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

Knowledge, attitude and practice of pediatric healthcare staff towards the therapy for patients with congenital heart disease

BACKGROUND

This study aimed to investigate the knowledge, attitude and practice (KAP) of pediatric healthcare staff towards the therapy for patients with congenital heart disease (CHD). CHD is a major global health concern, posing significant risks to health and life despite advancements in early detection and treatment.

METHODS

This web-based cross-sectional study was conducted from May 04, 2023 to August 12, 2023 in the Bengbu area (three counties and one city) for pediatric healthcare staff. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariate logistic regression.

RESULTS

A total of 332 valid questionnaires were enrolled, including 258 (77.7%) females, and 161 (48.5%) were pediatrician. The median (25% quartile, 75% quintile) of knowledge, attitude, and practice scores were 38 (36, 40) (possible range: 10-49), 28 (27, 31) (possible range: 7-35), and 35 (32, 39) (possible range: 9-45), respectively. Correlation analysis showed that significant positive correlations were found between knowledge and attitude (r = 0.528, P < 0.001), as well as practice (r = 0.399, P < 0.001). Meanwhile, there were also correlations between attitudes and practice (r = 0.528, P < 0.001). Univariate logistic regression showed that treated more than 100 children with congenital heart disease annually (OR = 2.976, 95% CI: 1.405, 6.303, P = 0.004) was independently associated with knowledge. Female (OR = 0.470, 95% CI: 0.277, 0.797, P = 0.005) and with more than 5 years of work experience (OR = 0.507, 95% CI: 0.262, 0.982, P = 0.044) were independently associated with attitude. Female (OR = 0.584, 95% CI: 0.343, 0.994, P = 0.048) and treated more than 100 children with congenital heart disease annually (OR = 3.743, 95% CI: 1.702, 8.232, P = 0.001) were independently associated with practice.

CONCLUSION

Pediatric healthcare staff had sufficient knowledge, positive attitude and proactive practice towards the therapy for patients with congenital heart disease. To improve clinical practice, prioritize training programs to build knowledge and positive attitudes among healthcare staff, encourage hands-on experience with CHD cases, and promote mentorship by experienced professionals for a collaborative work environment and better care.

The impact of an adapted SPIKES protocol vs routine care in the delivery of bad news to IVF patients: an exploratory pilot multicenter randomized controlled trial

PURPOSE

Determine if the SPIKES method was associated with less distress and more compassion than current modes of delivering negative pregnancy test results to patients undergoing in vitro fertilization.

METHODS

Twenty-seven nurses from two centers were randomized to use the modified SPIKES script or continue their standard of care; 136 patients with a negative hCG following embryo transfer were included. SPIKES nurses received 1 h of training by a study psychologist; nurses in the control group were instructed to deliver the news as done previously. Patients who underwent embryo transfer and received a call by a participating nurse with a negative test result received an email invitation on the following day.

RESULTS

Control patients reported significantly less distress than SPIKES patients; 33% of SPIKES patients reported that they had felt "extremely sad," compared to 15.2% of the control patients (p = 0.01). Perceived compassion did not differ between the groups (all p ≥ 0.22).

CONCLUSION

Patients who received a negative pregnancy test result from the nurses who received a brief training and a script on how to deliver bad news via the modified SPIKES protocol reported significantly more distress than patients receiving negative results from nurses utilizing their standard of care. It is unclear whether a modified SPIKES method to deliver negative pregnancy test results will benefit patients undergoing in vitro fertilization.

TRIAL REGISTRATION

Clinical trials.gov NCT04917445.

Examining Saudi Physicians' Approaches to Communicate Bad News and Bridging Generational Gaps

Breaking bad news is an intrinsic aspect of physicians' clinical practices. This study aims to investigate how Saudi physicians manage the process of communicating bad news and explore potential differences in breaking bad news practices between young physicians (interns) and their older colleagues. From 1 March to 15 April 2023, ok an anonymous online cross-sectional survey was conducted to explore the communication practices of Saudi physicians concerning breaking bad news using the Communicating Bad News Questionnaire. The physicians were recruited through convenience and snowball sampling methods, and the survey questionnaire was distributed on various social media platforms, including Facebook, Twitter, LinkedIn, and WhatsApp. Data were analyzed using R version 4.2.1. A total of 782 physicians were included in this study. Male physicians represented 50.9% of the participants. Three-quarters (74.7%) were aged 25-30 years. The largest proportion of physicians (45.3%) were interns, followed by junior residents (22.9%), senior residents (11.0%), and specialists (6.5%). The median years of experience was 1.0, ranging from 0 to 45 years. Regarding the place of work, most physicians (86.6%) worked in hospitals, while 13.4% worked in primary healthcare centers. A total of 14.8% said they were not comfortable with discussing patients'/relatives' issues (20.60 among interns vs. 10.50% among non-interns, χ2 = 27.50, p = 0.0001), 66.6% reported being trained to break bad news (59.60% among interns vs. 72.40% among non-interns, χ2 = 14.34, p = 0.001), 59.1% reported breaking bad news to the patient, 37.9% reported to the family, and 3.1% reported to both, with no significant difference between interns and non-interns. A substantial proportion of physicians reported feeling uncomfortable discussing sensitive issues with patients and their relatives despite having received training to deliver bad news and being willing to communicate bad news directly to patients. Notably, our analysis identified a significant disparity between intern and non-intern physicians, particularly in terms of their comfort level in addressing patient-related concerns and access to breaking bad news training.

Communication of medical errors in a simulated clinical scenario. Experience with a pediatric residency group

OBJECTIVE

To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing.

METHODS

Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient's father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing.

RESULTS

Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son's health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88).

CONCLUSIONS

We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents' self-perception of error management was regular and not modified by the debriefing.

Cenário para treinamento por simulação sobre comunicação de notícias difíceis: um estudo de validação

Resumo Objetivo construir e validar um cenário de simulação realística sobre comunicação de notícias difíceis no contexto de cuidados paliativos para graduandos de enfermagem. Método estudo metodológico, que seguiu três etapas; construção do cenário, fundamentada nos referenciais sobre simulação, comunicação de notícias difíceis e cuidados paliativos; validação de conteúdo, na qual nove juízes analisaram a adequação do cenário, por meio de uma escala Likert, para computar o Índice Validade de Conteúdo (IVC) e, de sugestões descritas no instrumento de análise do cenário; teste do cenário, que ocorreu com 15 estudantes de graduação em enfermagem que o analisaram pela Escala de Design da Simulação (EDS). Nesta amostra, a análise da fidedignidade da escala foi verificada pelo alfa de Cronbach. Resultados os juízes consideraram o conteúdo do cenário adequado. O IVC do cenário foi 0,84. Após o teste do cenário, os estudantes apontaram a adequação do design da simulação considerando-a adequada para a resolução do problema. O alfa de Cronbach foi 0,89 para o total da EDS. Conclusão e implicações para a prática o processo de construção e validação do cenário sobre comunicação de notícias difíceis resultou na produção de um material válido e consistente para ensino e pesquisas na área de cuidados paliativos.

Development and validation of the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication

OBJECTIVE

The purpose of this study was to develop and analyze the psychometric properties of an instrument that could analyze the communication of nursing professionals in nurse-patient therapeutic communication.

METHODS

A literature review and a panel of experts were used (N = 10) to develop the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication. The final version of the questionnaire was composed of 49 items and applied to a convenience sample of 370 nurses.

RESULTS

The construct validity was assessed by an exploratory factor analysis (EFA) and the reliability using Cronbach's Alpha. Three dimensions were identified that determine therapeutic communication: professional, contextual and/or situational and patient. The Cronbach's α total coefficient was 0.90, ranging from 0.71 to 0.81 for the dimensions.

CONCLUSION

The questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication represents a valid and reliable questionnaire to measure nurses' communication with patients in the clinical setting.

IMPLICATIONS FOR PRACTICE

The use of the questionnaire enables the analysis of elements that interfere with effective communication. This can assist in developing interventions to improve nurses' therapeutic communication with patients.

'Bad news consultations' with oncology nurses: Impact on perceived stress and patient experience

PURPOSE

'Bad News Consultations' (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC.

METHOD

This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC).

RESULTS

Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = -1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = -0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares.

CONCLUSION

Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway.

MeCP2 drives hepatocellular carcinoma progression via enforcing HOXD3 promoter methylation and expression through the HB-EGF/EGFR pathway

Homeobox D3 (HOXD3), a member of the homeobox family, was described to regulate tumorigenesis, invasion, metastasis, and angiogenesis in various tumor types. However, the molecular mechanisms regulating HOXD3 during hepatocellular carcinoma (HCC) migration, invasion, and angiogenesis remain elusive. In this study, we demonstrated that HOXD3 expression is enhanced by the binding of methyl-CpG-binding protein 2 (MeCP2), a methyl-CpG binding protein, together with CREB1to the hypermethylated promoter of HOXD3. Inhibition of HOXD3 eliminated the tumorigenic effects of MeCP2 on HCC cells. Furthermore, HOXD3 directly targeted the promoter region of heparin-binding epidermal growth factor (HB-EGF) via the EGFR-ERK1/2 cell signaling pathway and promoted invasion, metastasis, and angiogenesis of HCC in vitro and in vivo. Additionally, elevated expression of MeCP2, CREB1, and HB-EGF in HCC correlated with a poor survival rate. Our findings reveal the function of the MeCP2/HOXD3/HB-EGF regulatory axis in HCC, rendering it an attractive candidate for the development of targeted therapeutics and as a potential biomarker in patients with HCC.

Instruments for assessing health professionals' skills in breaking bad news: protocol for a systematic review of measurement properties

INTRODUCTION

Health professionals are often involved in the process of breaking bad news (BBN), which remains a difficult challenge, as it requires not only theoretical knowledge, but also the development of humanistic, emotional and communication skills. Therefore, optimal BBN assessment is essential. In this regard, sound measurement instruments are needed to evaluate BBN properly in research, teaching and clinical settings. Several instruments have been designed and validated to assess BBN. In this context, choosing the most appropriate instrument for assessing health professionals' skills in BBN is essential. The aims of this systematic review are to: (1) identify all the instruments used for assessing health professionals' skills in BBN; and (2) critically appraise their measurement properties.

METHODS

A systematic review will be undertaken according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments' (COSMIN) methodology. The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy will be performed following the Peer Review of Electronic Search Strategies. The search strategy will be conducted in CINAHL, MEDLINE, Embase, PsycINFO, SciELO and Open Grey. Two review authors will independently appraise the full-text articles according to the COSMIN Risk of Bias checklist. Quality ratings and evidence synthesis will be performed using a modified Grading of Recommendations Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference.

PROSPERO REGISTRATION NUMBER

CRD42020207586.

The Effectiveness of Communication Skills Training on Nurses' Skills and Participation in the Breaking Bad News

BACKGROUND

Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news.

MATERIALS AND METHODS

This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t-test) in SPSS software.

RESULTS

The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between-group difference was statistically significant (t59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses' participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between-group difference was statistically significant (t75,48 = 3.94, p < 0.001).

CONCLUSIONS

It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.

The Perimenopausal Fatigue Self-Management Scale Is Suitable for Evaluating Perimenopausal Taiwanese Women's Vulnerability to Fatigue Syndrome

The purpose of this study was to test the feasibility of utilizing the established perimenopausal fatigue self-management scale (P-MFSMS) to evaluate perimenopausal Taiwanese women's vulnerability to fatigue syndrome. A cross-sectional study design was adopted to survey 220 perimenopausal Taiwanese women with a mean age of 51.8 ± 4.64 years and a mean body mass index of 23.07 ± 3.04 kg/m2, 75.9% of whom were married, 52.3% had a college education or above, 80.4% had salaries, 81.3% had small families, and 96.4% were not using hormone therapy. The P-MFSMS consists of 25 questions based on six categories: (1) strive to maintain work energy and efficiency; (2) seek self-help from medical resources (doctor shopping); (3) strive to maintain the normal operation of the family (seeking help and support from family or significant other); (4) make time for activities or exercise in busy life; (5) slow down or adjust lifestyle; (6) frustration. For all of these six categories, the minimum loading of each question on the factor was calculated to be over 0.50, with a Cronbach's α of 0.78 and a corrected total-item correlation of >0.50. The goodness of fit of the model was determined to be acceptable, with a chi-square/df value of <3.0 (χ2 = 503.45 and df = 260), a root mean square error of approximation (RMSEA) value of 0.065 (<0.08), as well as a Kaiser-Meyer-Olkin (KMO) value of 0.892. The Tucker-Lewis index (TLI = 0.91), Comparative Fit index (CFI = 0.92), and Incremental Fit index (IFI = 0.92) were all >0.90. There was no statistically significant difference in the difficulty between perimenopausal and postmenopausal women utilizing differential item function (DIF) analysis. Taken together, the 25-question P-MFSMS may be a potentially valid and reliable instrument for suitably evaluating perimenopausal Taiwanese women's vulnerability to fatigue syndrome. Future studies will be conducted to test the effectiveness of the P-MFSMS for evaluating perimenopausal Taiwanese women's vulnerability to fatigue syndrome in clinical practice.