numerous barriers specific to trauma and acute care surgery (TRACS) that make these conversations more difficult. Prior protocols have all been designed for oncology and primary care with poorer application to TRACS. The lack of guidance for leading these conversations in TRACS led us to develop the SUNBURN protocol. It draws elements from prior protocols and discards the irrelevant aspects and pays particular attention to the TRACS-specific concerns.SUNBURN protocolStep 1: S–Set Up; Step 2: U–Understand Perceptions; Step 3: N–Notify (‘Warning Shot’); Step 4: B–Brief Narrative and Break Bad News; Step 5: U–Understand Emotions; Step 6: R–Respond; Step 7: N–Next Steps.ConclusionThis protocol can provide a framework to help guide and ease the delivery of bad news in TRACS.
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Affiliation(s)
- David Velez
- Department of Surgery, University of North Dakota, Grand Forks, North Dakota, USA
| | - Andrea Gerberding
- Department of Surgery, University of North Dakota, Grand Forks, North Dakota, USA
| | - Mentor Ahmeti
- Department of Surgery, University of North Dakota, Grand Forks, North Dakota, USA
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43
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Sengupta M, Roy A, Gupta S, Chakrabarti S, Mukhopadhyay I. Art of breaking bad news: A qualitative study in Indian healthcare perspective. Indian J Psychiatry 2022; 64:25-37. [PMID: 35400752 PMCID: PMC8992758 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_346_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/09/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Health-care communication is essential for amiable provider-recipient relationship. This study explored various health-care experiences and expectations of service recipients and providers in private clinical establishments of West Bengal, India, while breaking difficult news, bad news, and death. AIM The current study was framed with the following research question: What are the varying perceptions, experiences, and expectations of healthcare recipients and their providers while seeking/delivering support in situations of breaking bad news and communications on death? MATERIALS AND METHODS The data were collected through individual in-depth interviews-31 respondents that included 16 patients and their families (recipient) and 15 medical practitioners (provider). Inductive thematic analysis was used. RESULTS Three main themes and nine sub-themes were identified highlighting livid experiences and perceptions of respondents. The findings suggest that interpersonal communications involve language barriers, health literacy and COVID-19 pandemic, situations of sudden unexplained death, perceptual negativity surrounding healthcare, empathy as well as emotions and multiple affiliations leading to ethical moral conflicts to influence individual perception. Regarding treatment attributes, factors of inaccessibility misconceived as incompetence and waiting and contact time are involved. The behavior and personality dimensions include attitude and robustness of the patient party and capability to handle emotions that affect provider-recipient relationship during communications of bad news and death. CONCLUSION This study provided a local perspective about the experiences and expectations of healthcare recipients and their providers. Understanding this critical realm shall help in bridging the gap between recipient expectations and provider practices. It will also attempt towards possible alignment to improve patient satisfaction.
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Affiliation(s)
- Mitali Sengupta
- Department of Business Administration, University of Engineering and Management, Joka, Kolkata, West Bengal, India
| | - Arijit Roy
- Cradle Fertility Centre, Joka, Kolkata, West Bengal, India.,Chikitsa Medicare Centre Pvt. Ltd., Kolkata, West Bengal, India
| | - Saikat Gupta
- Chikitsa Medicare Centre Pvt. Ltd., Kolkata, West Bengal, India
| | - Satyajit Chakrabarti
- Department of Business Administration, University of Engineering and Management, Joka, Kolkata, West Bengal, India
| | - Indraneel Mukhopadhyay
- Department of Information Technology, Institute of Engineering and Management, Kolkata, West Bengal, India
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44
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Risco JR, Kelly AG, Holloway RG. Prognostication in neurology. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:175-193. [PMID: 36055715 DOI: 10.1016/b978-0-323-85029-2.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Prognosticating is central to primary palliative care in neurology. Many neurologic diseases carry a high burden of troubling symptoms, and many individuals consider health states due to neurologic disease worse than death. Many patients and families report high levels of need for information at all disease stages, including information about prognosis. There are many barriers to communicating prognosis including prognostic uncertainty, lack of training and experience, fear of destroying hope, and not enough time. Developing the right mindset, tools, and skills can improve one's ability to formulate and communicate prognosis. Prognosticating is subject to many biases which can dramatically affect the quality of patient care; it is important for providers to recognize and reduce them. Patients and surrogates often do not hear what they are told, and even when they hear correctly, they form their own opinions. With practice and self-reflection, one can improve their prognostic skills, help patients and families create honest roadmaps of the future, and deliver high-quality person-centered care.
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Affiliation(s)
- Jorge R Risco
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Adam G Kelly
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Robert G Holloway
- Department of Neurology, University of Rochester, Rochester, NY, United States.
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Basheikh M. Preferences of the Saudi Population in Breaking Bad Medical News: A Regional Study. Cureus 2021; 13:e19525. [PMID: 34934547 PMCID: PMC8668052 DOI: 10.7759/cureus.19525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
Objective To explore the preference among the Saudi population regarding breaking bad news (BBN) for the participant cases and their relatives and to determine the associated sociodemographic factors. Method A cross-sectional study was conducted among patients and companions attending inpatient and outpatient clinics of a tertiary care hospital in Western Saudi Arabia from 15 Jan to 30 May 2015. A six-item scale was designed to assess preference regarding diagnosis disclosure in three hypothetical conditions including chronic disease, incurable disease, and cancer if the participant or a close relative is concerned, separately. A BBN preference score (BBN-PS) was computed (range=0-6), with a higher score indicating a greater preference to disclose the diagnosis. Eventual motivations for diagnosis disclosure or withholding were explored. Result Five hundred participants were included; 56.0% were females and 55.0% were aged between 18 and 25 years. Preference to be informed with one’s diagnosis varied between 81.8% for incurable disease and 94.2% for chronic disease with complications. Preference to inform a relative with their diagnosis ranged between 69.0% for incurable disease and 86.8% for chronic disease with complications. Preference for diagnosis withholding was lower among participants of the younger age category (38.2% vs 51.2% or higher, p=0.002), with higher education (42.4% vs 60.8%, p=0.001), and working or studying in the medical field (39.7% vs 51.9%, p=0.006), compared to their counterparts, respectively. The most common motivations toward diagnosis disclosure preference were to enable the concerned person participate in their therapeutic decision (36.4%) and cope with the disease (27.4%); while preference toward diagnosis withholding was most commonly motivated by apprehensions regarding the psychological and social impact of the diagnosis (61.6%). Conclusion A non-negligible proportion of individuals prefer concealing a diagnosis of cancer or incurable disease to a relative, with an inter-generational disparity showing a shift to diagnosis disclosure in the young generations. There is an unmet need for evidence-based protocols for BBN based on a comprehensive assessment of patients’ expectations and needs, considering their cultural and religious values as well as the specific sociodemographic and clinical factors.
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Affiliation(s)
- Mohammed Basheikh
- Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Testoni I, Iacona E, Palazzo L, Barzizza B, Baldrati B, Mazzon D, Navalesi P, Mistraletti G, Leo DD. Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413338. [PMID: 34948947 PMCID: PMC8708256 DOI: 10.3390/ijerph182413338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
- Correspondence: ; Tel.: +39-049-827-6646
| | - Erika Iacona
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Lorenza Palazzo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Beatrice Barzizza
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Beatrice Baldrati
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Davide Mazzon
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35128 Padova, Italy;
- Department of Surgery and Medicine, University of Padua, 35128 Padova, Italy
| | - Giovanni Mistraletti
- Department of Medical-Surgical Pathophysiology and Transplantation, University of Milano, 20142 Milano, Italy;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4122, Australia;
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Edwards WF, Malik S, Peters J, Chippendale I, Ravits J. Delivering Bad News in Amyotrophic Lateral Sclerosis: Proposal of Specific Technique ALS ALLOW. Neurol Clin Pract 2021; 11:521-526. [PMID: 34992959 PMCID: PMC8723938 DOI: 10.1212/cpj.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Physician communication skills are a critical part of care for amyotrophic lateral sclerosis (ALS) patients and caregivers. They shape the development of autonomy and quality of life, and they mitigate emotional trauma. Communication skills are especially critical at 2 different time points in the course of the disease: early when delivering and establishing the diagnosis, and later when clarifying goals of care. RECENT FINDINGS Several techniques for physician communication of difficult information are available, including SPIKES (Setting up the interview, assessing the patient's Perception, obtaining the patient's Invitation, giving Knowledge and information to the patient, addressing the patient's Emotions with Empathetic responses, and Strategy and Summary), ABCDE (Advance preparation, Build a therapeutic environment/relationship, Communicate well, Deal with patient and family reactions, Encourage and validate emotions), and BREAKS (Background, Rapport, Exploring, Announce, Kindling, Summarize). These emphasize the physician's accountability and responsibility for communicating effectively. Formal training in these techniques is limited, and their applicability specifically to ALS is inexact. SUMMARY We propose an ALS-specific technique which we call ALS ALLOW to guide physicians in conducting difficult communications with ALS patients and caregivers to develop their understanding, establish autonomy, set goals, and mitigate emotional trauma. The techniques are useful in discussions both early and late stages in the disease.
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Affiliation(s)
- Wesleigh F Edwards
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Sahana Malik
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Jonathan Peters
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - Ivy Chippendale
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
| | - John Ravits
- University of California San Diego School of Medicine (WFE, SM, JP, IC, JR); Department of Internal Medicine (WFE), Scripps Green Hospital and Clinic, La Jolla, CA; Cooper Medical School of Rowan University (SM), Camden, NJ; Department of Neurosciences (JP, JR), University of California, San Diego; and University of New England College of Osteopathic Medicine (IC), Biddeford, ME
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48
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Dale MacLaine T, Lowe N, Dale J. The use of simulation in medical student education on the topic of breaking bad news: A systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:2670-2681. [PMID: 33926808 DOI: 10.1016/j.pec.2021.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.
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Affiliation(s)
| | - Nicholas Lowe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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PETRITA R. Ethical considerations associated with breaking bad news in early pregnancy units in UK. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Breaking Bad News of Surgical Complications in India. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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