Preferences of Malaysian cancer patients in communication of bad news

Breaking Bad News of a Cancer Diagnosis: A Mixed-Methods Study of Patients' Perspectives

PURPOSE

A cancer diagnosis is an overwhelming process for both patients and doctors. Many studies have addressed doctors' opinions and knowledge regarding breaking bad news (BBN). However, scarce knowledge exists regarding patients' perspectives for communicating bad news. Therefore, the current study aims to assess cancer patient preferences and satisfaction about BBN.

PATIENTS AND METHODS

This is a mixed methods study consisting of two phases; an in-depth interview and cross-sectional quantitative analysis. Thematic analysis was used for the qualitative data to explore patients' satisfaction and preferences about BBN. For quantitative analyses, the overall satisfaction was calculated as satisfaction percent. Bivariate analyses were performed, and statistical significance was set as p < 0.05. Quality function deployment was used to effectively define patient requirements of highest priority.

RESULTS

Thematic analysis revealed two main themes. Theme 1; patients' requirements for BBN and theme 2; patients' reaction at the time of diagnosis with their categories. For the quantitative part, a total of 222 patients responded to the survey, females made up 70% of the sample. Satisfaction score percent ranged from 25.5 to 100%, with a mean of 82.7±11.9%. The most preferred items were mainly concerned with the doctor being honest and encouraging, good listener and interacting giving simple smooth explanations without using medical terms, and empathetic (average score 4.8/5). Also, providing the diagnosis in a calm and private environment (4.7/5). Analysis also found that the requirements for improvement included providing a written summary after receiving the diagnosis and patient perception assessed by the doctor before telling the diagnosis.

CONCLUSION

Communicating bad news effectively is crucial in the management of cancer patients. The process of BBN should be patient-centered, focusing on patients' needs. Thus, the current study has demonstrated the patients' preferences and the requirements, which should be incorporated into BBN protocols.

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.

The relationship between personality traits of cancer patients and their preferences when receiving bad news

OBJECTIVE

This study aimed to determine the relationship between the personality traits of cancer patients and their preferences when receiving bad news.

METHODS

In this descriptive correlational study, 200 cancer patients who were selected by the continuous sampling method participated. Patients self-reportedly completed the demographic and medical information questionnaire, the Measure of Patients' Preference (MPP) scale, and the short form of the Eysenck Personality Inventory (EPI).

RESULTS

The majority of participants were female (73%), 42.5% had higher education, and 47.5% suffered from breast cancer. In this study, the mean scores of extraversion and neuroticism in patients were 14.59 ± 2.47 and 15.17 ± 3.43, respectively. Regarding patients' preferences for receiving bad news, the score obtained by them in the content category was greater compared to two categories of context and support. This study showed a significant and negative correlation between neuroticism and patients' preferences in the support category (P < 0.001 and r =  - 0.265). Regarding the categories of the MPP, there was a significant relationship between gender (P = 0.018) and marital status (P = 0.049) with context category, education (P = 0.011) with content category, and marital status (P = 0.003) and employment (P = 0.009) with support category.

CONCLUSION

Personality traits and demographic characteristics of cancer patients can influence their preferences for receiving bad news. Therefore, the consideration of these traits by health care team members is of particular importance to communicate with and deliver bad news to patients.

Communication Needs of Cancer Patients and/or Caregivers: A Critical Literature Review

Objective

Effective communication for cancer patients and/or caregivers can meet information needs, reduce caregiver burden, improve physical and mental health, and promote intimacy. The aim of this review was to identify the communication needs of cancer patients and/or caregivers and to explore their specific communication needs to guide the development of future communication interventions.

Methods

Chinese and English databases were systematically searched from January 2010 to October 2019, including MEDLINE, CINAHL, PubMed, and the China Academic Journal Full-text Database. The key search terms used were “cancer” or “carcinoma” or “oncology” AND “patient” or “caregiver” or “carer” AND “communication” or “discussion” or “talk” AND “need” or “needs” or “desire.”.

Results

A total of 26 articles was identified and included in this review. The findings revealed the needs of cancer patients and/or caregivers in terms of communication target, content, style, timing, and preferences. Communication targets included health professionals, peers, caregivers, and patients. Communication content included illness-related, emotional support, daily life, sexuality, death, and a way to communicate with health professionals. Communication style needed to be expressed through such things as language and communication atmosphere. Communication timing mainly referred to before treatment and approaching death. Communication preferences were related to factors such as demographics and ethnic origin.

Conclusions

Cancer patients and/or caregivers have different communication needs in terms of target, content, style, and communication timing. A better understanding of the unique communication needs of patients and/or caregivers will offer health professionals detailed information on designing appropriate interventions to support cancer patients and caregivers.

The experiences of patients and their family members when receiving bad news about cancer: A qualitative meta-synthesis

OBJECTIVE

This qualitative meta-synthesis explored the subjective experiences of patients and their family members when receiving bad news about cancer, with a focus on what was important to them during this process and making future recommendations.

METHODS

A search of five electronic databases yielded 587 different records that resulted in 88 articles assessed against the inclusion/exclusion criteria. With the supplement of four additional records, 29 articles were analysed using thematic synthesis. A quality appraisal checklist was used to provide further information about the included articles.

RESULTS

Patients and family members experienced receiving bad news as a process that involved three phases, labelled as follows: "preparation", "delivery", and "adjusting and coping". The "preparation" phase had four themes: the setting, developing a relationship, knowing the patient, and forewarning. Four themes were identified during the "delivery" phase: emotional reactions, empathy not sympathy, active participation, and understanding. "Adjusting and coping" comprised four themes: hope, holistic support, being a protector, and ongoing relationships.

CONCLUSIONS

Receiving bad news is a significant experience for patients and family members. They want bad news delivered in an appropriate setting, in a manner consistent with their personal preferences, and have their psychological needs attended to within the context of an established relationship. Healthcare professionals can be assisted to deliver bad news in the best way possible by additional training and their workplace institutions providing quiet, private rooms, and sufficient time. Future research is needed to better understand family members' experiences and needs.

Cancer Patients' Informational Needs: Qualitative Content Analysis

Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.

Determinants of health information-seeking behavior: implications for post-treatment cancer patients

Health information-seeking behavior (HISB) is active need-fulfillment behavior whereby health information is obtained from diverse sources, such as the media, and has emerged as an important issue within the transforming medical environment and the rise of medical consumers. However, little is known about the factors that affect HISB and its associations, and the health outcome of HISB. The aim of this study was to examine individual and social contextual factors associated with HISB and to systematically review their effects on health status among post- treatment cancer patients. Individual determinants of HISB included demographic factors, psychosocial factors, perceived efficacy and norms, and health beliefs. Contextual determinants of HISB encompassed community characteristics, neighborhood social capital, and media advocacy. Improving through factors on these two levels, HISB raised individuals' self-care management skills and medical treatment compliance, and enhanced shared decision-making and medical treatment satisfaction. Moreover, because HISB can differ according to individuals' social contextual conditions, it can give rise to communication inequalities. Because these can ultimately lead to health disparities between groups, social interest in HISB and balanced HISB promotion strategies are necessary.

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

BACKGROUND

Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients' desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia.

METHODS

In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation.

RESULTS

There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient' programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan.

CONCLUSION

In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.