Mothers' preferences toward breaking bad news about their children cancer

The experiences of Indonesian parents receiving bad news about their children's diseases: A qualitative descriptive study

PURPOSE

Breaking bad news about children's chronic diseases is challenging and is often not performed according to the needs of parents. The aim of the study was to explore the experiences of Indonesian parents receiving bad news about their chronically ill child.

DESIGN AND METHOD

This is a qualitative descriptive study that used semi-structured interviews. Twenty one parents who met the inclusion criteria were face-to-face interviewed between August 2021 and September 2022. Interviews were audio-recorded and transcribed. The data were analyzed using content analysis. The trustworthiness of the study was established through member checking, triangulation, and detailed transcriptions. The COREQ checklist was followed in this study.

FINDINGS

Findings revealed four categories: 1) reactions when receiving bad news; 2) expectations while receiving bad news; 3) conflicting feelings and situations; and 4) perceived roles of nurses in delivering the news.

CONCLUSION

Parents reacted in different ways when receiving bad news about their children's disease, mostly experiencing negative thoughts and being unable to bear the news. Despite those reactions, parents highlighted their right to receive the news with an understandable explanation through the roles of nurses as educators, advocates, and empathizers.

PRACTICE IMPLICATION

Nurses are encouraged to strengthen their roles in breaking bad news. Nurses and healthcare professionals are also suggested to use understandable language and explain medical terms that are used in delivering the information to parents.

[The announcement of treatment resistance in pediatric oncology: Understanding parents' experiences and influencing factors with a mixed methodology]

OBJECTIVE

The announcement of a resistance to treatment in pediatric oncology occurs within the framework of an established parent-pediatrician relationship. The aim of this study was to understand the parents' experience of this announcement and the relational and communicational factors likely to impact it.

METHOD

A mixed-methods study was conducted in a pediatric oncology department with 15 parents of a child with treatment-resistant cancer, with an average age of 40.8years. The parents completed three questionnaires to assess their anxiety and depression (HADS) and their information needs (EORTC - QLQ Info 25 and PTPQ). Semi-structured interviews were conducted and a content analysis was performed.

RESULTS

The majority of parents have "suspected" or "proven" anxiety and/or depressive disorders. The experience of this announcement was influenced by the quality of the parent-pediatrician relationship, the perceived quality of the management, the anticipation of the announcement, the context of the announcement, and the experience of previous announcements. The parents interviewed were very satisfied with the informational exchanges. This satisfaction was underpinned by honest communication and by the responsiveness and availability of the pediatricians.

DISCUSSION

The establishment of a relationship of trust between the family and the pediatrician throughout the course of care plays a major role in the parents' experience of the announcement of resistance to treatment.

Da técnica à tékhnē: comunicação de notícias difíceis em unidade de terapia intensiva pediátrica

RESUMO Objetivo compreender as percepções de familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica diante da comunicação de notícias difíceis. Método estudo fenomenológico com 15 familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica de um hospital universitário público do estado de São Paulo. Entrevistas foram realizadas no período de outubro de 2018 a março de 2019. A compreensão dos discursos se deu à luz da fenomenologia existencial heideggeriana. Resultados duas categorias ontológicas emergiram: O familiar da criança existindo em um mundo impróprio; e O familiar da criança vislumbrando a essência da técnica. O familiar recebe as notícias difíceis dos profissionais de saúde na instrumentalidade, emergindo a necessidade de extrapolar a técnica em busca da sua essência. Conclusão e implicações para a prática os discursos revelam que a tecnologia moderna se sobrepõe à ontologia tradicional, uma vez que o profissional de saúde, ao comunicar as notícias difíceis, afasta-se do ser e perde-se de sua essência. O aprimoramento de competências interpessoais e de comunicação dos profissionais de saúde pode extrapolar a dimensão técnica, prevalente em terapia intensiva.

From technology to tékhnē: communication of bad news in pediatric intensive care unit

ABSTRACT Objective to understand the perceptions of family members of children hospitalized in the Pediatric Intensive Care Unit regarding the communication of bad news. Methods this is a phenomenological study with 15 family members of children hospitalized in the Pediatric Intensive Care Unit of a public university hospital in the state of São Paulo. Interviews were carried out from October 2018 to March 2019. The discourses were understood grounded Heidegger’s existential phenomenology. Results two ontological categories emerged: The child’s family member existing in an inappropriate world; and The child’s family member glimpsing the essence of technology. Family members receive difficult news from health professionals in the instrumentality, emerging the need to extrapolate the technology in search of its essence. Conclusions and implications for practice the discourses reveal that modern technology overlaps with traditional ontology, since health professionals, when communicating difficult news, move away from the being and lose their essence. Health professionals’ improving interpersonal and communication skills can extrapolate the technical dimension, prevalent in intensive care.

Preferences of the Saudi Population in Breaking Bad Medical News: A Regional Study

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.