Receive Bad News Research Articles

Intervention for Standardized Patients' Anxiety After “Receiving Bad News” Scenarios

BackgroundThis study aimed to determine the anxiety levels of standardized/simulated patients (SPs) who received bad news and to explore the effects of relaxation exercises during the de-roling/debriefing phase on the anxiety levels of the SPs. MethodA pretest/post-test pattern was used for 19 SPs who participated in the study. ResultsThe SPs were mildly anxious (mean State-Trait Anxiety Inventory [STAI] score, 38.16 ± 8.69) before delivery of the bad news. After delivery of the bad news, the SPs showed moderate anxiety levels (mean STAI score, 47.89 ± 8.95). The relaxation exercises showed a statistically significant decrease in the anxiety levels, and the SPs (p < .001) showed mild anxiety levels (STAI mean score, 25.63 ± 5.43). ConclusionRelaxation exercises during de-roling/debriefing showed promising effects to provide a psychologically safe working environment for SPs, especially after portraying difficult scenarios.

Receiving Bad News: A Thematic Analysis of Stroke Survivor Experiences.

Background:Breaking bad news to patients may be required in service provision to stroke survivors. While challenging, it may be critical to the retention of optimism and participation in rehabilitation.Objectives:To explore the experience of stroke survivors when receiving bad news (RBN) from medical practitioners.Methods:Data were obtained via 1:1 interviews conducted at stroke support groups with survivors at least 12 months into recovery and subsequently transcribed for thematic analysis and coded using NVivo.Results:Eight of 10 participants experienced RBN, and 2 participants did not. The themes of being “lucky to be alive” and waiting for “delayed information” were expressed by all participants early in the interviews. Three sub-themes emerged and were labelled alliance, dissent, and dissatisfaction, each with a further 3 contextual themes. The perception of RBN was marked amongst the dissent and dissatisfaction groups, with the latter reporting negative implications for their rehabilitation as well as negative emotions, such as anger and anxiety. The perception of a poor-quality relationship with medical practitioners was said to impede rehabilitation and recovery processes. The dissent group was characterized by initial disbelief after RBN and consequently poorer long-term outcomes, whilst the Alliance group experienced very good quality of care due to existing personal knowledge and therefore did not perceive RBN during their early medical meetings.Conclusions:In the period soon after their stroke, survivors required their medical practitioners to not only communicate knowledge and information, but also needed validation of their hopes and fears for the future from an empathically attuned clinician.

Perspetivas das Pessoas que Recebem Más Notícias em Contexto Hospital: Revisão Integrativa

Enquadramento: a transmissão de más notícias é uma realidade incontornável na prática de enfermagem. O estabelecimento de um processo de comunicação eficaz implica disponibilidade, capacidade de escuta e de compreensão. Objetivo: conhecer as perspetivas das pessoas que recebem más notícias e compreender o impacte que estas notícias representam na vida das mesmas. Metodologia: revisão integrativa da literatura nas bases de dados Academic Search Complete, Medline with full text e CINAHL Plus with full text, selecionando um total de sete estudos publicados entre 2011 e 2016. Resultados: aquando o momento de transmissão de notícias desfavoráveis os profissionais de saúde devem considerar o contexto familiar e social do doente. A informação a ser partilhada, o momento e a responsabilidade da partilha, os métodos utilizados na comunicação e a reação dos doentes ao que lhes é comunicado deverão também constituir foco da sua atenção. Conclusão: é transversal a importância que a comunicação clara e eficaz tem na transmissão de más notícias para os doentes e suas famílias e o impacto que pode ter no decurso da doença.

The Testing of Belief-Adjustment Model and Framing Effect on Non-Professional Investor’s Investment Decision-Making

This study aims to find out the effect of belief-adjustment model and framing effect on non-professional investor’s investment decision making. The designs of experiment used in this study are the presentation pattern of 2x2x2, disclosure pattern (step-by-step and end-of-sequence), disclosure evidence of information order (good news followed by bad news and bad news followed by good news), and framing effect (framing condition according to the information and framing condition with the reversed information). The research hypotheses in this study are tested using parametric test. The dependent variable used in this study is investment decision making, while, the independent variables used in this study are belief-adjustment model and framing effect. The number of participants involved in this study is 80 undergraduate students of STIE Perbanas Surabaya majoring in Accounting or Management. The results indicate that there are significant differences in decision making and recency effect occurs between the investors who receive good news followed by bad news and the investors who receive bad news followed by good news in the step-by-step disclosure pattern with framing condition according to the information. The results of this study also show that primacy effect occurs between the investors who receive good news followed by bad news and the investors who receive bad news followed by good news in the step-by-step disclosure pattern with framing condition in reversed information.

Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey

Prior abstract publication: 2nd Medical Rehabilitation Congress; Nov 4–7, 2010; Ankara, Turkey Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors. Design: A cross sectional, qualitative study. Setting: Community. Participants: Fourteen spinal cord injury survivors. Interventions: Subjects participated in a semi-structured interview about ‘when’, ‘where’ ‘by whom’ and ‘how’ they received and ‘would’ prefer to receive bad news. Outcome measures: Answers to ‘how’ questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary). Results: Eight participants (57%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them. Conclusion: Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation.

Children with cancer share their views: tell the truth but leave room for hope.

One in five children diagnosed with cancer will die from the disease. The aim of the study was to explore how children with cancer want to receive bad news about their disease, such as when no more treatment options are available. We conducted individual interviews with ten children with cancer, aged seven to 17 years, at a single paediatric oncology unit in central Sweden. Interviews were audio-taped and analysed with systematic text condensation. Bad news was defined as information about a potentially fatal outcome, such as a disease relapse, or information that the treatment administered was no longer working and that there was no more treatment possible. All children expressed that they wanted truthful information and they did not want to be excluded from bad news regarding their illness. They wanted to be informed as positively as possible, allowing them to maintain hope, and in words that they could understand. They also wanted to receive any bad news at the same time as their parents. Children with cancer want to be fully informed about their disease, but they also wanted it to be relayed as positively as possible so that they could stay hopeful.

Is Waiting the Hardest Part? Comparing the Emotional Experiences of Awaiting and Receiving Bad News.

Awaiting uncertain news is stressful, but is it more stressful than receiving bad news? We compared these emotional experiences in two studies. Participants in Study 1 reflected on a personal experience awaiting news that ultimately turned out badly, and participants in Study 2 were law graduates awaiting their results on the bar exam who ultimately failed the exam. In Study 1, participants were ambivalent as to whether awaiting or receiving bad news was more difficult, and emotion ratings in both studies confirmed this ambivalence. Anxiety was higher in anticipation of bad news (at least at the moment of truth) than in the face of it, whereas other negative emotions were more intense following the news than during the waiting period. Thus, whether waiting is "the hardest part" depends on whether one prefers to be racked with anxiety or afflicted with other negative emotions such as anger, disappointment, depression, and regret.

Breaking bad news: Effects of forecasting diagnosis and framing prognosis

ObjectiveResearch 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. MethodsIn 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. ResultsWarning 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. ConclusionsResults contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care. Practice ImplicationsAlthough 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.

A Mapping of People’s Positions Regarding the Breaking of Bad News to Patients

The objective of this study was to map people’s positions regarding the breaking of bad news to patients. One hundred forty adults who had in the past received bad medical news or whose elderly relatives had in the past received bad news, 25 nurses, and 28 nurse’s aides indicated the acceptability of physicians’ conduct in 72 vignettes of giving bad news to elderly patients. Vignettes were all combinations of five factors: (a) the severity of the disease (severe but not lethal, extremely severe and possibly lethal, or incurable), (b) the patient’s wishes (insists on knowing the full truth vs. does not insist), (c) the level of social support during hospitalization, (d) the patient’s psychological robustness, and (e) the physician’s decision about communicating bad news (tell the patient that the illness is not severe and minimize the severity of the illness when talking to the patient’s relatives, tell the full truth to her relatives, or tell the full truth to both the elderly patient and her relatives). Four qualitatively different positions were found. Twenty-eight percent of participants preferred the full truth to be told; 36% preferred the truth to be told but understood that the physician would inform the family first; 13% did not think that telling the full truth is best for patients; and 23% understood that the full truth would be told in some cases and not in others, depending on the physician’s perception of the situation. The present mapping could be used to detect the position held by each patient and act accordingly. This would be made easier if breaking bad news was conceived as a communication process involving a range of health care professionals, rather than as a single occurrence in time.

Breaking bad news: issues relating to nursing practice.

The breaking of bad news was traditionally regarded to be the time when a doctor and nurse sat down with a patient and family members to provide information about, for example, a life-limiting diagnosis or a poor prognosis. However, breaking bad news is now generally accepted as a process, not a one-off event, and is considered to refer to any bad, sad or difficult information that alters patients' perceptions of their present and future. Nurses have an important role in the process of providing information and helping patients prepare for, receive, understand and cope with the bad news they have been given. This article aims to help nurses understand the process of breaking bad news and discuss the challenges and difficulties that nurses can face when they are involved with patients who have been given bad news. It also provides guidance with regard to preparing for breaking bad news, giving difficult information, responding to possible reactions, and supporting patients and their relatives after they have received bad news.

Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial.

The aim of this study was to identify the effects of a communication skills training (CST) program for oncologists, developed based on patient preferences regarding oncologists' communication. Thirty oncologists were randomly assigned to either an intervention group (IG; 2-day CST workshop) or control group (CG). Participants were assessed on their communication performance during simulated consultation and their confidence in communicating with patients at baseline and follow-up. A total of 1,192 patients (response rate, 84.6%) who had consultations with the participating oncologists at baseline and/or follow-up were assessed regarding their distress using the Hospital Anxiety and Depression Scale, satisfaction with the consultation, and trust in their oncologist after the consultation. At the follow-up survey, the performance scores of the IG had improved significantly, in terms of their emotional support (P = .011), setting up a supportive environment (P = .002), and ability to deliver information (P = .001), compared with those of the CG. Oncologists in the IG were rated higher at follow-up than those in the CG in terms of their confidence in themselves (P = .001). Patients who met with oncologists after they had undergone the CST were significantly less depressed than those who met with oncologists in the CG (P = .027). However, the CST program did not affect patient satisfaction with oncologists' style of communication. A CST program based on patient preferences is effective for both oncologists and patients with cancer. Oncologists should consider CST as an approach to enhancing their communication skills.

Giving bad news: a qualitative research exploration.

Background:The manner in which healthcare professionals deliver bad news affects the way it is received, interpreted, understood, and dealt with. Despite the fact that clinicians are responsible for breaking bad news, it has been shown that they lack skills necessary to perform this task.Objectives:The purpose of this study was to explore Iranian mothers’ experiences to receive bad news about their children cancer and to summarize suggestions for improving delivering bad news by healthcare providers.Materials and Methods:A qualitative approach using content analysis was adopted. Semi-structured interviews were conducted with 14 mothers from two pediatric hospitals in Iran.Results:Five major categories emerged from the data analysis, including dumping information, shock and upset, emotional work, burden of delivering bad news to the family members, and a room for multidisciplinary approach.Conclusions:Effective communication of healthcare team with mothers is required during breaking bad news. Using multidisciplinary approaches to prevent harmful reactions and providing appropriate support are recommended.

Improving consultations in oncology: the development of a novel consultation aid

Background:The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered.Methods:We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid.Results:A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid.Conclusions:Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations.

Personal fear of death affects the proper process of breaking bad news

IntroductionBreaking bad news may be affected not only by insufficient knowledge of a physician, but also by his attitude, religious beliefs, fears, lack of experience, etc. This survey was aimed to test the relation between physicians’ fear of own death and philosophy of life and their inclination to break bad news.Material and methodsOne hundred seventy students of the last year of medical faculty filled in a 4-item questionnaire created by the authors. The participants were asked on their opinion on whether to inform patients on upcoming death, as well as fear of their own death and willingness to receive bad news. The last question was aimed to distinguish the respondents based on their determination in philosophy of life.ResultsNinety-three percent of respondents think that patients should be informed about unfavorable prognosis but only 86% would like to be informed about their own upcoming death. There is a negative correlation between determination of philosophy of life and fear of own death (p = 0.024), but no correlation between fear of own death and the degree of religiousness (Fisher’s accurate p = 0.18). Persons determined to receive information on their own upcoming death are more prone to inform patients about their upcoming death (ρ = 0.31; p < 0.0001).ConclusionsPersonal fear of own death and low level of determination of philosophy of life may restrain medical professionals from breaking bad news to patients. Not only knowledge of the principles, but also personal attitude should be addressed in the curriculum of physician-patient communication education.

Breaking Bad News

The focus of this article is on the meanings attributed by nurses who worked with patients receiving a cancer diagnosis within acute care settings in Ireland. The aim of this article was to explore the nurses' perceptions of caring for patients who receive bad news in the form of a cancer diagnosis while in an acute care setting. The article focuses on the perceptions of 20 nurses who formed the nurse participant group in a larger phenomenological study exploring giving and receiving a cancer diagnosis. Data were collected using unstructured in-depth interviews. Analysis was conducted using Koch's analytical framework. The nurses' narratives provided 2 emerging themes entitled, "connectedness: journeying as professional within the everyday world" and "connectedness: exclusion of professional within the everyday world." This article focuses on the first emerging theme and highlights the experiences of nurses as they reflect on their interactions with their patients before, during, and after the giving of a cancer diagnosis. This study highlights the importance of professional companionship. It provides insights into the nurse-patient challenges as a result of lack of information. Lack of information and involvement affects the nurse's ability to be authentically present for the recipient and results in a fracture to the nurse-patient relationship. Understanding the experiences of nurses from acute care settings where the cancer diagnosis is often given will inform and enable the nurse working in oncology settings to engage patients in a more meaningful and focused way.

Incentives to Innovate and the Decision to Go Public or Private

We model the impact of public and private ownership structures on firms' incentives to invest in innovative projects. We show that it is optimal to go public when exploiting existing ideas and optimal to go private when exploring new ideas. This result derives from the fact that private firms are less transparent to outside investors than are public firms. In private firms, insiders can time the market by choosing an early exit strategy if they receive bad news. This option makes insiders more tolerant of failures and thus more inclined to invest in innovative projects. In contrast, the prices of publicly traded securities react quickly to good news, providing insiders with incentives to choose conventional projects and cash in early.

An interview with Angela Nieto

Angela Nieto is Full Professor at the Instituto de Neurociencias (CSIC-UMH) in Alicante, Spain, and Head of the institute's Developmental Neurobiology Unit. She is also the current president of the Spanish Society for Developmental Biology (Sociedad Española de Biología del Desarollo, SEBD). We interviewed her to talk about the plans of the SEBD for the coming years.

Expanding Communication Skills and Empowering Practitioners With the Comfort Framework (P5)

1.Discuss key literature, current nursing communication curriculum, and data summarizing nurses' communication needs.2.Describe the COMFORT initiative and detail the seven principles of the basic communication model.3.Describe narrative nursing (C-communication) and team communication (T-team), and practice these skills using role play and interactive exercises. Communication is essential to improve patient care, safety, and satisfaction and to increase healthcare team cohesion and effectiveness. It is also the foundation of quality palliative care. However, few nurses receive formal communication skills training. There is evidence that nurses lack competence and confidence to navigate difficult conversations that arise during patient/family interactions, such as decision-making, psychosocial or spiritual distress, and interdisciplinary communication. This competency gap leads to feelings of moral distress and the risk of emotional burnout and reduced staff retention. Nurses acknowledge the need for skills training in the following communication situations: (a) talking with patients after they have received bad news; (b) broaching palliative care issues with physicians; and (c) exploring patients’ psychosocial and spiritual concerns. During this preconference session, participants will have the opportunity to identify personal communication barriers, learn effective strategies for communication, and practice new communication skills and how to teach them to others. This offering represents a unique collaboration between communication theorists focused on palliative nursing and expert palliative nurses who serve as faculty. The skills training is derived from the COMFORT Initiative, a holistic, narrative communication framework developed specifically for palliative care nurses. Nurses have unique relationships with patients that result in less hierarchical interactions. They are also trained to view the patient and family holistically and to listen to their stories. COMFORT is based on evidence about key communication tasks and barriers, and offers solutions and exercises to build competence during difficult communication. The COMFORT components are: C-communication, O-orientation and opportunity, M-mindful presence, F-family, O-openness, R-radically adaptive messages, and T-team. Content is based on an upcoming text on palliative nursing communication written by Drs. Ferrell, Wittenberg-Lyles, and Goldsmith from the preconference faculty.

The Views Of Cancer Patients On Receiving Bad News

AIM: This study was performed in a descriptive matter to determine the views of inpatients at an oncology state hospital on receiving bad news. METHOD: The study sample consisted of 237 inpatients (155 females, 82 males) at an oncology state hospital between October and November 2008 who were determined using the random sampling method and accepted participating in the study. The data collection tool used was a survey form that consisted of 24 questions related to the sociodemographic features and views on receiving bad news. RESULTS: The mean age of the study subjects was 53.1±13.9 (min.=18, max.=83). The patients were undergoing the treatment process in 84% and the diagnostic process in 16%. The bad news had been given by the physician in 87.8% and while in the physician\'s room in 74.8%. The patients had been told while receiving the bad news that \'there is a mass/problem/lesion/tumor and you will undergo surgery\' in 47.7% while 24.9% had been told that they had cancer directly. The patients stated that they froze, fainted, were shocked, felt their life was shattered and experienced emotions such as sadness, fear, hopelessness, sorrow, disappointment, desperation, etc. at a rate of 93.7%. We found that 58.2% of the patients had not been given an opportunity to express their emotions when they received the bad news, 67.4% preferred to have a relative with them at the time, 40.9% felt that the bad news should be given in a special environment, 30% wanted the bad news to be given as soon as the diagnosis was known while 36.7% preferred being told everything about the disease when receiving the bad news CONCLUSION: Taking into account the information content, family participation, and the individual preferences of the patients regarding time and place when giving bad news and encouraging them to ask questions and express themselves may make it easier for the patients to cope with bad news.

Delivering and Receiving Bad News: What School Psychologists Need to Know

Delivering bad news to students, teachers, and parents is not an uncommon occurrence for school psychologists. Skillfully communicating bad news requires sensitivity, thoughtful wording, and an awareness of the potential effect on the recipients. Despite the importance of this skill, school psychology has devoted little attention to what is currently known about delivering bad news. This article synthesizes the literature on presenting and receiving bad news, devoting special attention to how information can be used by school psychologists in their day-to-day practices. Primarily drawn from medicine, the scholarship is instructive as a guide to the many dimensions of bad news delivery including what needs to be considered beforehand, how to communicate, cultural factors to consider, and conveying hope.