Communication Of Bad News Research Articles

Comunicación de malas noticias en el ámbito sanitario en tiempos de COVID-19. La comunicación telefónica.

Este artículo ha examinado la comunicación telefónica de malas noticias en el ámbito sanitario durante la emergencia de salud pública de importancia internacional decretada por la OMS el 11 de marzo de 2020. Comunicar malas noticias no es una tarea fácil ni grata, especialmente cuando se trata de un fallecimiento. Sus efectos, tanto para el emisor como para el receptor, dependerán del modo en que esta se realice. En relación al receptor, una adecuada comunicación puede facilitar el proceso de aceptación y adaptación a la nueva realidad, aquella en la que su ser querido ya no está. Por lo que respecta al emisor, una correcta transmisión de la información puede suponer una disminución de los niveles de estrés aumentando la eficacia de la comunicación, presente y futura, así como reduciendo la probabilidad de aparición de problemáticas como el burnout. Una buena notificación de noticias desfavorables precisa de habilidades de comunicación y del manejo de pautas técnicas básicas de actuación, para lo cual es preciso formación. La situación de pandemia ocasionada por el virus SARS-CoV-2 ha convertido la comunicación de malas noticias, hasta ahora considerada una competencia menor, en un elemento central del proceso asistencial. Las circunstancias excepcionales de esta emergencia sanitaria han supuesto además, tener que realizar en muchas ocasiones las comunicaciones a través del teléfono, acción no recomendada en situaciones normales por los inconvenientes asociados y que ha supuesto un auténtico reto para los profesionales. La escasez de material específico sobre comunicación remota en situaciones excepcionales como la actual, hace necesario estudios e investigaciones que profundicen sobre el área. El presente artículo, ha tratado de abordar estas cuestiones.

Breaking bad news: what parents would like you to know

ObjectiveBreaking bad news about life-threatening and possibly terminal conditions is a crucial part of paediatric care for children in this situation. Little is known about how the parents of children...

Approach to the hidden curriculum through narrative medicine in the training of medical students

Hidden curricula are those contents learned that do not belong to the formal curriculum. Narrative medicine allows knowledge of health professionals' experiences. Approaching to the hidden curriculum can allow modifying or reinforcing instances of the nonformal learning. Analyze narrative medical students' productions to identify hidden curriculum contents. A cross-sectional study was conducted with Pediatric students during 2017. All the students of the course (14) participated and performed 50 narrative productions: 53 % corresponded to the hospitalization context, 17 % to ambulatory care, 17 % to the emergency center and 13 % to neonatology. The main topics described were doctor-patient communication, importance of family inclusion in the pediatric consultation, empathy, impact of chronic disease in children and communication of bad news. Narrative productions allowed an approximation to the hidden curriculum through reflections on professional actions.

Oncologists' Experience of Delivering Bad News in Korea.

This study explored oncologists' experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists' perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient-physician relationships in communication of bad news.

Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting.

Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task.Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center.Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017.Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol.Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for “knowledge” (p < 0.001), “emotions,” (p = 0.004) and “strategy and summary” (p = 0.002).Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

Assessing patients´ preferences for breaking Bad News according to the SPIKES-Protocol: the MABBAN scale

ObjectiveQuality of breaking bad news can seriously affect the course of disease. A frequently applied guideline is the SPIKES-Protocol that have been designed from the physician’s perspective. Little is known about patients’ preferences in breaking bad news. Our aim was to develop a questionnaire based on the SPIKES-protocol to detect patients´ preferences for breaking bad news communication. MethodsTheMarburg Breaking Bad News Scale (MABBAN) was developed and administered to 336 cancer patients. We used exploratory factor analysis. To examine potential relationships according to demographic and medical variables, regression analyses were conducted. ResultsThe novel questionnaire supported the six SPIKES-components of breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy. Perception and Invitation clustered together to one subscale. Depending on clinical and demographic variables different components were rated as important. ConclusionCommunication preferences in breaking bad news can be assessed using a SPIKES-based questionnaire. Physicians should improve the setting, share knowledge in all clarity, involve the patients in further planning, and consider demographical variables. Practice implicationsUsing SPIKES as a framework can optimize breaking bad news conversations but it seems important to emphasize the individual preferences beyond the six steps and tailor the communication process to the individual.

Recommendations for communicating bad news by phone during the SARS-CoV-2 pandemicRecomendações para a comunicação de más notícias por telefone durante a pandemia do SARS-CoV-2

RESUMENLa pandemia actual por SARS-CoV-2 presenta desafíos específicos para los profesionales de salud en el campo de la atención sanitaria. En este contexto de emergencia, la comunicación de malas noticias toma especial relevancia por el modo particular en que debe llevarse a cabo: la necesidad de mantener distanciamiento sanitario y las restricciones de movilidad impuestas a la población general hacen que esta tarea deba ser realizada, muchas veces, de manera remota, en su mayoría mediante llamados telefónicos. Esto enfrenta a los profesionales a una serie de obstáculos particulares: a) la mayoría de ellos poseen escasa o nula formación sobre esta clase de habilidades comunicativas, b) la comunicación efectiva de malas noticias depende, en gran parte, del lenguaje corporal utilizado, ausente en este tipo de intercambios, y c) dado que este tipo de diálogo remoto no es recomendable -con excepción de circunstancias particulares como la actual- existe escasa literatura disponible para guiar a quienes deben cumplir esta tarea. Este manuscrito ofrece recomendaciones sobre pautas básicas para la comunicación remota de malas noticias por teléfono, en situaciones en las cuales no se pueda llevar a cabo esta tarea de forma presencial. Se presenta una propuesta estructurada en torno de cuatro “momentos” para orientar la transmisión de malas noticias a distancia, con el fin de mejorar los cuidados a pacientes, familiares y cuidadores durante este intercambio y también reducir el impacto negativo que este intercambio tiene sobre los profesionales de la salud.

Design and Validation of a Questionnaire on Communicating Bad News in Nursing: A Pilot Study.

Communicating bad news (CBN) is a fundamental skill in nursing; nevertheless, few instruments exist for its evaluation. This study presents a questionnaire designed to measure nurses’ knowledge and ability of CBN, as well as the analysis of its psychometric properties. Based on a literature search, the initial dimensions of CBN were identified to construct the questionnaires’ items, which were evaluated by experts for the validity of the items’ contents. Construct validity and reliability of the resulting questionnaire was carried out in a sample of 71 nurses of an Andalusian university hospital. A questionnaire with 25 items was constructed with a high internal consistency (Cronbach’s alpha 0.816). The content validity was evaluated via a literature review and additionally by the assessment of seven experts. The Kaiser-Meyer-Olkin test (KMO) obtained a score of 0.683, and the Bartlett test of sphericity a value of p < 0.001. The principal component analysis supported a construct of four dimensions. This questionnaire was found to be a valid and reliable instrument with a high internal consistency for the evaluation of CBN knowledge and skills of nursing professionals.

Communication of bad news in pediatrics: integrative review.

to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics. integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included. the evidence from the 40 studies were organized according to the elements of communication: sender (family and/or professional), receiver (family and/or child), message (bad or difficult news about diagnosis/prognosis; empathetically, honestly, objective, hopeful and available), channel (materials, quality, quantity and pace), context and effects (social and emotional changes), noise (feelings and language) and failures (silencing and misleading information). there is a need to prepare the institution and team, as well as the family and the child, in order to promote co-responsibility in this process, to minimize suffering and communication noise and to avoid failures, recognizing the child's right to know their condition.

BREAKING BAD NEWS IN A NEONATAL INTENSIVE CARE: THE PARENT'S EVALUATION.

ABSTRACTObjective: To describe the reports of parents of newborns (NB) with congenital malformations hospitalized in a Neonatal Intensive Care Unit (NICU) who received bad news, in order to identify the issues related to the perception of bad news given adequately or inadequately.Methods: A cross-sectional study was conducted from January to October 2018, in which parents of newborns with congenital malformations hospitalized in NICUs were interviewed at visiting hours, according to inclusion criteria. The questionnaire had semi-structured questions related to reception of bad news. Analysis of the data was descriptive.Results: 28 mothers and two fathers were interviewed and 16 (53.3%) reported having had at least one bad news in the NICU. Of those, 10 (62.5%) considered appropriate the way in which the news was given. The justifications were: sincerity of the professional, delicacy to give the news, giving hope to the family, use of appropriate words and demonstration of caring about the newborn. Six participants (37.5%) considered inadequate the way of breaking bad news. The reasons were: unpreparedness and lack of knowledge about the child’s case, use of difficult language, haste or anxiety and discouragement of family hope. Most of the news was given by a professional alone, often by a medical resident.Conclusions: The communication of bad news was considered adequate by the parents, although this perception was not unanimous. This study, therefore, indicates that it is necessary to improve the communication of bad news in this NICU. Training professionals can assist in this process.

The Difficulties Doctors Have in Communicating Bad News Regarding Cancer and Its Treatment and What Doctors Seek from Nurses

The Difficulties Doctors Have in Communicating Bad News Regarding Cancer and Its Treatment and What Doctors Seek from Nurses

The Dying Process across Human Life Cycle: Ethical Considerations on Terminal Care

Dying is an event that affects human development throughout the life cycle—impacting individuals, communities, and society. Providing terminal care may mitigate the suffering of patients and families. Notwithstanding, it poses challenges concerning patients’ decision-making and autonomy, in regard to communicating bad news, resuscitation orders, and voluntary termination of life. This study seeks to discuss ethical issues underlying terminal care, showing how the problem of patients’ decision-making and autonomy can be addressed at the end of life. It distinguishes the notion of worthy death, which could ground ethical decisions for health attention across different developmental stages.

Unfavorable Medical Diagnosis – Oncological Patients’ Experiences and Preferences

ABSTRACT The study aims at analyzing the experiences of Polish patients who received an unfavorable medical diagnosis. In order to reach a random group of patients with an unfavorable diagnosis, we started cooperating with 19 independent patient organizations and associations. A nationwide study, based on a self-constructed e-survey questionnaire, was carried out with the use of the CAWI method. Three hundred and fourteen patients in total participated in the study, all of whom had received an unfavorable diagnosis, including 119 oncological patients and 195 suffering from other chronic diseases. This paper focuses on the analysis of the opinions expressed by oncological patients. It also highlights the differences in oncological and non-oncological patients’ reactions to an unfavorable diagnosis. Caution and tactfulness displayed by a physician while conveying an unfavorable diagnosis were assessed negatively by 36% of the respondents, 8 in 10 oncological patients claim that Polish doctors are insufficiently prepared to communicate bad news. As far as the model of the physician–patient relationship is concerned, over half of the surveyed (59%) prefers partnership, 18% opts for an informative model, 16% chooses a model based on dialogue and empathy and 7% is in favor of a paternalistic model. We have demonstrated that the very location where diagnosis is conveyed affects the quality of medical communication: patients visiting a private doctor’s office have a better chance to express their doubts than the ones treated at a hospital or a public outpatient clinic. The majority of oncological patients, especially individuals under the age of 40, prefer shared decision-making.

Cultural Differences in Perceived Appropriateness of Breaking Bad News to Patients: A Direct Comparison of Togo and France

We examined cross-cultural differences in people’s positions regarding the appropriateness of breaking of bad news to elderly patients. A total of 450 Togolese and French people who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the appropriateness of physicians’ conduct in each case. The vignettes comprised five pieces of information: (a) the severity of the disease, (b) the patient’s wishes, (c) the level of social support during hospitalization, (d) the patient’s psychological robustness, and (e) the physician’s decision about communicating bad news. Through cluster analysis, six qualitatively different positions were found: (a) Always Tell the Truth to Patients, (b) Tell the Truth to Patients or their Relatives, (c) Depends on Patients’ Wishes, (d) Tell the Truth to the Relatives, (e) Don’t Tell the Truth to Patients, and (f) Undetermined. The French participants reported a stronger tendency to endorse the view that physicians should always tell the truth directly to the patient than the Togolese participants. In contrast, there was a stronger tendency among the Togolese participants to endorse the view that physicians should inform the patient’s family first than among the French. These findings highlight the importance for physicians, at the time of delivering bad news, of considering patients’ cultural values and of tailoring their disclosure approaches to match the diversity of patients’ personal preferences.

Challenges in delivering bad news in a multi-ethnic intensive care unit: An ethnographic study

ObjectiveDuring critical care, physicians are frequently confronted with bad-news communication because of patients’ frail conditions. Delivering bad news is not easy, certainly not when patients from ethnic minority groups are involved. In this study we investigate the delivery of bad news in a multi-ethnic critical care context. MethodsEthnographic fieldwork in one intensive care unit of a multi-ethnic urban hospital in Belgium. Data were collected through negotiated interactive observation, in-depth interviews and from reading patients’ medical records. Data were thematically analysed. ResultsBad-news communication was primarily dominated by physicians. Patients’ and relatives’ input and other professionals’ involvement in the communication was limited. Staff encountered ethno-cultural related difficulties, firstly, in choosing suitable conversation partner(s); secondly, in choosing the place of conversations and thirdly, in the information exchange. Staff usually tried to address these problems themselves on the spot in a quick, pragmatic way. Sometimes their approaches seemed to be more emotion-driven than well thought-out. ConclusionDelivering bad news in a multi-ethnic intensive care unit has a number of specific difficulties. These can have negative consequences for parties involved. Practice implicationsThe challenges of an adequate delivery of bad news need a team-approach and a well thought-out protocol.

Teaching how to deliver bad news: a systematic review

Abstract “Bad news”, defined as information with huge emotional valence and potential to change personal perspectives, is, by definition, a challenge for physicians. However, the subject is not always taught in medical schools. This systematic literature review compiles all articles regarding communication of bad news after researching in databases for “medical school” and “bad news” in English, Portuguese and Spanish. The criterion was to include articles that elucidated about teaching techniques. From all 313 papers, we included 27 and classified their strategies. Most results showed that mixed strategies are more common and that, in general, the subject is well-received and appreciated by students, who reported an improvement in communicative capability after the training. We conclude that all techniques are valid and medical schools should focus on integrating this training in their regular curriculum.

Communicating Bad News: Insights for the Design of Consumer Health Technologies.

BackgroundAs people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news.ObjectiveThe aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health.MethodsOn the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design.ResultsWe describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek.ConclusionsThe results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next.

How to say bad news without compromising the patient's humanity

Communicating bad news is still a communication challenge in the field of care and, despite the there being methodologies that allow us to humanize information that has a great impact on people's lives, it is usually neither taught nor used in daily life, thus bringing about emotional outcomes, that can be, at times, more serious than the disease itself. The art of communication is a component of medical praxis, so training in the early years of medicine on methodologies related to the communication of bad news incorporating cultural diversity, beliefs, and customs will develop skills for the benefit of the patient. Although at times it is better not to use verbal language, it is important to remember that nonverbal communication can also convey the respect that every human being requires before the arrival of bad news.

The communication of bad news in health: approximations with the person-centered approach

espanolLa forma de comunicar malas noticias impacta directamente en la adhesion al tratamiento por parte del paciente. Frente a las dificultades en comunicar malas noticias, se elaboraron protocolos que auxiliar a los profesionales de salud en esos momentos de mayor vulnerabilidad. Este estudio teorico tuvo por objetivo aproximar las actitudes / condiciones facilitadoras descritas originalmente por Carl Rogers en el contexto psicoterapico con tres protocolos de comunicacion de malas noticias a menudo relatados en la literatura del area: SPIKES, CLASS y P-A-C-I-E-N-T-E. Diversas etapas de esos protocolos emergen como acciones que se aproximan a la congruencia / autenticidad, ya la consideracion positiva incondicional o de la empatia, haciendo licito afirmar que la comunicacion de malas noticias tambien posibilita el establecimiento de una relacion de ayuda. Se concluye que esta asociacion entre los protocolos y las tres actitudes elaboradas por Rogers puede contribuir a la formacion academica de los profesionales de la salud y tambien en el establecimiento de un mejor vinculo entre medico, paciente y familiares. portuguesA forma de comunicar mas noticias impacta diretamente na adesao ao tratamento por parte do paciente. Frente as dificuldades em comunicar mas noticias, foram elaborados protocolos que auxiliassem os profissionais de saude nesses momentos de maior vulnerabilidade. Este estudo teorico teve por objetivo aproximar as atitudes/condicoes facilitadoras descritas originalmente por Carl Rogers no contexto psicoterapico a tres protocolos de comunicacao de mas noticias frequentemente relatados na literatura da area: SPIKES, CLASS e P-A-CI-E-N-T-E. Diversas etapas desses protocolos emergem como acoes que se aproximam ora da congruencia/autenticidade, ora da consideracao positiva incondicional ou da empatia, tornando licito afirmar que a comunicacao de mas noticias tambem possibilita o estabelecimento de uma relacao de ajuda. Conclui-se que esta associacao entre os protocolos e as tres atitudes elaboradas por Rogers pode contribuir para a formacao academica dos profissionais de saude e tambem no estabelecimento de um melhor vinculo entre medico, paciente e familiares. EnglishThe way of communicating bad news directly impacts in the treatment adherence of the patient. In light of the difficulties of communicating bad news, protocols were developed to assist the health care professionals in these moments of major vulnerability. This theoretical study aimed to approach the core conditions/attitudes described originally by Carl Rogers in the psychotherapic context to three bad news communication protocols reported from the field specific literature: SPIKES, CLASS and P-A-C-I-E-N-T-E. Diverse steps of these protocols emerge as actions that approximate one moment to congruency/authenticity and another moment to unconditional positive consideration or empathy. It makes licit to affirm that the communication of bad news also approaches to the establishment of a help relation. It can be concluded that this approach between the protocols and the three attitudes developed by Rogers can contribute to the academic training of the health care professionals and also to the better connection between doctor, patient and family.

Breaking Barriers to Effective Communication of Bad News - Obstetric Outlook

Breaking Barriers to Effective Communication of Bad News - Obstetric Outlook