Communication Of Bad News Research Articles

“There won‘t’ be anything else…it's over”: Perceptions of women referred to palliative care only

BackgroundIt is not well-known how women with advanced breast and gynecological cancers cope with the transition to palliative care (PC) only, but we anticipate that this is a challenging situation for them. ObjectiveTo investigate women's understanding on the reasons of anticancer treatment withdrawal, their ideas about PC, and also perceptions of the communication of bad news. MethodTwenty women were interviewed by a single researcher after being informed that their antineoplastic treatment would be discontinued and they would be exclusively monitored by PC staff. The interviews were audiotaped, transcribed verbatim, and analyzed according to content analysis. ResultsThree categories were identified in the participants' narratives: (1) an understanding of the meaning of PC; (2) a lack of understanding of the shift in treatment and follow-up; (3) differing perspectives about hope. The PC Unit was stigmatized as a place to die, resulting in a “place to die” subcategory. The narratives of the participants who previously had experienced PC converged on a subcategory that reveals better recognition of the importance of the PC Unit as “a place that enhances the quality of life”. ConclusionThe participants manifested little knowledge about PC and the forthcoming strategies for their clinical follow-up. In addition, the PC Unit was patently stigmatized as a place to die. Early referral to PC seems to be associated with a less painful therapeutic transition, based on more accurate knowledge of the importance of PC.

The Role of Multidisciplinary Teams: A Focus on Communicating Bad News

Communication is one of the key processes of being human, furthermore, being a good communicator can help with building good quality relationships between people. Communication may be used to construct a mental image of individuals. The paper focuses on the research and results of a study concerned with the quality of communication between parents and doctors. From the findings of the study, quality communication can be used in the rapeutic intervention and practice, when bad news has to be conveyed by medical practitioners to clients and/or patients. The target group for the research was parents of children with hearing impairment. The authors present results pointing to a possible remedy of the issue of communicating bad news.

Medical training for communication of bad news: A literature review.

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.

Preparing Prelicensure and Graduate Nursing Students to Systematically Communicate Bad News to Patients and Families

Communicating bad news, otherwise known as difficult conversations, is a complex communication skill that requires didactic learning and practical application. Students learn that what may be interpreted as bad news is determined by the recipient and not by the person who is delivering the news. Learning a systematic approach, such as the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) mnemonic, prepares prelicensure and graduate nursing students for difficult conversations with patients and families in the clinical setting. Role-playing commonly includes clinical scenarios, and using video recording and playback of the encounters in such scenarios is one method of learning the systematic approach to communicating bad news. Follow-up practice after application in the clinical setting and feedback from faculty and mentors are essential for nursing students to achieve competence in this complex set of communication skills.

Ethical issues in the geriatric patient with advanced cancer ‘living to the end’

Cancer incidence will increase as the population ages; there will be a 50% increase in new cancer cases over the next 20 years, and the biggest rates of increase will occur in the developing world. Owing to technical advances in the care of critical illness, as it is the case in elderly people with advanced cancer, physicians, patients and families are often confronted with ambiguous circumstances in which medical advances may inadvertently prolong suffering and the dying process rather than bring healing and recovery. In this review of the ethical issues confronting physicians who care for patients with advanced life-limiting illnesses like cancer, a philosophical debate continues in the medical community regarding the rightness or wrongness of certain actions (e.g. physician-assisted death, euthanasia), while at the same time there is a strong desire to find a common ground for moral discourse that could guide medical decision-making in this difficult period in the lives of our patients. We will discuss how a good palliative care can be an alternative to these ethical dilemmas. Although some issues (e.g. the role of physician-assisted death in addressing suffering) remain very controversial, there is much common ground based on the application of the four major principles of medical ethics, no malfeasance, beneficence, autonomy and justice. Thus, the physician's primary commitment must always be the patient's welfare and best interests, whether the physician is treating illness or helping patients to cope with illness, disability and death. A key skill here is the communication of bad news and to negotiate a treatment plan that is acceptable to the patient, the family and the healthcare team. Attention to psychosocial issues demands involvement of the patients and their families as partners. Physicians should be sensitive to the range of psychosocial distress and social disruption common to dying patients and their families. Spiritual issues often come to the fore. An interdisciplinary healthcare team can help in these areas. The goals of this review are to raise the awareness of doctors, nurses and other members of the healthcare team to the important ethical issues that must be addressed in providing medical care to elderly patients with advanced cancer; and also to encourage members of the healthcare team to take the ethical issues seriously so that we can improve the circumstances of a vulnerable group of patients-the elderly patients with cancer.

“To Be a Phenomenal Doctor You Have To Be the Whole Package”: Physicians' Interpersonal Behaviors during Difficult Conversations in Pediatrics

Delivery of bad news is a challenging task for physicians and other health care professionals. Several studies have assessed parental perceptions of the delivery of bad news, but none have focused on the role of physicians' interpersonal behaviors in the communication process. The study's objective was to assess parental perceptions of physicians' interpersonal behaviors and their role in communication of bad news. The design was a cross-sectional qualitative interview study of 13 parents of patients hospitalized or previously hospitalized in the pediatric intensive care unit or oncology/bone marrow transplant unit at an academic children's hospital. Eleven interpersonal behaviors were identified as important by parents. The majority of parents identified empathy in physicians as critical. Availability, treating the child as an individual, and respecting the parent's knowledge of the child were mentioned by almost half of parents. Themes also considered important but by a smaller number of parents were allowing room for hope, the importance of body language, thoroughness, going beyond the call of duty, accountability, willingness to accept being questioned, and attention to the suffering of the child. To increase parental satisfaction and enhance the parent-physician therapeutic partnership, we recommend that physicians consider attending to the 11 interpersonal behaviors described in this manuscript, and that educational programs pay particular attention to these behaviors when training health care providers in the communication of bad news.

Breaking bad news: Comparison of perspectives of Middle Eastern cancer patients and their relatives.

9568 Background: It is believed in some Middle Eastern (ME) cultures that disclosure of bad news to cancer patients may cause loss of hope. On many occasions the relatives’ and patients’ wishes are opposed regarding this matter. This study investigates cancer patients’ and their relatives’ perspectives regarding communication of cancer-related bad news in a ME population. Methods: Nine close-ended questions were designed in a questionnaire format to obtain cancer patients’ (cohort I) and their relatives’ (cohort II) perspectives regarding communication of cancer related bad news from diagnosis to end-of-life. The questionnaire was answered by patients and relatives during out-patient visits. Chi-square test was used to test differences in responses between the two cohorts. Results: 203 participants (100 patients and 103 relatives) completed the questionnaire. In cohorts I and II, 28% and 58% of participants were males respectively (p<0.001). In contrast to relatives’ views, majority of patients preferred to be informed of diagnosis and possible adverse outcome of their illness, as detailed in the Table. Conclusions: Our study indicates that there is significant discordance between the preferences of ME cancer patients and their relatives regarding disclosure of cancer related bad news to the patient. As opposed to relatives’ beliefs, most patients would prefer to know bad news throughout the course of their illness. Unless a patient indicates otherwise, physicians should strive to keep cancer patients informed of their health related events. [Table: see text]

Problemas éticos relatados por internos com ênfase na saúde da criança

OBJETIVO: Conhecer problemas éticos vivenciados por internos de Medicina, principalmente durante a atenção à saúde da criança, sentimentos suscitados e sugestões dos estudantes para promover habilidades para lidar com problemas éticos. MÉTODO: Estudo transversal, descritivo e qualitativo exploratório com 40 de 104 internos (38,5%) do 11º semestre do curso de Medicina da Universidade Federal de Santa Catarina. DADOS: Coletados por questionário que solicita relato de até três situações vivenciadas pelo estudante como um dilema ético, preferencialmente na atenção à saúde da criança; descrição sobre sentimento nestas situações; e sugestões para promover habilidades para lidar com problemas éticos. ANÁLISE: De conteúdo categorial e descritiva. RESULTADOS: Foram relatados 84 problemas considerados éticos relativos a atitudes profissionais inadequadas; autonomia; sigilo e confidencialidade; violência; situações de limite de vida; comunicação de más notícias; processo ensino-aprendizagem; fragilidade da rede de suporte à atenção à saúde; e situações específicas. Os sentimentos mais referidos foram impotência e revolta/indignação. As sugestões mais fornecidas para promoção de habilidades para lidar com problemas éticos foram a discussão de casos e o prolongamento da disciplina de ética. CONCLUSÕES: Ao longo da formação acadêmica, os estudantes se deparam com uma diversidade de situações que consideram problemas éticos. Utilizar estas situações em discussões e em uma reflexão sobre ética no cotidiano poderia ser uma das estratégias para desenvolver habilidades para lidar com estes problemas na prática médica.

A Live Patient Simulation Model for Neurology Residents and Fellows to Effectively Communicate Bad News (P02.001)

A Live Patient Simulation Model for Neurology Residents and Fellows to Effectively Communicate Bad News (P02.001)

Communicating Bad News During an Office Visit

Communicating Bad News During an Office Visit

A Simulation-Based Curriculum To Address Relational Crises in Medicine

Preparing health care professionals for challenging communication tasks such as delivering bad news to patients and families is an area where a need for improved teaching has been identified. We developed a simulation-based curriculum to enhance the skills of health care professionals, with an emphasis on the communication of difficult or bad news, which we termed relational crises. Our approach was based on a review of existing simulation-based curricula, with the addition of unique features, including a learner-focused needs assessment to shape curriculum development, use of 360-degree evaluations, and provision of written feedback. Development and implementation of our curriculum occurred in 3 phases. Phase I involved a multidisciplinary needs assessment, creation of a clinical scenario based on needs assessment results, and training of standardized patients. In Phase II we implemented the curriculum with 36 pediatric and internal medicine-pediatrics residents, 20 nurses, and 1 chaplain. Phase III consisted of the provision of written feedback for learners, created from the 360-degree evaluations compiled from participants, observers, faculty, and standardized patients. Participants felt the scenarios were realistic (average rating of 4.7 on a 5-point Likert scale) and improved their practice and preparedness for these situations (average rating, 4.75/5 and 4.18/5, respectively). Our curriculum produced a statistically significant change in participants' pre- and postcurriculum self-reported perceptions of skill (2.42/5 vs. 3.23/5, respectively, P < .001) and level of preparedness (2.91/5 vs. 3.72/5, respectively, P < .001). A simulation-based curriculum using standardized patients, learner-identified needs, 360-degree evaluations, and written feedback demonstrated a statistically significant change in participants' self-perceived skills and preparedness for communicating difficult news in pediatrics.

Preferences of Malaysian Cancer Patients in Communication of Bad News

Breaking bad news to cancer patients is a delicate and challenging task for most doctors. Better understanding of patients' preferences in breaking bad news can guide doctors in performing this task. This study aimed to describe the preferences of Malaysian cancer patients regarding the communication of bad news. This was a cross-sectional study conducted in the Oncology clinic of a tertiary teaching hospital. Two hundred adult cancer patients were recruited via purposive quota sampling. They were required to complete the Malay language version of the Measure of Patients' Preferences (MPP-BM) with minimal researcher assistance. Their responses were analysed using descriptive statistics. Association between demographic characteristics and domain scores were tested using non-parametric statistical tests. Nine items were rated by the patients as essential: "Doctor is honest about the severity of my condition", "Doctor describing my treatment options in detail", "Doctor telling me best treatment options", Doctor letting me know all of the different treatment options", "Doctor being up to date on research on my type of cancer", "Doctor telling me news directly", "Being given detailed info about results of medical tests", "Being told in person", and "Having doctor offer hope about my condition". All these items had median scores of 5/5 (IQR:4-5). The median scores for the three domains were: "Content and Facilitation" 74/85, "Emotional Support" 23/30 and "Structural and Informational Support" 31/40. Ethnicity was found to be significantly associated with scores for "Content and Facilitation" and "Emotional Support". Educational status was significantly associated with scores for "Structural and Informational Support". Malaysian cancer patients appreciate the ability of the doctor to provide adequate information using good communication skills during the process of breaking bad news. Provision of emotional support, structural support and informational support were also highly appreciated.

Patient and carer reports of care in metastatic presentation of cancer of unknown primary origin

BackgroundPatient and caregiver experiences of cancer of unknown primary (CUP) have been under-researched. Common challenges include diagnostic uncertainty, poor prognosis and difficulty in identifying this population.Aims and methodsAs part of...

Delivering Bad News: Improving Communication Skills Training of Medical Students and Residents Through the Use of Second Life Technology (755)

1.Assessing methods to improve student and resident communication skills with a head-to-head comparison of Second Life technology to more traditional methods.2.Evaluate the effect of training method choice on how residents and students perceive the learning experience.3.Evaluate the validity of using Second Life technology as a teaching tool. One of the most challenging and stressful tasks that clinicians must perform regularly is the communication of bad news with distressed patients. In spite of the importance of this clinical skill, very few doctors receive formal training in this area. Physicians and residents generally report both a lack of confidence and feelings of incompetence when asked to self-assess their communication skills. Research has shown that effective communication is a skill that can be learned. Recently, there have been studies done to explore various methods of communication skills training for adult-learners in medical school and residency programs. Second Life technology is a virtual computer world that has shown promise for providing a positive training experience by allowing trainees to act out a bad news communication experience through the use of “avatars” which are on-line graphical self-representations. 1) Evaluate the effect of various training methods, including the use of Second Life technology, on objective measurements of communication skills 2) Determine how receptive medical trainees are to Second Life technology as a teaching method 3) Examine the validity of using Second Life technology as a teaching tool 4) demonstrate that Second Life technology can improve students' self-assessments of their communication skills. Participating medical students and medical residents were first observed acting as the physician in a clinical scenario during which he/she communicated bad news to a simulated patient. This even was followed by one of 3 pathways to which each was randomized: 1) no additional training, 2) participation in a Second Life scenario using avatars, 3) attending a didactic session. All participants ended the study by participating in an observed scenario similar to the first. Communication skills improved with use of avatars. Second Life is a useful teaching tool.

NICU Bereavement Breast Milk Donation (756)

Background. One of the most challenging and stressful tasks that clinicians must perform regularly is the communication of bad news with distressed patients. In spite of the importance of this clinical skill, very few doctors receive formal training in this area. Physicians and residents generally report both a lack of confidence and feelings of incompetence when asked to self-assess their communication skills. Research has shown that effective communication is a skill that can be learned. Recently, there have been studies done to explore various methods of communication skills training for adult-learners in medical school and residency programs. Second Life technology is a virtual computer world that has shown promise for providing a positive training experience by allowing trainees to act out a bad news communication experience through the use of ‘‘avatars’’ which are on-line graphical self-representations.

The Congruence of Patient Communication Preferences and Physician Communication Behavior in Cardiac Patients

The purpose of this study was to examine the communication preferences of patients with chronic ischemic heart disease (CIHD) and matching between the preferences and physician communication behavior. Prior to this, psychometric testing was performed on a questionnaire on the perceived communication behavior of the physician (KOVA Questionnaire). Patients with CIHD undergoing rehabilitation (N = 342) in Germany were questioned. At the beginning of rehabilitation, patients answered questions about their communication preferences (KOPRA Questionnaire), and at the end of rehabilitation, they answered questions regarding the perceived communication behavior of the physician. Preference-matching values were determined by combining the KOPRA and KOVA items. The KOVA Questionnaire psychometric properties proved to be good. Patients with CIHD indicated clear and open communication and patient participation were especially important. This was followed by emotionally supportive communication and, finally, communication about personal things. Overall, the behavior of physicians corresponded quite closely with the patients' communication preferences. However, preference matching was low (the physicians demonstrated too little of the desired behavior) regarding the open communication of bad news and explanation of treatments. There was relatively high fulfillment of expectations on the part of patients in terms of seeking information from the physician, the physician's explanation of the diagnosis, and regarding aspects of shared decision making. We observed no gender differences, but did identify age-group differences. The instruments developed (KOPRA and KOVA questionnaires) can be used for communication studies of patients with chronic conditions. However, some patient communication needs seem to require greater consideration from physicians.

Informing Parents About the Actual or Impending Death of Their Infant in a Newborn Intensive Care Unit

Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being.

Breaking Bad News: The Patient's Viewpoint

The objective of this study was to ascertain how patients judge the acceptability of physicians' communication of bad news. Two hundred forty-five adults, who had in the past received bad medical news, indicated the acceptability of physicians' conduct in 48 vignettes of giving bad news to patients. Vignettes were all combinations of five factors: level of bad news (infection with hepatitis C, cirrhosis of the liver, or liver cancer); request or not to the patient to come with spouse or partner; attempt or not by the physician to find out the patient's expectations about the test results; presence or absence of emotional supportiveness; and provision or not of complete and understandable information. In addition, nine physicians rated the same vignettes. Quality of information and emotional supportiveness explained more than 95% of the variance in patients' acceptability judgments, while the degree of badness of the news had no impact. In addition, for patients, low emotional supportiveness could not be fully compensated by high quality of information, nor the inverse. Physicians, in contrast, responded as if such compensations were possible. Physicians must appreciate that patients expect high levels of both empathy and information quality, no matter how bad the news.

The Role of Self-Reflection in Palliative Care Education: A Pilot Study of Students Attitudes and Perspectives on End-of-Life Care (740)

1.Discuss the need to assess students’ experiences and attitudes when incorporating a new palliative medicine curriculum into medical schools.2.Recognize the role of self-reflection as a key component to evaluating students’ competency in end-of-life care. Background. An innovative, longitudinal educational program in end-of-life (EOL) care is being integrated across all four years of medical school at University of Chicago (UC). Self-reflection is one modality of evaluation proposed in the literature to assess students’ comfort in dealing with death and dying. The validity and utility of this method of evaluation is being explored at UC. Research objectives. (1) Assess medical students’ experiences and attitudes towards EOL care utilizing a death attitudes survey and narrative exercises. (2) Perform a qualitative analysis of narratives to assess their utility as an evaluation method. Methods. First-year medical students enrolled in a 4-week elective comprised of didactic and experiential training. Data includes pre/post course (N = 11) attitudes surveys (2008 and 2009) utilizing an adapted version of Bugen's Coping with Death Scale and self-reflection exercises (five per student, N = 4, 20 essays total, 2009) detailing (1) personally experienced loss; (2) attitudes/expectations of one's own death; (3) experience with communication of bad news; (4) meaning of suffering; and (5) EOL decision making and surrogacy. Results. Analysis of attitudes surveys using a paired samples test showed a significant increase in mean scores from 109 to 146 (p < 0.001, SD = 24). Themes emerging from the qualitative narrative analysis included students’ attitudes towards (1) different coping methods for personal loss; (2) preferences for place of death; (3) perceived need for communication training; (4) heterogeneous interpretation of suffering; and (5) early advance care planning. Implications for research, policy, or practice. Future research will explore the longitudinal use of narrative exercises as an evaluation tool during implementation of the new EOL curriculum at UC.

How to communicate bad news to caregivers of patients with amyotrophic lateral sclerosis: a human challenge

In patients with amyotrophic lateral sclerosis families require assistance especially when bad news needs to be faced. We developed a binary items talk protocol on various aspects of the disease at its late stages to be submitted to caregivers: it was also aimed at identifying the personality of the caregiver. The report was prepared as a 6-question score (0→10). Thirty-three subjects were identified. The caregivers’ ability to help the patient, the satisfaction after talk and level of comprehension were: 7.6, 7 and 6.4, respectively. The mean level of calm and confusion was 6 and 4.7, respectively. The average number of meetings was 2.33±1.1; 22% of caregivers needed only 1 meeting, 39% two and 39% >2. The average total time for the meetings was 54±26 min. A simple bad news communication protocol dedicated to caregivers of patients with amyotrophic lateral sclerosis may be used on a routine basis.