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Ebelhar JS, Brock KE. Communicating difficult news in pediatric radiology. Pediatr Radiol 2024; 54:663-670. [PMID: 38326566 DOI: 10.1007/s00247-024-05861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish… I worry… I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations.
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Affiliation(s)
- Jonathan S Ebelhar
- Department of Pediatrics, Divisions of Pediatric Hematology/Oncology and Palliative Care, Emory University, 2015 Uppergate Drive, Suite 400, Atlanta, GA, 30322, USA.
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Katharine E Brock
- Department of Pediatrics, Divisions of Pediatric Hematology/Oncology and Palliative Care, Emory University, 2015 Uppergate Drive, Suite 400, Atlanta, GA, 30322, USA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Lopez-Aguiar AG, Sarna A, Wells-DiGregorio S, Huang E, Kneuertz PJ, Beane J, Kim A, Ejaz A, Pawlik TM, Cloyd JM. Surgeon Perspectives on the Management of Aborted Cancer Surgery: Results of a Society of Surgical Oncology Member Survey. Ann Surg Oncol 2024; 31:2295-2302. [PMID: 38127216 DOI: 10.1245/s10434-023-14804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND While surgery is generally necessary for most solid-organ cancers, curative-intent resection is occasionally aborted due to unanticipated unresectability or occult metastases. Following aborted cancer surgery (ACS), patients have unique and complex care needs and yet little is known about the optimal approach to their management. OBJECTIVE The aim of this study was to define the practice patterns and perspectives of an international cohort of cancer surgeons on the management of ACS. METHODS A validated survey assessing surgeon perspectives on patient care needs and management following ACS was developed. The survey was distributed electronically to members of the Society of Surgical Oncology (SSO). RESULTS Among 190 participating surgeons, mean age was 49 ± 11 years, 69% were male, 61% worked at an academic institution, and most had a clinical practice focused on liver/pancreas (30%), breast (23%), or melanoma/sarcoma cancers (20%). Participants estimated that ACS occurred in 7 ± 6% of their cancer operations, most often due to occult metastases (67%) or local unresectability (30%). Most surgeons felt (very) comfortable addressing their patients' surgical needs (92%) and cancer treatment-related questions (90%), but fewer expressed comfort addressing psychosocial needs (83%) or symptom-control needs (69%). While they perceived discussing next available therapies as the patients' most important priority after ACS, surgeons reported avoiding postoperative complications as their most important priority (p < 0.001). While 61% and 27% reported utilizing palliative care and psychosocial oncology, respectively, in these situations, 46% noted care coordination as a barrier to addressing patient care needs. CONCLUSIONS Results from this SSO member survey suggest that ACS is relatively common and associated with unique patient care needs. Surgeons may feel less comfortable assessing psychosocial and symptom-control needs, highlighting the need for novel patient-centered approaches.
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Affiliation(s)
- Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Angela Sarna
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sharla Wells-DiGregorio
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emily Huang
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joal Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Shah S, Usman A, Zaki S, Qureshi A, Lal K, Uneeb SN, Bari N, Hasnani FB, Shah N, Iqbal SP, Ullah O, Abid S. The role of family and culture in the disclosure of bad news: A multicentre cross-sectional study in Pakistan. PEC Innov 2023; 3:100200. [PMID: 37674774 PMCID: PMC10477806 DOI: 10.1016/j.pecinn.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
Objectives Disclosure of bad news is distressing for patients and family members. Our aim was to assess patients' perceptions and preferences regarding bad news in the health setting. Methods Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A sample size of 1673 patients and family members was used. Ethics permission/consent was taken from each participating hospital and participant. Responses were compared across provinces, gender, age, education and income. Results >80% patients preferred their relatives to know the diagnosis first and they wanted the news to be disclosed to them by doctors. Significant association between education level, income and preference for wanting to know the diagnosis was found. Reasons for wanting to know the diagnosis included treatment, prognosis and prevention options whereas reasons for not wanting to know included fear of emotions and God's will. Conclusion The majority of Pakistani patients want to be informed and want the family to know first. Preferences for disclosure vary across, age, education and income level. Innovation First countrywide study on this topic. Identifies need for culturally sensitive guidelines that include the family's role in disclosure of bad news.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, North Island Hospital Campbell River and District, Island Health, Campbell River, BC, Canada
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Asma Usman
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Asra Qureshi
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Karishma Lal
- Aga Khan University Medical College, Karachi, Pakistan
| | | | | | - Fauzia Basaria Hasnani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nasir Shah
- Department of Family Medicine, University of Health Sciences, Lahore, Pakistan
| | - Saima Parwaiz Iqbal
- Division of Family Medicine, Department of Community Health Sciences, Shifa International, Islamabad, Pakistan
| | - Obaid Ullah
- Pakistan Medical Research Council, Peshawar, Pakistan
| | - Sumera Abid
- Pakistan Medical Research Council, Islamabad, Pakistan
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von Blanckenburg P, Köhler C, Petzel A, Jülicher A, Schneider V, Schneider A. Quality of breaking bad news to patients diagnosed with neoplasia of the uterine cervix. J Cancer Res Clin Oncol 2023; 149:17215-17222. [PMID: 37792062 PMCID: PMC10657321 DOI: 10.1007/s00432-023-05442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Little is known about the quality of receiving bad news (BN) for women diagnosed with cervical neoplasia. We evaluated adherence to the SPIKES protocol in three cohorts of women with different stages of the disease and treatment modalities. PATIENTS AND METHODS We included women with cervical cancer who underwent radical vaginal trachelectomy (RVT group, n = 110), radical hysterectomy or chemo-radiation (HE/RCT group, n = 101), and women with CIN 3 treated by loop excision (CIN group, n = 108). We asked the participants about how they received the bad news delivery in reality and how they would envision an ideal communication process based on the main items of the SPIKES protocol. The participants filled out a questionnaire with 38 items of the Marburg Breaking Bad News (MABBAN) Scale representing the six SPIKES subscales. RESULTS Only 72% of all patients reported being satisfied with their BBN experience. The following factors were considered important by 90% of the patients: an undisturbed atmosphere, taking enough time, coherent explanation of the disease, and the possibility to ask questions. However, the reality of their experiences fell significantly short of their expectations. Asking about the patient's knowledge of the disease, addressing their concerns, allowing them to show emotions, providing clarity about the change in quality of life, informing them about alternative therapies, and involving them in further planning were also significantly lacking in the actual BBN encounters compared to the patients' preferences. The experience of RVT patients was more negative compared to the HE/RCT patients (p = 0.036). The CIN patients had an overall satisfactory impression (p < 0.0001). CONCLUSION The process of breaking bad news in German women diagnosed with cervical neoplasia requires substantial improvement. The SPIKES protocol can be used as a guideline for enhancement but should be supplemented by incorporating a second consultation as the norm rather than the exception. Continuous monitoring and improvement of the quality of BBN is recommended for all oncologic institutions, utilizing the MABBAN questionnaire as a valuable tool.
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Affiliation(s)
- Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | - Christhardt Köhler
- Institute for Cytology and Dysplasia, Hohenzollerndamm 123, 14199, Berlin, Germany
| | - Anja Petzel
- Institute for Cytology and Dysplasia, Hohenzollerndamm 123, 14199, Berlin, Germany
| | - Anne Jülicher
- Institute for Cytology and Dysplasia, Hohenzollerndamm 123, 14199, Berlin, Germany
| | - Viola Schneider
- Institute for Cytology and Dysplasia, Hohenzollerndamm 123, 14199, Berlin, Germany
| | - Achim Schneider
- Institute for Cytology and Dysplasia, Hohenzollerndamm 123, 14199, Berlin, Germany
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Alhalabi MN, Khalaf IA, Zeilani RS, Bawadi HA, Musa AS, Nashwan AJ. Palliative care needs of Jordanian women's experience of living with stroke: a descriptive phenomenological study. BMC Palliat Care 2023; 22:106. [PMID: 37507696 PMCID: PMC10375733 DOI: 10.1186/s12904-023-01216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Stroke is a prevalent neurological disease that can have a profound impact on women's physical, psychosocial, and spiritual well-being. In many cases, women living with stroke may have marginalized palliative care needs that are often not adequately addressed by healthcare providers. Unfortunately, the experience of women with stroke and their specific palliative care needs have been largely overlooked in research conducted in Jordan. AIM The purpose of this study is to examine the specific palliative care needs of women who have experienced a stroke and are currently living in Jordan. By conducting this research, we aim to identify the various physical, emotional, social, and spiritual needs of women with stroke and gain a better understanding of how these needs can be addressed through palliative care interventions. METHODS This research utilized a phenomenological descriptive study approach to explore the experiences of twelve women recruited from the outpatient clinic of rehabilitation centers. The data was collected through semi-structured interviews. The analysis was conducted using the method of Colaizzi (1978), which involves identifying significant statements, extracting meanings, and formulating an exhaustive description of the phenomenon under study. RESULTS The study findings uncovered three primary themes that reflect the palliative care needs of women who are currently living with stroke in Jordan, including (1) Spiritual practices, beliefs, and needs; (2) Coping with distressing symptoms; and (3) Managing the delivery of unfavorable news. DISCUSSION This study provides valuable insights into the experiences of Jordanian women living with stroke, highlighting the far-reaching consequences of this condition on various aspects of their lives. The findings reveal that stroke has a significant impact on women's physical, emotional, social, and spiritual well-being, with many facing unmet palliative care needs. By illuminating these challenges, our study underscores the importance of taking a holistic approach to stroke care that addresses the multifaceted needs of women living with stroke. Healthcare providers must consider these findings and integrate palliative care interventions into treatment plans to improve the quality of life of women living with stroke in Jordan. CONCLUSION This study provides valuable insights into the palliative care needs of women who have experienced a stroke. Our findings highlight the importance of addressing women's physical, psychosocial, and spiritual needs as part of a comprehensive approach to stroke care. We recommend integrating palliative care interventions into rehabilitation programs to improve the quality of life of women living with stroke in Jordan. By doing so, we can address the pain and complications that can arise from stroke, while also providing holistic support to address the emotional and spiritual impact of the illness. This approach has the potential to improve outcomes for women living with stroke and enhance their overall well-being.
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Affiliation(s)
- Marwa Nayef Alhalabi
- Department of Adult Health Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Inaam Abdulla Khalaf
- Department of Maternal and Child Health Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Ruqayya Sayed Zeilani
- Department of Adult Health Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Hala Ahmad Bawadi
- Department of Maternal and Child Health Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmad S Musa
- Department of Adult Health Nursing, Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bendary MM, Sherif GM, Ibrahim AS, Gadallah MA. Truth-telling in Oncology: Egyptian Patients' Attitudes and Preferences. Asian Pac J Cancer Prev 2022; 23:4227-4231. [PMID: 36580005 PMCID: PMC9971476 DOI: 10.31557/apjcp.2022.23.12.4227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Truth-telling in oncology is a major challenge, particularly in the absence of disclosure protocols in Egypt and the lack of Egyptian studies examining patients' preferences regarding cancer disclosure. This study aimed to reveal the preferences of patients seeking care at the National Cancer Institute - Cairo University regarding disclosing cancer diagnosis and the type and amount of information to be told. METHODS This cross-sectional study was conducted on 200 patients selected consecutively from those attending the outpatient clinics of the National Cancer Institute - Cairo University. Face-to-face interviews were performed with the patients according to a structured questionnaire. The questionnaire consisted of five parts: socio-demographic characteristics, knowledge about cancer disease, attitudes towards cancer disease, experience during the disclosure of the diagnosis, and preferences regarding disclosure of cancer diagnosis. RESULTS Most patients (89.5%) preferred to know the diagnosis. Of them, 94.4% wished to know from the physician. No agreement was found between most patients' preferences and physicians' practice. On multivariate logistic regression analysis, patients' education was the only significant predictor of the preference to know the diagnosis (OR = 5.298, 95% CI = 1.258 - 22.301, P = 0.023). CONCLUSION Patients have a great desire to know the diagnosis and other information related to treatment and prognosis.
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Affiliation(s)
- Mohamed M Bendary
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt. ,For Correspondence:
| | - Ghada M Sherif
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Amal S Ibrahim
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Mohsen A Gadallah
- Department of Public Health, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Vitto C, Del Buono B, Daniel L, Rivet E, Cholyway R, Santen SA. Teaching Toolbox: Breaking Bad News with Virtual Technology in the Time of COVID. J Cancer Educ 2022; 37:1429-1432. [PMID: 33851370 PMCID: PMC8043776 DOI: 10.1007/s13187-021-01975-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 05/13/2023]
Abstract
Breaking bad news is a key component of the physicians' work. Traditionally, breaking bad news has been encouraged to be performed in person whenever possible (Monden et al. Proc (Bayl Univ Med Cent) 29(1):101-102, 2016; Nickson 2019). The common practice prior to the pandemic can be summarized by "The first rule of breaking bad news is: do not do it over the phone." It is important to be present with the family and provide support through compassion and empathy. Until recently, virtual communication technology for serious medical discussions was rare and primarily used when compelled by circumstances such as distance. The COVID-19 pandemic has transformed our ability to deliver news in person and has required the medical community to increase the utilization of telephone and video conferencing to communicate with patients and their family members. Breaking bad news through virtual media is a new skill in need of further guidance and education regarding how to set up the conversation, provide empathy, and lend support (Wolf et al., Oncologist 25(6):e879-e880, 2020). Therefore, we have created a teaching toolbox to help educate healthcare providers on how to deliver bad news by phone or video.
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Affiliation(s)
| | | | - Lily Daniel
- Virginia Commonwealth University, Richmond, VA, USA
| | - Emily Rivet
- Virginia Commonwealth University, Richmond, VA, USA
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Abstract
Giving bad news is a recurrent and predictable task in our lives as humans interacting with other humans. This article presents frameworks and best practices that can help us to deliver bad news in health care in a way that is experienced as caring and empathic, and supports the patient as they adjust to their new reality. Key skills include responding to patients' emotions empathically, structuring bad news conversations, leading with an exploration of the patient's understanding and expectations, delivering the bad news clearly and concisely, and individualizing the balance of empathy and support with providing information and developing a plan.
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Affiliation(s)
- David Harris
- Department of Palliative and Supportive Care, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, CA-53 Cleveland, OH 44195, USA
| | - Timothy Gilligan
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, CA-60, Cleveland, OH 44195 USA.
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Guerdoux E, Trouillet R, de Forges H, Valy L, Jouvet F, Chauvet C, Champoiral P. ' Bad news consultations' with oncology nurses: Impact on perceived stress and patient experience. Eur J Oncol Nurs 2021; 56:102085. [PMID: 34990998 DOI: 10.1016/j.ejon.2021.102085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE 'Bad News Consultations' (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC. METHOD This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC). RESULTS Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = -1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = -0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares. CONCLUSION Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway.
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Ekberg S, Parry R, Land V, Ekberg K, Pino M, Antaki C, Jenkins L, Whittaker B. Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice. BMC Palliat Care 2021; 20:186. [PMID: 34876096 PMCID: PMC8651503 DOI: 10.1186/s12904-021-00876-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing recognition that a diverse range of healthcare professionals need competence in palliative approaches to care. Effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions. METHODS The current rapid review updates findings of a 2014 systematic review, focussing more specifically on evidence related to illness progression and end-of-life conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies. RESULTS Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in discussions about illness progression and end-of-life. CONCLUSION The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life.
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Affiliation(s)
- Stuart Ekberg
- School of Psychology & Counselling, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ruth Parry
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK.
| | - Victoria Land
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK
| | - Katie Ekberg
- School of Early Childhood & Inclusive Education, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.,School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Marco Pino
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK
| | - Charles Antaki
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK
| | - Laura Jenkins
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK
| | - Becky Whittaker
- School of Social Sciences and Humanities, Loughborough University, Brockington Building, Epinal Way, Margaret Keay Road, Loughborough, LE11 3TU, UK
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Ehsani M, Farahani MA, Negari F, Ranjbar H, Shariati B, Marandi F. The relationship between personality traits of cancer patients and their preferences when receiving bad news. Support Care Cancer 2021; 30:2299-2306. [PMID: 34719738 DOI: 10.1007/s00520-021-06630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Maryam Ehsani
- Mental Health Research Center, Psychosocial Health Research Institute, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Negari
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Marandi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Ichhpujani P, Kalra G, Singla E, Kumar S. Breaking bad news about glaucoma: a SPIKES strategy primer. Int Ophthalmol 2021. [PMID: 34319501 DOI: 10.1007/s10792-021-01956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Most ophthalmic physicians are not formally trained for breaking the news of having sight threatening diseases, requiring lifelong therapy. This study aims to ascertain physician practices and patients' experiences regarding delivery of bad news. METHODS An online, anonymous questionnaire was sent to 400 ophthalmologists practising glaucoma to gather information as to how they deliver bad news to their patients. A parallel survey was also conducted amongst 100 established glaucoma patients to know whether how their doctor had delivered the diagnosis of glaucoma to them. After this, resident doctors were trained in SPIKES strategy and the patient survey was repeated in 100 new patients. RESULTS Two hundred and eighteen out of 400 ophthalmologists responded to our survey resulting in a survey yield of 54.5%. About 56.5% ophthalmologists dealt with disclosing the diagnosis >20 times a month; 70% of responders always discussed about the true severity of disease up-front. Only 8.70% respondents had formal training for breaking the bad news. Results of first phase of patient survey revealed that nearly one-third of patients (27%), felt that their doctor used incomprehensible medical terminology and 42% patients said that their doctor downplayed their diagnosis. Only 12% provided information to their patients about reliable sources to gather additional information. After the resident doctors were trained in SPIKES strategy, the second phase of patient survey had marked positive change in the way information was delivered. CONCLUSION The current study shows that despite years of clinical experience, many ophthalmologists face difficulty in delivering bad news for a sight threatening disease such as glaucoma. Therefore, SPIKES strategy or a similar protocol must be taught to practising ophthalmologists at all levels, to alleviate worries of patients suffering from chronic, visually debilitating diseases.
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Bongelli R, Bertolazzi A, Piccioni L, Burro R. Italian onco-haematological patients' preferences in bad news communication: a preliminary investigation. BMC Cancer 2021; 21:555. [PMID: 34001021 PMCID: PMC8127256 DOI: 10.1186/s12885-021-08181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The manner in which bad news is communicated in oncological contexts can affect patients' engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients' experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. METHODS In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). RESULTS While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients' preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. CONCLUSIONS The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients' preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.
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Affiliation(s)
- Ramona Bongelli
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy.
| | - Alessia Bertolazzi
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Ludovica Piccioni
- Department of Political Science, Communication and International Relations, University of Macerata, Via Don Minzoni 22/A, 62100, Macerata, Italy
| | - Roberto Burro
- Department of Human Sciences, University of Verona, Verona, Italy
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Abstract
PURPOSE OF REVIEW Our goal was to provide healthcare professionals (HCPs) with evidence-based data about what can be done to handle prognostic discussions with empathy. RECENT FINDINGS First, disclosing prognosis involves a good reason to do so and making sure that the patient will be able to process the discussion. Second, communication tips are given for the three dimensions of empathy: "establishing rapport with the patient," which should not be overlooked; the emotional dimension, which involves an accurate understanding of the patient and communication skills; and the "active/positive" dimension which is about giving hope, explaining things clearly and helping patients take control with shared decision-making and a planned future. Although communication tips are helpful, empathy training should be based more on the development of HCPs' emotional skills, in order to help them regulate their emotions and thus be more comfortable with those of patients and families. Furthermore, research into empathy toward minorities and relatives is needed.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000, Lille, France.
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16
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Toffolo SR, Natour J, Boni RC, Nunes-Tamashiro JC, Furtado RNV. The SPIKES protocol does not influence the tolerance or effectiveness of intra-articular corticosteroid injection in the knees of osteoarthritis patients: A prospective, controlled, randomized single-blinded trial. Knee 2021; 29:432-40. [PMID: 33740751 DOI: 10.1016/j.knee.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.
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Westmoreland KD, Banda FM, Steenhoff AP, Lowenthal ED, Isaksson E, Fassl BA. A standardized low-cost peer role-playing training intervention improves medical student competency in communicating bad news to patients in Botswana. Palliat Support Care 2019; 17:60-5. [PMID: 30328405 DOI: 10.1017/S1478951518000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news. METHOD A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.
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Lelorain S, Cattan S, Lordick F, Mehnert A, Mariette C, Christophe V, Cortot A. In which context is physician empathy associated with cancer patient quality of life? Patient Educ Couns 2018; 101:1216-1222. [PMID: 29409676 DOI: 10.1016/j.pec.2018.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/03/2018] [Accepted: 01/30/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In cancer settings, physician empathy is not always linked to a better patient emotional quality of life quality of life (eQoL). We tested two possible moderators of the inconsistent link: type of consultation (bad news versus follow-up) and patient emotional skills (emoSkills, i.e., the way patients process emotional information). METHODS In a cross-sectional design, 296 thoracic and digestive tract cancer patients completed validated questionnaires to assess their physician empathy, their emoSkills and eQoL. Moderated multiple regressions were performed. RESULTS In follow-up consultations, physician empathy was associated with a better eQoL in patients with low or average emotional skills. Those with high emotional skills did not benefit from physician empathy. Their eQoL was nonetheless very good. In bad news consultations, the pattern was reversed: only patients with average or high emotional skills benefited from physician empathy. Those with low emotional skills were not sensitive to it and presented a poor eQoL. CONCLUSION Medical empathy is important in all consultations. However, in bad news consultations, patients with low emoSkills are at risk of psychological distress even with an empathetic doctor. PRACTICE IMPLICATIONS Accordingly, physicians should be trained to detect patients with low emoSkills in order to refer them to supportive care.
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Affiliation(s)
- Sophie Lelorain
- Univ. Lille, CNRS, CHU Lille, UMR 9193, SCALab, Cognitive and Affective Sciences, Lille, France; SIRIC (French comprehensive cancer center), ONCOLille, France.
| | - Stéphane Cattan
- Univ. Lille, Department of Digestive Diseases, Claude Huriez University Hospital, Lille, France
| | - Florian Lordick
- University Medicine Leipzig, University Cancer Center Leipzig (UCCL), Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Germany
| | - Christophe Mariette
- SIRIC (French comprehensive cancer center), ONCOLille, France; Univ. Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; Univ. Lille, UMR-S 1172, JPARC, Research Center Jean-Pierre AUBERT Neurosciences and Cancer, Lille, France
| | - Véronique Christophe
- Univ. Lille, CNRS, CHU Lille, UMR 9193, SCALab, Cognitive and Affective Sciences, Lille, France; SIRIC (French comprehensive cancer center), ONCOLille, France
| | - Alexis Cortot
- Univ. Lille, Department of Thoracic Oncology, Albert Calmette University Hospital, Lille, France
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Leone D, Menichetti J, Barusi L, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Livi C, Luehwink A, Tomasi G, Vegni E. Breaking bad news in assisted reproductive technology: a proposal for guidelines. Reprod Health 2017; 14:87. [PMID: 28728610 PMCID: PMC5520370 DOI: 10.1186/s12978-017-0350-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Daniela Leone
- Department of Health Sciences, Università degli Studi di Milano, San Paolo University Hospital, Via di Rudinì 8, 20142 Milan, Italy
| | - Julia Menichetti
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Lorenzo Barusi
- Assisted Reproductive Unit, Parma University Hospital, Parma, Italy
| | | | - Mauro Costa
- Ospedale Evangelico Internazionale, Assisted Reproductive Unit, Genoa, Italy
| | | | | | - Claudia Livi
- Demetra Assisted Reproductive Center, Florence, Italy
| | - Arne Luehwink
- Azienda Provinciale per i Servizi Sanitari- Provincia Autonoma di Trento, Assisted Reproductive Unit, Arco, Italy
| | | | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, San Paolo University Hospital, Via di Rudinì 8, 20142 Milan, Italy
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Kugimoto T, Katsuki R, Kosugi T, Ohta A, Sato H. Significance of Psychological Stress Response and Health-related Quality of Life in Spouses of Cancer Patients When Given Bad News. Asia Pac J Oncol Nurs 2017; 4:147-154. [PMID: 28503648 PMCID: PMC5412153 DOI: 10.4103/2347-5625.204494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). Methods: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.
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Affiliation(s)
| | - Ryo Katsuki
- Deptartment of Anesthesiology, NHO Ureshino Medical Center, Ureshino, Japan
| | - Toshifumi Kosugi
- Deptartment of Palliative Care, Saga-ken Medical Center, Koseikan, Saga, japan
| | | | - Hidetoshi Sato
- Department of Comprehensive Community-based Palliative Care, Faculty of Medicine, Saga University Hospital, Saga University, Saga, Japan
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Abstract
OBJECTIVE Communication based on patient preferences can alleviate their psychological distress and is an important part of patient-centered care for physicians who have the task of conveying bad news to cancer patients. The present study aimed to explore the demographic, medical, and psychological factors associated with patient preferences with regard to communication of bad news. METHODS Outpatients with a variety of cancers were consecutively invited to participate in our study after their follow-up medical visit. A questionnaire assessed their preferences regarding the communication of bad news, covering four factors-(1) how bad news is delivered, (2) reassurance and emotional support, (3) additional information, and (4) setting-as well as on demographic, medical, and psychosocial factors. RESULTS A total of 529 outpatients with a variety of cancers completed the questionnaire. Multiple regression analyses indicated that patients who were younger, female, had greater faith in their physician, and were more highly educated placed more importance on "how bad news is delivered" than patients who were older, male, had less faith in their physician, and a lower level of education. Female patients and patients without an occupation placed more importance on "reassurance and emotional support." Younger, female, and more highly educated patients placed more importance on "additional information." Younger, female, and more highly educated patients, along with patients who weren't undergoing active treatment placed more importance on "setting." SIGNIFICANCE OF RESULTS Patient preferences with regard to communication of bad news are associated with factors related to patient background. Physicians should consider these characteristics when delivering bad news and use an appropriate communication style tailored to each patient.
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22
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Abstract
Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to “realize” the bad news because it involves the deliverer and recipient in a particular social relation. The deliverer of bad news initiates the telling by giving an advance indication of the bad news to come; this allows the recipient to calculate the news in advance of its final presentation, when the deliverer confirms what the recipient has been led to anticipate. Thus, realization of bad news emerges from intimate collaboration, whereas stalling and being blunt require recipients to apprehend the news in a social vacuum. Exacerbating disruption to recipients' everyday world, stalling and being blunt increase the probability of misapprehension (denying, blaming, taking the situation as a joke, etc.) and thereby inhibit rather than facilitate realization. Particular attention is paid to the “perspective display sequence”, a particular forecasting strategy that enables both confirming the recipient's perspective and using that perspective to affirm the clinical news. An example from acute or emergency medicine is examined at the close of the paper.
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Porensky EK, Carpenter BD. Breaking bad news: Effects of forecasting diagnosis and framing prognosis. Patient Educ Couns 2016; 99:68-76. [PMID: 26238257 DOI: 10.1016/j.pec.2015.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Research to support guidelines for breaking bad news is lacking. This study used an experimental paradigm to test two communication strategies, forecasting bad news and framing prognosis, in the context of cancer. METHODS In a 2×2 design, 128 participants received bad news in a hypothetical consultation. A videotaped physician presented diagnostic and prognostic information, varying warning (warning shot vs. no warning), and framing (positive vs. negative). Effects on psychological distress, recall accuracy, and subjective interpretations of the news were assessed. RESULTS Warning was not associated with lower psychological distress or improved recall. Individuals who heard a positively-framed prognosis had significantly less psychological distress, rated their prognosis better, and were more hopeful than those who heard a negatively-framed prognosis. However, they also showed a trend toward reduced accuracy in recalling prognostic statistics. CONCLUSIONS Results contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care. PRACTICE IMPLICATIONS Although research in clinical settings is needed to bolster results, findings suggest that when providers use positive framing to reduce distress about prognosis, they should also consider ways to overcome potential reductions in recall accuracy, such as repeating statistical information or supplementing with written information.
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Affiliation(s)
- Emily K Porensky
- Department of Psychology, Washington University in St. Louis, St. Louis, USA.
| | - Brian D Carpenter
- Department of Psychology, Washington University in St. Louis, St. Louis, USA
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Imanipour M, Karim Z, Bahrani N. Role, perspective and knowledge of Iranian critical care nurses about breaking bad news. Aust Crit Care 2016; 29:77-82. [PMID: 26256781 DOI: 10.1016/j.aucc.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 05/24/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the issue of caring critically ill patients, nurses are involved in the process of breaking bad news in critical care units, while little research has been conducted on this challenging issue. OBJECTIVES The purpose of this study was to determine the role, perspective and knowledge of Iranian critical care nurses regarding breaking bad news. METHODS This descriptive study was conducted on a sample of 160 nurses working in critical care units of hospitals affiliated to Tehran University of Medical Sciences. Stratified and quota sampling methods were used. The data collection tool was a four-part questionnaire with validity and reliability confirmed via content validity and test-retest, respectively. RESULTS The study showed that most critical care nurses were involved in breaking bad news, with different roles. The majority of participants (91.2%) had a positive attitude towards involvement of nurses in breaking bad news. In this study, 78.8% of nurses had moderate knowledge about how to break bad news, and only a few had good level of knowledge (16.2%). CONCLUSION According to the findings, while critical care nurses took different roles in the process of breaking bad news and they had positive attitude towards participation in this process, yet their knowledge about this process was inadequate. Thus, designing educational programmes to enhance critical care nurses' knowledge and skills in this area seems necessary.
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Abstract
We reflect on the impact of bad news on both clinician and patient in the setting of cancer treatment failure. We review the classic six-step SPIKES (setting, perception, invitation for information, knowledge, empathy, summarize and strategize) protocol for giving bad news that has been widely adopted since it was first published in this journal in 2005. The goal of such a conversation guide is to describe both the process and the tasks that constitute vital steps for clinicians and to comment on the emotional impact of the conversation on the clinician. Confronting therapeutic failure is the hardest task for oncologists. We offer practical tips derived from a thorough review of the evidence and our clinical experience.
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Affiliation(s)
- Alicia K Morgans
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lidia Schapira
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
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Naimer SA, Prero M. Delivering bad news: an approach according to jewish scriptures. Rambam Maimonides Med J 2014; 5:e0020. [PMID: 25120920 PMCID: PMC4128591 DOI: 10.5041/rmmj.10154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite a preoccupation in the medical literature with developing an effective approach for breaking bad news, the sources are based on personal opinion alone and only in some instances on qualitative research. Recognizing the gravity of this topic coupled with respect for the wisdom of the written and oral Jewish scriptures, this work is an attempt to delve into the diverse ancient writings to draw conclusions regarding a recommended methodology to guide and inform this task. It is interesting to learn that most elements related to this topic have previously been raised in various forms in the scriptures. The issues range from where, when, and how the bearer of bad news should undertake this duty, to details such as the environment, the format, the speed, and depth of the details to be disclosed. The essence of this paper is to enrich the reader using both positive and negative examples found in the Jewish heritage. Adopting these principles will hopefully provide an effective method for performing this unpleasant obligation, with the goal of limiting harmful consequences as much as possible.
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Affiliation(s)
- Sody A. Naimer
- Eilon Moreh Family Health Center, Shomron, Israel
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- To whom correspondence should be addressed. E-mail:
| | - Moshe Prero
- Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
In recent years, medical guidelines for communicating bad news to patients have been published. Training for this task was included in the curricula of undergraduate medical courses, specialization, and continuing medical education. The objective of this review is to evaluate the existing evidence in the literature on the effectiveness of such training. Only seven controlled trials were found, four of which were randomized, and these four indicate an improvement in the trainees. These findings suggest that training undergraduate and postgraduate doctors in skills for communicating bad news may be beneficial but there are important limitations to reach a definitive conclusion. These limitations are discussed in this article.
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Affiliation(s)
- Somia M. Alelwani
- Department of Pediatrics Hematology/Oncology, Department of Training and Medical Education, Comprehensive Cancer Center, King Fahad Medical City, Saudi Arabia
| | - Yasar A. Ahmed
- Adult Medical Oncology, King Abdulaziz Medical City, National Guard Health Affair, Saudi Arabia
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28
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Arbabi M, Rozdar A, Taher M, Shirzad M, Arjmand M, Ansari S, Mohammadi MR. Patients' preference to hear cancer diagnosis. Iran J Psychiatry 2014; 9:8-13. [PMID: 25561942 PMCID: PMC4277609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Bad news disclosure is one of the complex communication tasks of the physicians. Bad news is defined as:" any news that adversely and seriously affects an individual's view of his or her future". Recent studies indicate that the patients' and physicians' attitudes toward disclosure of bad news have been changed since few years ago. The evidence of breaking bad news is also different across different cultures. In the present study, we aimed to evaluate the patients' prospect about breaking bad news and to provide a clinical guidance for Iranian patients and those patients in countries with a similar cultural background. METHODS A cross sectional descriptive study was conducted on a sample of 200 cancer patients at a cancer institute in Tehran. The patients' demographic characteristics and their attitudes toward the manner of disclosing the diagnosis were registered in a research based questionnaire. RESULTS In this study, 165 patients (82.5%) claimed to be aware of the diagnosis; however, only 121 patients (73%) were aware of the actual diagnosis of their disease. Most patients tended to know the diagnosis (n = 186, 93%) and accepted patient as the first person to be informed (n = 151, 75.5%) by their physician (n = 174, 87%). The preference of being alone or with a family member when exposed to bad news was almost the same. Most patients (n = 169, 84.5%) believed that physicians should consult the patients to make treatment decisions. Treatment options (n = 140, 70%) and life expectancy (n = 121, 60.5%) were the most desirable topics to be discussed. Most patients (n = 144, 72%) agreed upon allowing them to express their emotional feelings. CONCLUSION According to the patients' preferences about being fully informed about the diagnosis, it is suggested that the disclosure of cancer diagnosis be done by a physician and in the presence of a family member. It is also recommended that physicians consult the patients about treatment options.
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Affiliation(s)
- Mohammad Arbabi
- Psychiatry and Psychology research center, Department of psychiatry,Tehran University of Medical sciences. Tehran, Iran
| | - Ava Rozdar
- Psychiatry and psychology research center, Teheran. Iran
| | - Mohammad Taher
- Psychiatry and psychology research center, Teheran. Iran
| | - Maryam Shirzad
- Psychiatry and psychology research center, Teheran. Iran
| | | | - Sahar Ansari
- Psychiatry and psychology research center, Teheran. Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology research center, Department of psychiatry,Tehran University of Medical sciences. Tehran, Iran
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Lee HR, Yi SY. Delivering bad news to a patient: a survey of residents and fellows on attitude and awareness. Korean J Med Educ 2013; 25:317-25. [PMID: 25804966 PMCID: PMC8813403 DOI: 10.3946/kjme.2013.25.4.317] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/10/2013] [Indexed: 05/16/2023]
Abstract
PURPOSE Delivering bad news (DBN) to a patient or patient's family is one of the most difficult tasks for physicians. As a complicated task, DBN requires better than average communication skills. This study investigated trainee's attitude and awareness of DBN based on a self-assessment of their experiences and performance in practice. Survey subjects were also asked to assess their perception and the need for education in conducting DBN. METHODS A survey was carried out on their experiences with DBN, how they currently deal such situations, how they perceive such situations and the need for education and training programs. A SPIKES protocol was used to assess how they currently deal with DBN. RESULTS One hundred one residents and fellows being trained in a teaching hospital participated in the survey. Around 30% had bad experiences due to improperly delivered bad news to a patient. In terms of self-assessment of how to do DBN, over 80% of trainees assessed that they were doing DBN properly to patients, using a SPIKE protocol. As for how they perceived DBN, 90% of trainees felt more than the average level of stress when they do DBN. About 80% of trainees believed that education and training is much needed during their residency program for adequate skill development regarding DBN. CONCLUSION We suggest that education and training on DBN may be needed for trainees during the residency program, so that they could avoid unnecessary conflict with patients and reduce stress from DBN.
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Affiliation(s)
- Hye Ran Lee
- Division of Hematology/ Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Seong Yoon Yi
- Division of Hematology/ Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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Kondo K, Fujimori M, Shirai Y, Yamada Y, Ogawa A, Hizawa N, Uchitomi Y. Characteristics associated with empathic behavior in Japanese oncologists. Patient Educ Couns 2013; 93:350-353. [PMID: 23896125 DOI: 10.1016/j.pec.2013.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 06/22/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Oncologists must have empathy when breaking bad news to patients who have incurable advanced cancer, and the level of empathy often depends on various individual characteristics. This study aimed to clarify the relationship between these characteristics and empathic behavior in Japanese oncologists. METHODS We videotaped consultations in which oncologists conveyed news of incurable advanced cancer to simulated patients. Oncologists' empathetic behaviors were coded, and regression analysis was performed to determine the existence of any relationships with factors such as age, sex, and specialism. RESULTS Sixty oncologists participated. In a multivariate model, only age was related to the empathy score (r=0.406, p=0.033); younger oncologists scored higher than did older oncologists. CONCLUSIONS We found that empathic behaviors were more frequent in younger oncologists. PRACTICE IMPLICATIONS This information could be useful in determining the best approach for implementing future empathy and communication training programs for experienced oncologists in Japanese medical institutions.
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Affiliation(s)
- Kyoko Kondo
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of Pulmonary Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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Kumar M, Goyal S, Singh K, Pandit S, Sharma D, Verma AK, Rath G, Bhatnagar S. Breaking bad news issues: a survey among radiation oncologists. Indian J Palliat Care 2011; 15:61-6. [PMID: 20606858 PMCID: PMC2886220 DOI: 10.4103/0973-1075.53533] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice. Materials and Methods: We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients. Results: Most responders had an oncology experience of three to seven years (20/35). Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer. Conclusion: Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.
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Affiliation(s)
- Milind Kumar
- Department of Radiotherapy, Dr. BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110 029, India
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