Lay people's and health professionals' views about breaking bad news to children

Risking the social bond: motivations to defend or to repair when dealing with displeasing information

Our choice to withhold or disclose displeasing information to another can motivate concern about damage to our social bonds. In two experiments, using two different samples of university students in Norway, (N = 174 and N = 217), we found that withholding unpleasant information led to greater concern for self- image and social-image than did disclosure. We also found that withholding elicited more shame, inferiority and rejection than disclosure, and in Experiment 2, withholding elicited more defensive motivation than disclosure. Consistent with our model, defensive motivation was mostly explained by concern for social-image, whereas relationship repair motivation was mostly explained by concern for self-image and felt shame. We discuss implications for the literature on shame and social bonds.

Communication of bad news in pediatrics: integrative review

OBJECTIVES

to identify the scientific evidence of the elements of communication in the process of communicating bad news in pediatrics.

METHODS

integrative review searched in the LILACS, PubMed and WoS databases. Primary studies in Portuguese, Spanish or English were included.

RESULTS

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).

CONCLUSIONS

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.

The Practice of Mutual Protection in the Care of Children with Palliative Care Needs: A Multiple Qualitative Case Study Approach from Jordan

PURPOSE

This study explores the experience of disclosing critical information in the care of children with palliative care needs, from the perspective of physicians, nurses, and mothers in Jordan.

DESIGN AND METHODS

This study employed a qualitative case study approach. It was conducted in three paediatric units in a Jordanian hospital. Each case comprised a child aged 1-12 years with a condition eligible for palliative care who received health care in one of these units, and their most involved carers (e.g. mother, physician and nurse). Two data collection methods were employed: participant observation and semi-structured interviews with three categories of participants: mothers, physicians, and nurses. Ethical approval was obtained from the hospital ethical review board. Written consent was obtained from all participants.

RESULTS

Qualitative case studies were developed around 15 children (aged 1-12 years, nine were boys and six were girls, with varying diagnoses: renal disease, neurological conditions, and congenital heart defects). A total of 197 observational hours and 60 interviews were completed (15 mothers, 12 physicians and 21 nurses). The findings demonstrate that the practice of 'mutual protection' dominated communication between children, parents and clinical staff. Parents protected their children by disclosing only partial information about their disease, and by avoiding any information they thought would cause the child distress or loss of hope. Similarly, children avoided expression to their parents of their anxieties or fears, in order to protect them. In turn, nurses attempted to ensure observance of professional boundaries with children and mothers to avoid a sense of loss when a child died.

CONCLUSION

The findings of the current study indicate that while open and honest communication between parents and children is generally recommended by literature, not all mothers agree with adopting open communication with their children concerning their illnesses. Therefore, any future intervention planned for them should respect parents' autonomy and decisions in addition to their cultural backgrounds.

PRACTICAL IMPLICATIONS

The provision of ongoing education and specialised training for professionals to provide them with culturally sensitive skills in communication and provision of emotional support for children and parents is needed to improve clinical practice in healthcare settings with limited access to specialist palliative care such as Jordan.

Telling children their mother is seriously ill or dying: mapping French people's views

BACKGROUND

What to tell children when their mother's life is seriously endangered is a largely unstudied issue.

METHODS

We had 255 lay persons in France judge the appropriateness of the parents' behaviour in 48 scenarios of parents dealing with this problem. The scenarios comprised according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10 years), severity of disease (lethal or worrisome but curable), child's concern or not about his or her mother's illness and parents' decision about how much to tell (tell nothing, minimize or tell the full truth).

RESULTS

Cluster analysis revealed four clusters, labelled 'always tell the truth' (33%), 'tell the truth or minimize' (16%), 'tell nothing or minimize' (22%) and 'depends on child's age and level of concern' (29%). Women and participants who had already faced breaking bad news like this to children were more frequently members of the two 'tell the truth' clusters than other participants.

CONCLUSIONS

People who have already experienced a situation of having to tell a child about their mother's bad health tend to think, more than others, that telling the truth is the best policy.

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.