Sharing Bad News Research Articles

What is bad news in fertility care? A qualitative analysis of staff and patients' accounts of bad and challenging news in fertility care.

What do fertility staff and patients think is bad news in fertility care? Staff and patients agree bad news is any news that makes patients less likely to achieve parenthood spontaneously or access and do successful treatment, but their appraisals of how bad the news is are differently influenced by specific news features and the context of its delivery. Bad news is common in fertility care, but staff feel unprepared to share it and four in 10 patients react to it with unanticipated emotional or physical reactions. Research has paid much attention to how bad news should be shared, but considerably less to what news is perceived as bad, despite the fact this may dictate elements of its delivery. Two cross-sectional, online, mixed-method surveys (active 7 January-16 July 2022) were distributed to fertility staff and patients across the UK and Europe. Staff inclusion criteria were being a healthcare professional working in fertility care and having experience of sharing bad news at least once a month. Patients' inclusion criteria were being adults and having had a conversation in which staff shared or explained bad news concerning their fertility care within the last 2 months. Surveys were created in English using Qualtrics, reviewed by patients and healthcare professionals, and distributed via social media, Prolific, fertility organizations, and scientific societies. Patients were asked, regarding the last time bad news were shared with them, 'What was the bad news?' and 'What other news would you consider bad news in fertility care?'. Staff were asked to 'List the three most challenging topics of bad news you share with your patients'. Staff and patient data were separately thematically analysed to produce basic codes, organized into sub-themes and themes. Themes emerging from patients' and staff data were compared and synthesized into meta themes. Three hundred thirty-four staff accessed the survey, 286 consented, and 217 completed (65% completion rate). Three hundred forty-four patients accessed the survey, 304 consented, and 222 completed (64% completion rate). Eighty-five percent of participants were women, 62% resided in Europe, and 59% were in private care. Average staff age was 45.2 (SD = 12.0), 44% were embryologists or lab technicians, 40% were clinicians (doctors, consultants, or physicians), and 8% nurses or midwifes. Average patient age was 32.2 (SD = 6.4) and 54% had children. Staff answers originated 100 codes, 19 sub-themes and six themes. Patients' answers produced 196 codes, 34 sub-themes, and 7 themes. Staff and patient themes were integrated into three meta-themes reflecting main topics of bad news. These were Diagnosis and negative treatment events and outcomes, Inability to do (more) treatment, and Care and patient factors disrupting communication. Staff and patients agreed that some news features (uncertain, disruptive, definitive) made news more challenging but disagreed in relation to other features (e.g. unexpected/expected). Patient factors made bad news more challenging to staff (e.g. difficult emotions) and care factors made bad news more challenging to patients (e.g. disorganized care). Participants were self-selected, and most were women from private European clinics. Questions differed for staff and patients, focused on subjective perceptions of news, and did not measure news impact. The badness of fertility news is not only a product of the extent to which the news compromises parenthood goals but also of its features (timing, nature, number) and the context in which the news is delivered. Guidance on sharing bad news in fertility care needs to go beyond easing the process for patients to also consider staff experiences. Guidance may need to be tailored to news features and context. Cardiff University funded the research. S.G., J.B., O'.H., and A.D. report funding from the Higher Education Funding Council for Wales and the European Society for Human Reproduction and Embryology (ESHRE) to develop fertiShare: a sharing bad news eLearning course for fertility care. fertiShare will be distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). No other conflicts are reported in relation to this work. N/A.

O-034 Staff and patient evaluation of fertility staff performance during sharing bad news conversations.

Abstract Study question What are fertility staff and patients’ evaluation of staff performance during sharing bad news (SBN) conversations? Summary answer In positive SBN conversations, staff and patient ratings of staff performance are similarly good, but in negative SBN conversations patients’ ratings are lower than staff’s. What is known already Bad news, defined as news that negatively alters patients’ view of their future, happens at all stages of fertility care. Fertility staff perceive SBN among the biggest challenges of their job. 47% of patients express staff could improve bad news delivery. SPIKES is an evidence-based protocol that has shown promise in guiding SBN in fertility care via breaking the task in six steps: Setting the scene, evaluating patients’ Perception, getting patients Invitation, sharing Knowledge, addressing Emotions, and Summarizing and planning future care. Knowledge about how staff perform during SBN conversations and which factors are associated with performance is lacking. Study design, size, duration Two cross-sectional mixed-methods online surveys were distributed to staff (via ESHRE) and patients (via charities, social media). Inclusion criteria for staff were working at a fertility clinic and SBN at least once a month and for patients being 18 years of age and having had a SBN conversation with staff in past two months. 334 staff and 345 patients clicked survey links, of which 217 staff and 222 patients completed it (65% and 64% completion). Participants/materials, setting, methods Dependent variable was staff SBN performance across SPIKES steps, measured with CARE (empathy) and the Breaking Bad News Assessment Schedule (other steps). Independent variables were actor (staff, patient) and overall evaluation of the SBN conversation (positive, negative). Factors assessed related to staff and patients’ background (e.g., gender, age), fertility care context (e.g., patients: parental status, treatment stage, staff: role, burnout, time pressure, SBN training), and SBN conversation (e.g., patients: person vs remotely, alone vs accompanied). Main results and the role of chance Crosstabs of actor and evaluation showed a higher proportion of staff (85%) than patients (67%) evaluated the SBN conversation as positive (Χ2(1) = 38.863,P<.001). MANOVA investigating differences in staff’s SBN performance according to actor and overall evaluation revealed significant effects of actor (Hotelling’s Trace T = .236,F(388,6) = 15.279,p<.001,η2p = .191), overall evaluation (T = .344,F(388,6) = 22.233,p<.001,η2p = .256), and their interaction (T = .127,F(388,6) = 8.243,p<.001,η2p = .113). Follow-up ANOVAs showed the same pattern for all SPIKES steps: in positive SBN staff and patient ratings of staff performance were similar (∼4 from 1 = poor/not at all to 5 = excellent/completely), but in negative SBN patients’ ratings were lower than staff’s (∼2.5 vs 4, η2p ranged .160[Setting] to .289[Perception]). Among staff, physicians and nurses tended to rate their SBN performance better than embryologists across all SPIKES steps except Knowledge and Emotions (β ranged .166[Invitation] to .312[Perception]). Reporting ≥1 burnout symptom was associated with worse performance in Emotions (β = -.168,P = .049), time pressure was associated with worse performance in Perception (β = -.185,P = .019), and having attended SBN training with better performance in Setting (β = .295,P<.001). Patients who were alone during the SBN conversation rated staff SBN performance worse than patients who were accompanied in all SPIKES steps (β from -.154[Summary] to -.403[Setting]). Patients with children rated staff performance in Setting (β = .156,P = .015), Emotions (β = .158,p = .031), and Summary (β = .142,p = .048) better than childless patients. Limitations, reasons for caution Online data collection attracted mostly UK patients while staff were from all over the world. SBN performance was reported and not based on behavioral observation, though based on sound questionnaires that evaluate different aspects of performance. Wider implications of the findings Staff and patients agree about what good SBN conversations are, but patients are more critical of bad SBN conversations. Staff SBN performance seems more a function of the context in which news are shared than of actors’ background. SBN training can support staff recognizing bad SBN conversations and improving performance. Trial registration number not applicable

Sharing Bad News: Communication Between Patients and Their Loved Ones in a Palliative Care Context.

Background: Although communication is strongly emphasized in palliative care, not much research has focused on communication between patients and their loved ones. The purpose was to increase understanding of communication around severe illness between patients with a life-threatening disease, receiving palliative care, and their loved ones. Secondary intention was to identify strategies making easier for patients to talk about their condition with loved ones. The article is based on in-depth interviews with 15 patients and 8 loved ones. Interviews were analysed using qualitative content analysis. Communication about patient's illness was often described as balancing between wanting to inform or know and wanting to protect. Both patients and loved ones deliberately talk in a way that reflects their relationship. They act, negotiate and communicate aiming at not wanting to create situations that are perceived as uncomfortable, either for themselves or for others. Patients also take everyday practicalities into account. In these interactions, some people become the patients' inner circle - people with whom information is shared and co-owned. Other people find themselves outside the circle and patients may use them as test-subjects - speaking to them about things they might not dare reveal to their inner circle. These considerations are reflected in the themes: What is communicated, How communication is performed, and When it takes place. Our findings show that acting on the ideals of an "open and honest" form of communication is not always to be recommended. Professionals must instead strive to understand and respect the intentions of those involved.

Communicating bad news to patients and families in African oncology settings.

To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings. A cross-sectional study of cancer care providers in African oncology settings (N=125) was conducted. Factor analysis was used to assess cross-cultural adaptation and uptake of an evidence-based protocol for disclosing bad news to patients with cancer and of providers' perceived barriers to disclosing bad news to patients with cancer. Analysis of Various (ANOVA) was used to assess strength of association with each dimension of these two measurement models by various categorical variables. Providers from Nigeria, Kenya, Ghana, and Rwanda represented 85% of survey respondents. Two independent, psychometrically reliable, multi-dimensional measurement models were derived to assess providers' personal communication practices and providers' perceived barriers to disclosing a cancer diagnosis. Forty percent (40%) of respondent nurses but only 20% of respondent physicians had had formal communications skills training. Approximately 20%-25% of respondent physicians and nurses reported having a consistent plan or strategy for communicating bad news to their cancer patients. Results show that effective communication about cancer diagnosis and prognosis requires an appreciation and clinical skill set that blends an understanding of cancer-related internalized stigmas harbored by patient and family, dilemmas posed by treatment affordability, and the need to navigate family wishes about cancer-related diagnoses in the context of African oncology settings. Findings underscore the need for culturally grounded communications research and program design.

Ease of Mind or Ties That Bind? Costs and Benefits of Disclosing Daily Hassles in Partnerships

People often tell others about recent daily hassles. Such social sharing of emotion is often assumed to support affect repair, but empirical evidence points to the contrary. We tested the notion that social sharing primarily serves relationship closeness, rather than immediate affect repair. Using dyadic experience sampling with N = 100 couples, we captured social sharing in everyday contexts and assessed socioemotional implications for speakers and listeners. Across M = 87 individual measurement occasions, both partners reported potential social-sharing episodes following daily hassles and rated their momentary negative affect and relationship closeness. Global evaluations of relationship closeness were assessed at baseline and 2.5 years later. Social sharing involved both affective benefits and costs, but it predicted momentary and long-term increases in partners’ relationship closeness. These results suggest that sharing bad news in relationships may not primarily serve immediate affect–repair functions. Rather, it may be a catalyst for creating and nourishing relationship closeness.

Digitised remote delivery of simulation in psychiatry during the pandemic and for the future

IntroductionSurrey and Borders NHS Foundation Trust’s AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient simulation system, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents.During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ’out-of-body’ perspective, immersed in a customdesigned interactive virtual environment. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. During the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.ObjectivesTo evaluate the feedback from Doctors in training taking part on the education sessions.MethodsWe collected qualitiative and quanttaive infromation from participants after the teaching session.ResultsWe received strongly positive reults in all parameters measured. the presenters will show a detailed breakdoen in the session.ConclusionsThe digitalised delivery of the virtual patient simulation, has been pivotal in limiting interruptions to communication skills training in mental health.DisclosureThe NHS trust has co produced the simulation platform with a private software firm Xenadu Virtual Environments

Digitalised remote-delivery of AVATr Simulation in Psychiatry: a unique success in COVID-19 pandemic

AimsSurrey and Borders NHS Foundation Trust's AVATr (Augmented Virtual-reality Avatar in Training) is a unique ground-breaking Virtual Patient Simulation System, which uses the Xenodu platform to train learners in essential clinical and complex communication skills. Over 30 patient scenarios have been developed after identifying learner-specific development needs, including exploration of overt psychosis, assessment of capacity, sharing bad news, and neglect in care home residents. Actors are filmed responding to several domains of clinical questions, further categorised into three narrative-modes of being ‘Engaged, Neutral or Disengaged’, to build a bank of scenarios. During the session, the trainee is projected on to a large screen, using a camera and video special effects, which results in a life-like interaction with the Virtual Patient. Trainees can view themselves interacting with the Virtual Patient in real-time, from a unique ‘out-of-body' perspective, immersed in a custom-designed interactive virtual environment. The simulation facilitator engages with the learner and determines the appropriate choices of responses for the Virtual Patient and if needed, can prompt with explorative cues to continue the narrative-linked conversation. AVATr model pioneered in United Kingdom the use of an innovative ‘self-observational approach’ in Psychiatry training. This is different to a first-person perspective used in virtual or augmented-reality systems in several clinical specialties. The use of Facilitated-Debrief and Peer-Debrief in sessions, render another layer to the simulation experience.MethodDuring the COVID-19 pandemic, we evolved the AVATr model to remote or hybrid sessions, where simulations were digitally enhanced, and have been run through Microsoft Teams. The simulation facilitator is connected to a multi-user video call, enabling the Virtual Patient to be projected as an attendee using Microsoft Teams.ResultThe hybrid model of AVATr has received tremendous feedback, as it now simulates video-consultations that a vast majority of Psychiatry trainees, especially community-based, undertake due to COVID-19 restrictions. The format of AVATr simulation sessions has remained unchanged, and the remote delivery has been particularly successful as it allows trainees to log in from different remote locations to come together for an interactive training session, without any physical restrictions.ConclusionSince 2015, our simulation platform has been utilised for Post-Graduate Medical Education, to enhance essential professional skills and stimulate professional growth. Currently the hybrid model of AVATr is being expanded to Nursing, Psychology and Allied Health Professional (AHP) clinical training streams, along with Undergraduate Medical Education, to address identified gaps in face-to-face training amidst COVID-19 pandemic.

<p>Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients: a qualitative study</p>

IntroductionAlthough guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, “recurrent/metastatic”) breast cancer, and determine how these beliefs are related to the process of treating patients.Materials and methodsSemi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process.ResultsThe process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a “belief that the patient is an entity who cannot accept death,” and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a “belief that the patient is an entity who can accept death.” From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient’s ability to have a good death, they proposed terminating treatment.ConclusionWe demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care.

Breaking Bad News: Finding Triumph in Tragedy

Breaking Bad News: Finding Triumph in Tragedy

Sharing Bad News: A Retrospective Analysis of First-Year Residents’ Performance in an Objective Structured Clinical Examination

Sharing Bad News: A Retrospective Analysis of First-Year Residents’ Performance in an Objective Structured Clinical Examination

Relationships between oncohematopediatrics, mothers and children in communicating bad news.

We present a study about the relations between pediatric oncological haematologists, mothers, and children in sharing bad news (BN) in a public hospital in Rio de Janeiro. The text emphasizes the intertwining of technique and emotions for the treatment of children with diagnoses in which the fatal outcome is always a probability. We used a qualitative approach, privileging participant observation and open interviews with oncologists (at this service all professionals were female) and mothers. We sought to understand the importance of communication which includes expressions and control of emotions; bioethical issues that require sensitivity, serenity, and truth about approaching the end of life; and how the professionals balance proximity to children and families and objectivity in their activity. The main results showed: intense exchanges on BN among professionals; relapse of children who were evolving positively as the most difficult news; constant update of BN facing terminally ill children; quality of communication influencing the treatment; professionals permanently balancing between closeness and distance from patients and evidence of the their irreplaceable role to secure the family and the child.

Breaking and Sharing Bad News in End of Life: The Religious and Culture Matters.

In the recent issue of the J Relig Health, Kassim and Alias well described the importance of ethics, religion, and law as guidance for medical decision making in the end-of-life decision-making-related issues in a narrative review. Also, the authors highlighted this subject based on various historical and religious prospective. Besides, they truly underlined the undeniable need of medical team’s extra attention to the heterogeneous combination of modern societies nowadays, containing different ethnicities, cultures, and religious in order to modify the sensitivity which resulted in trustworthy enhancement (Kassim and Alias 2016). One of the most challenging dilemmas facing health care team is how to tell newly diagnosed cancer patients about their disease and future prognosis. Besides, it is well known that culturaland religious-related issue is one of the important aspects in delivering such bad news. The issue of whether, how, and how much to tell these patients concerning their diagnosis is still a controversial matter, and it has been approached differently depending on various determinants including sociocultural factors. Previous investigations assessed the association between truth telling and culture. In most cases, patients’ families, in an effort to protect them from despair and feeling hopelessness, exclude the patient from the process of information exchange (Mystakidou et al. 2004). This kind of reaction is more common in Mediterranean and Middle East Asian societies which cultural factor is the crucial player in behaving with the cancer patients. They thought that by concealing bad news from the patient they favoring their patient by protecting him/her against further psychological disturbances that revealing the diagnosis can cause (Costantini et al. 2009). In this culture, the family plays a crucial role in disease management. In addition, family members want to know honest information about the patient’s status. The family may

Sharing bad news of a lung cancer diagnosis: understanding through communication privacy management theory.

The aim of this paper is to understand the process of information disclosure and privacy as patients share their news of lung cancer with significant others. Twenty patients with lung cancer and 17 family members/friends accompanying them at diagnosis-giving completed either individual or dyad semi-structured interviews. Initial thematic analysis, then Petronio's Communication Privacy Management theory was used to inform interpretation. Patients described a sense of ownership of the news of their cancer and sought control of how, when and with whom it was shared. Family members expressed a need to follow the patients' rules in sharing this news, which limited their own support systems. Patients and family members had to live within the relational communication boundaries in order to maintain their trusting relationship and avoid potential disruptions. Patients as individuals are strongly interlinked with significant others, which impacts on their experience of disclosing private information. This shapes their psychological processes and outcomes impacting on their illness experience. This should be considered when developing interventions to support patients with sharing bad news. Copyright © 2015 John Wiley & Sons, Ltd.

Sharing news of a lung cancer diagnosis with adult family members and friends: a qualitative study to inform a supportive intervention

ObjectiveExtensive research exists on breaking bad news by clinicians. This study examines perspectives of patients and those accompanying them at diagnosis-giving of subsequently sharing news of lung cancer with adult family/friends, and views of healthcare professionals, to inform development of a supportive intervention. MethodsQualitative interviews with 20 patients, 17 accompanying persons; focus groups and interviews with 27 healthcare professionals from four Thoracic Oncology Units. Intervention development workshops with 24 healthcare professionals and six service users with experience of sharing a cancer diagnosis. Framework thematic analysis. ResultsPatients and accompanying persons shared news of lung cancer whilst coming to terms with the diagnosis. They recalled general support from healthcare professionals but not support with sharing bad news. Six elements were identified providing a framework for a potential intervention: 1-people to be told, 2-information to be shared, 3-timing of sharing, 4-responsibility for sharing, 5-methods of telling others and 6-reactions of those told. ConclusionThis study identifies the challenge of sharing bad news and a potential framework to guide delivery of a supportive intervention tailored to individual needs of patients. Practice ImplicationsThe identified framework could extend the portfolio of guidance on communication in cancer and potentially in other life-limiting conditions.

HOW DO PATIENTS SHARE NEWS OF A CANCER DIAGNOSIS WITH FAMILY/FRIENDS; NEW UNDERSTANDINGS OF THE PROCESS AFTER BAD NEWS HAS BEEN BROKEN

The study was funded by a grant from Dimbleby Cancer Care.IntroductionExtensive research exists on how bad news is broken by physicians to patients, but little is known about the subsequent stage: when patients face the difficult task of sharing this news with family members and friends.Aim(s)To understand the experience of sharing news of a lung cancer diagnosis with wider family members and friends to inform a supportive intervention to prepare patients for sharing bad news.MethodsQualitative interviews with 20 patients with lung cancer and 17 family members/friends present at diagnosis-giving to explore experiences of receiving their diagnosis and how news was shared with wider family/friends.Thematic framework analysis was conducted.ResultsThree key findings: (1) sharing bad news happened over time, at any point along the illness trajectory—it was a process, not a discrete event;(2) timing of sharing bad news was very individual—people needed to feel ready to share their diagnosis and had to prepare themselves to do so;(3) regardless of when news was shared it had consequences in terms of the reactions of those told, which required managing. Illustrative timelines of processes of early and later sharing of bad news will be presented.Conclusion(s)Understanding sharing bad news as a process which happens over time is a significant finding for design and delivery of a supportive intervention. Preparing patients to share news of a lung cancer diagnosis, which often presents at an advanced stage, is highly relevant for future palliative care delivery.

Capitalizing on everyday positive events uniquely predicts daily intimacy and well-being in couples coping with breast cancer.

Capitalization is the relational process of savoring positive life events by sharing them with responsive relationship partners. The purpose of the present study was to use dyadic intensive longitudinal methods to examine novel hypotheses regarding links between capitalization processes and daily intimacy and well-being in women with breast cancer and their intimate partners. Although couples coping with cancer often experience an increase in negative daily life events, we hypothesized that it would be important for them to share and capitalize on positive events in addition to sharing negative events. Female patients with early stage breast cancer and their intimate partners (99 couples) completed electronic daily diaries for 7 to 10 consecutive days tapping everyday processes of sharing negative and positive events with each other. Dyadic multilevel process modeling revealed that on days when capitalization attempts (i.e., sharing the best event of the day) occurred, daily feelings of intimacy in the sharer were higher for both patients and partners. Moreover, greater perceived partner responsiveness to capitalization attempts was associated with increases in the sharer's daily feelings of intimacy and decreases in the sharer's daily negative affect. When the patient's partner was the sharer, perceived partner responsiveness also was associated with increased daily positive affect. More important, all effects of capitalization were observed above and beyond the effects of event positivity and sharing negative events (i.e., social support attempts). Findings suggest that, even in the midst of significant life adversity, sharing daily good news with intimate partners enhances relationship well-being independently of sharing bad news.

Content analysis of postings in a stomach cancer survivor and caregiver support group on Facebook.

223 Background: Patients diagnosed with cancer are increasingly turning to patient created social media groups to connect with others suffering from similar conditions. These groups allow sharing of information and support between their members, without involving medical or mental health professionals. This study examines the content of communications within one of these groups in order to identify the needs these groups are addressing, and in order to explore implications for mental health. Methods: This study focuses on a single Facebook group for stomach cancer patients and caregivers which has grown from 239 members a year ago to 1,128 members now and which has been operating for about four years. Two thirds of members are cancer patients, and the rest are caregivers. About 75% of members are from the US. The age range is 40-79, with a mean of 54. Members are 55% women, and 80% are middle class. Most members have been in the group for six to twelve months. The site averages about five original posts and about 50 responses a day. 100 consecutive posts were assigned to one of 12 pre-selected content categories. Results: Primary purpose of each of 100 consecutive posts (1) Sharing updates on their condition: 14 (2) Questions about treatment side effects: 13 (3) General requests for information: 13 (4) Requests for support or prayers: 11 (5) Sharing good news: 11 (6) Welcoming new members: 11 (7) Giving general support: 9 (8) Announcing a death: 5 (9) Sharing information about new treatments: 5 (10) Sharing humor: 4 (11) Sharing bad news: 2 (12) Asking "How are you?": 2. Conclusions: This Facebook group served many of the same functions that are served by face to face support groups for cancer patients. Members routinely shared intimate details with each other, and they routinely asked questions about their illness that they could not get answers to anywhere else. Leaderless Facebook groups such as this one are an important, and little studied, psychological resource for patients suffering from cancer.

Breaking Good and Bad News: Face-Implicating Concerns as Mediating the Relationship Between News Valence and Hesitation to Share the News

Explanations for the hesitation to share bad news (i.e., the MUM effect) have emerged largely absent of an organizing theoretical framework. The current article aims to recast these explanations in terms of the face-related concerns senders anticipate when sharing bad news. Specifically, we questioned whether face-related concerns mediate the link between the valence of the news and the psychological reluctance and behavioral hesitation that are subsequently triggered in senders. Two samples (Ns = 138, 229) using different experimental methodologies revealed data consistent with mediation for two different concerns (fear of distressing the target, desire to avoid a negative mood). Implications for MUM effect research and limitations are discussed.

SHARING BAD NEWS: DEVELOPMENT OF AN INTERVENTION TO SUPPORT PATIENTS WITH LUNG CANCER SHARE NEWS OF THEIR CANCER DIAGNOSIS WITH FAMILY MEMBERS AND FRIENDS

IntroductionMuch research has focussed on breaking bad news (BBN) i.e. on how physicians communicate a cancer diagnosis to patients. There is little understanding of the subsequent process, when patients go...

102 Sharing Bad News: Understanding the communication processes of a lung cancer diagnosis

102 Sharing Bad News: Understanding the communication processes of a lung cancer diagnosis