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Blanchet I, Michel F, Tardieu C, Camoin A. Difficulties experienced by dentists and orthodontists regarding ethical issues when announcing the diagnosis of a rare oral disease: a qualitative study in Marseille, France. Eur Arch Paediatr Dent 2024; 25:169-179. [PMID: 38457081 DOI: 10.1007/s40368-024-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE It is traditionally considered that breaking bad news to patients does not represent a cause for concern for dental professionals. However, there are situations where they will be confronted with this task, as in the case of rare dental diseases. Little information is available regarding the feelings of healthcare professionals on this subject. There are no qualitative studies that explore how a diagnosis of oligodontia is announced to patients by dentists and orthodontists. The aim of our study is to explore the difficulties and ethical issues experienced by dental health professionals when they have to announce a diagnosis of oligodontia to a patient and their family. METHODS This study relied on a qualitative research method using focus groups of dentists and orthodontists and a thematic analysis procedure. RESULTS The difficulties experienced could be summarised within five topics: organisational difficulties, difficulties with the management of dental treatment and with the administrative management associated with this anomaly, difficulties with the content of the announcement, and relational difficulties. These could be grouped in two categories: practical difficulties and ethical difficulties. CONCLUSION This survey allowed us to understand the difficulties encountered by dentists and orthodontists when announcing oligodontia. The participants felt uncomfortable with this task and were under stress. They reported difficulties in delivering the medical information and in adapting to the message. It is essential that dental professionals develop skills in medical communication.
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Affiliation(s)
- I Blanchet
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France.
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France.
| | - F Michel
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
| | - C Tardieu
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
| | - A Camoin
- APHM Timone Hospital, 264 Rue Saint Pierre, 13005, Marseille, France
- Medical and Paramedical Sciences Faculty, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- ADES CNRS EFS, UMR 7268, Aix-Marseille University, 51 Bd Pierre Dramard, 13344, Marseille, France
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Turner A, Gopakumar S, Minard C, Guffey D, Allen N, Kuo D, Poszywak K, Pillow MT. Development of an integrated milestone assessment tool across multiple early-adopter programs for breaking bad news: a pilot project. BMC Med Educ 2024; 24:313. [PMID: 38509520 PMCID: PMC10953138 DOI: 10.1186/s12909-023-04715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/22/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND The transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol. METHODS The IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be "easy" and "intermediate" in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cases in sessions held in November 2013 and May 2014. Standardized patients completed an assessment checklist to evaluate each resident's performance in breaking bad news based on their use of the SPIKES protocol and IMA tool. Residents answered post-encounter questions about their training and comfort in breaking bad news. The association between SPIKES and IMA scores was investigated by simple linear regression models and Spearman rank correlations. RESULTS There were 136 eligible medical residents: 108 (79.4%) participated in the first session and 97 (71.3%) participated in the second session, with 96 (70.6%) residents participating in both sessions. Overall, we were able to identify residents that performed at both extremes of the assessment criteria using the integrated milestone assessment (IMA) and the SPIKES protocol. Interestingly, residents rated themselves below "comfortable" on average. CONCLUSION We developed an integrated milestone assessment (IMA) that was better than the SPIKES protocol at assessing the skill of breaking bad news. This collaborative assessment tool can be used as supplement tool in the era of milestone transformation. We aim assess our tool in other specialties and institutions, as well as assess other shared milestones across specialties.
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Affiliation(s)
- Anisha Turner
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Charles Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Nathan Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Dick Kuo
- Department Chair of Emergency Medicine at Baylor College of Medicine, Houston, TX, USA
| | - Kelly Poszywak
- Simulation and Standardized Patient Program at Baylor College of Medicine, Houston, TX, USA
| | - M Tyson Pillow
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
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Koch M, Seifart C. Rethinking parameters of "success" in breaking bad news conversations from patient's perspective: the successful delivery process model. Support Care Cancer 2024; 32:181. [PMID: 38386098 PMCID: PMC10884081 DOI: 10.1007/s00520-024-08354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Studies that focus on improving the difficult process of breaking bad news in oncology should include the patient perspective and be guided by appropriate outcome measures. Endpoints such as "patient satisfaction" fall short to capture the complex nature of breaking bad news (BBN) conversations. However, this is true of many studies. The present study attempts to develop a framework model from a new, patient-centered perspective, which can be applied equally in clinical practice and in education. METHODS Semi-structured in-depth interviews with twelve cancer patients were conducted. Transcripts were analyzed by "qualitative content analysis" following Mayring. Outcomes were further extrapolated in interpretational steps, and a model of "success" from patients view in BBN was developed. RESULTS Two central needs of the patients could be identified: understanding and feelings. Their fulfillment depends on two groups of variables: first, structural characteristics, such as the inevitable shock, individuality, and processability; second, strongly influenceable variables, such as relationship, transfer of knowledge, and atmosphere. From these results, a framework model for successful breaking of bad news from the patient's perspective was developed: The successful delivery process model (SDP model). CONCLUSION As a basic model for the framework for breaking bad news from the patient's perspective, the SDP model can be applied to many different situations in oncology and help to frame the difficult conversations by tailoring the BBN conversations on determinants that favorably influence the process in a patient centered manner. In this sense, the model can be useful in clinical practice as well as in education.
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Affiliation(s)
- Martin Koch
- Clinic for Internal Medicine I, University Hospital, Technical University, Dresden, Germany
| | - Carola Seifart
- Research Group Ethics in Medicine, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.
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Gagnerie P, Sanges S, Guerreschi P, Wiel E, Lebuffe G, Sanctorum T, Jourdain M, Morell-Dubois S, Zéphir H. Training first-year medical residents to break bad news using healthcare role-play and trainees as simulated patients: Experience of the "ADIAMED" program from Lille University School of Medicine. Rev Med Interne 2023; 44:632-640. [PMID: 37923588 DOI: 10.1016/j.revmed.2023.10.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. METHODS The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. RESULTS Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. CONCLUSION Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity.
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Affiliation(s)
- P Gagnerie
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - S Sanges
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France.
| | - P Guerreschi
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Chirurgie Plastique, Inserm, CHU de Lille, 59000 Lille, France
| | - E Wiel
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Université de Lille, CHU de Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Pôle de l'Urgence, CHU de Lille, 59000 Lille, France
| | - G Lebuffe
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Pôle d'anesthésie réanimation - ULR 7365-GRITA - groupe de recherche sur les formes injectables et les techniques associées, Université de Lille, CHU de Lille, 59000 Lille, France
| | - T Sanctorum
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - M Jourdain
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, U1190, Department of Intensive Care Medicine, 59000 Lille, France
| | - S Morell-Dubois
- Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France
| | - H Zéphir
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Neurologie, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm U 1172, CHU de Lille, 59000 Lille, France
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Ayalew EA, Mphuthi DD, Matlhaba KL. Patients' preferences for delivering bad news in palliative care in Ethiopia: a qualitative study. BMC Palliat Care 2023; 22:170. [PMID: 37924030 PMCID: PMC10623733 DOI: 10.1186/s12904-023-01275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/03/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND One of the major challenges for healthcare professionals relates to awareness of patients' preferences relative to how and when to break bad news and how much information should be disclosed in the eventuality of a serious medical diagnosis or prognosis. On occasions, a serious medical diagnosis or prognosis is withheld from the patient. There is a scarcity of evidence about cultural preferences regarding breaking bad news in the palliative care setting in Ethiopia. Therefore, it is necessary to understand the surrounding cultural issues to properly convey bad news. The purpose of the study was to explore Ethiopian patients' cultural preferences for receiving bad news in a palliative care setting. METHODS A qualitative research approach and nonprobability, purposive sampling method were applied. In-depth interviews were employed to collect data from eight patients who were diagnosed with cancer and cancer with HIV/AIDS during the time of data collection. Thematic analysis was applied to identify themes and subthemes. The data were transcribed verbatim and analysed using ATLAS.ti 22 computer software. RESULTS The following three themes emerged and are reported in this study: (1) Perceptions about life-threatening illness: religious values and rituals are essential for establishing perspectives on life-threatening illnesses and preferences in receiving bad news. (2) Experiences with life-threatening illness: study participants' experience with the method of breaking bad news was sad, and they were not provided with sufficient details about their medical condition. Making appropriate decisions, fulfilling the ordinance of religious faith, and avoiding unnecessary costs were outlined as benefits of receiving bad news. (3) Preferred ways of breaking bad news; the findings revealed that incremental, amiable and empathic methods for delivering bad news were preferred. It was suggested that the presence of family members is crucial when receiving bad news. CONCLUSION Patients choose to be told about their medical conditions in the presence of their family. However, the patient's needs for receiving bad news were unmet. Patients should be involved in the treatment decision process. Delivery of bad news needs to tailor the preferred methods, cultural values, and religious beliefs. Delivering bad news according to the patients' preferences helps to fulfil their wishes in palliative care.
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Affiliation(s)
| | - Ditaba David Mphuthi
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Mansoursamaei M, Ghanbari Jolfaei A, Zandi M, Mansoursamaei A, Salehian R. Self-assessment of residents in breaking bad news; skills and barriers. BMC Med Educ 2023; 23:740. [PMID: 37803375 PMCID: PMC10559449 DOI: 10.1186/s12909-023-04720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Breaking bad news (BBN) is inevitable in medicine and is one of the most important and difficult professional tasks of physicians. The main aims of this study are to evaluate residents' practice of BBN and identify perceived barriers to its implementation. METHODS In this cross-sectional study in 2021, 240 residents from medical, surgical, and emergency medicine departments completed the demographic questionnaire, the Persian SPIKES questionnaire (P-SPIKES), and the researchers-made questionnaire of Barriers to Breaking Bad News (BBBN). In addition, they were asked about their previous experience, previous training, and their perceived level of competence in BBN. RESULTS 46.5% and 36.84% of residents rated their perceived competence in BBN and managing the patient's emotions during BBN as good or very good, respectively. The most difficult aspects of BBN for residents were expressing upsetting information (78.1%) and not disappointing the patient while being honest (58.3%). The mean and standard deviation of the score of the P- SPIKES was 55.92 ± 6.84. The most common SPIKES item was not giving bad news by phone (98.9%). The SPIKES total score was only related to age (positive relationship). The most commonly reported barriers to BBN were concerns about controlling the patient's emotions (61%) and the aggressiveness of the patient or companions (52.6%). A significant proportion of participants identified lack of training (28%) and insufficient skills (21.9%) as significant barriers to BBN. CONCLUSIONS The skill of residents in BBN is insufficient in some aspects and points to the need for BBN training courses during residency. BBN is difficult for residents in some aspects and residents may perceive barriers. To overcome the existing barriers and increase residents' confidence in BBN, strategies such as incorporating BBN training into residency educational curricula and communication skills are recommended.
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Affiliation(s)
- Maryam Mansoursamaei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, 19857-17443 Tehran, Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
| | - Mehdi Zandi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
| | - Ali Mansoursamaei
- Student Research Committee, School of Medicine, Shahroud University of Medical Science, 36147-73943 Shahroud, Iran
| | - Razieh Salehian
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, 14456-13131 Tehran, Iran
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Deluche E, Salle H, Leobon S, Facchini-Joguet T, Fourcade L, Taibi A. ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news. J Visc Surg 2023; 160:323-329. [PMID: 37005112 DOI: 10.1016/j.jviscsurg.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. METHODS This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training. RESULTS Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills. CONCLUSION Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.
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Affiliation(s)
- E Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France; Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France.
| | - H Salle
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - S Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - L Fourcade
- Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France; Department of Pediatric Visceral Surgery, Limoges University Hospital, Children's Hospital, Limoges, France
| | - A Taibi
- Department of Digestive, General and Endocrinology Surgery, Limoges University Hospital, Limoges, France
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Wahyuni S, Gautama MSN, Simamora TY. A Literature Review of Nurses Challenges and Barriers in Assisting Patients and Families Facing Breaking Bad News. Indian J Palliat Care 2023; 29:243-249. [PMID: 37700890 PMCID: PMC10493690 DOI: 10.25259/ijpc_128_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/22/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Breaking bad news (BBN) is a challenging task for healthcare professionals, including nurses. The manner in which bad news is delivered can have a significant impact on patients and their families, either positive or negative. Understanding the roles, methods, obstacles, and challenges that nurses face in the process of delivering bad news is crucial for improving the quality of the delivery process. Material and Methods This narrative review synthesises related studies. The search was conducted through PubMed, Scopus, ScienceDirect and Sage, with no restriction on publication year. The main keywords were 'nurse's challenge', 'nurse's barrier', 'bad news', 'breaking bad news', and 'communicating bad news.' A total of 12 articles were selected from 1075 articles. Results Nurses play a key role in BBN before, during and after the process. Their activities include preparing patients to receive bad news, supporting patients and families when doctors deliver bad news and clarifying information obtained by patients and families regarding the prognosis of their illness. Nurses should possess skills such as building interpersonal relationships, therapeutic communication and providing emotional care for patients and their families. The main challenges and barriers for nurses in implementing BBN are due to a lack of skills and unpreparedness for patient and family reactions. After BBN, the most reported roles of nurses were supporting patients and families and helping them understand the information received from doctors. It is essential for nurses to have the necessary skills and preparedness to effectively deliver bad news to patients and their families. Conclusion Nurses play a crucial role in delivering bad news to patients and their families. They should be equipped with the necessary skills to effectively communicate with patients and their families during this difficult time. Further training for nurses in therapeutic communication, emotional care for patients and their families, and building interpersonal relationships could help to improve the quality of the delivery process.
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Affiliation(s)
- Surya Wahyuni
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Made Satya Nugraha Gautama
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tiur Yulianta Simamora
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Baliga MS, Lasrado S, Krishna A, George T, Madathil LP, D’souza RF, Palatty PL. Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362104 PMCID: PMC10206566 DOI: 10.1007/s12070-023-03738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023] Open
Abstract
Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.
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Affiliation(s)
- Manjeshwar Shrinath Baliga
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka 575002 India
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Kankanady, Mangalore, 575002 India
| | - Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Karnataka 570001 India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, NY 11235 USA
| | - Lal P. Madathil
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
| | - Russell Franco D’souza
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
- Chair Department of Education, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa); Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Princy Louis Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
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Karnieli-Miller O, Palombo M, Laor N. The hidden curriculum of breaking bad news: Identification of three dimensions and four communication patterns. Patient Educ Couns 2023; 114:107807. [PMID: 37236123 DOI: 10.1016/j.pec.2023.107807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. METHODS We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. RESULTS The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. CONCLUSIONS Compared to the main literature on breaking bad news that focuses on two dimensions-the present study identified a third, prominent dimension-discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. PRACTICE IMPLICATIONS When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.
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Affiliation(s)
| | - Michal Palombo
- Department of Medical Education, Tel Aviv University, Tel-Aviv, Israel; Department of Family Medicine, Clalit Heath Services, Petach Tikva, Israel
| | - Nathaniel Laor
- Department of Medical Education, Tel Aviv University, Tel-Aviv, Israel; Departments of Psychiatry and Philosophy, Tel Aviv University, Tel Aviv, Israel
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11
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Bosshard M, Schmitz FM, Guttormsen S, Nater UM, Gomez P, Berendonk C. From threat to challenge-Improving medical students' stress response and communication skills performance through the combination of stress arousal reappraisal and preparatory worked example-based learning when breaking bad news to simulated patients: study protocol for a randomized controlled trial. BMC Psychol 2023; 11:153. [PMID: 37165406 PMCID: PMC10173625 DOI: 10.1186/s40359-023-01167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians' increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition. METHODS In a randomized controlled trial with a 2 (SAR vs. control) x 2 (WE vs. control) between-subjects design, we will determine the effects of both interventions on stress response and BBN skills performance in N = 200 third-year medical students during a simulated BBN encounter. To identify students' stress responses, we will assess their perceived coping resources and task demands, record their cardiovascular activity, and measure salivary parameters before, during, and after BBN encounters. Three trained raters will independently score students' BBN skills performances. DISCUSSION Findings will provide unique insights into the psychophysiology of medical students who are tasked with BBN. Parameters can be understood more comprehensively from the challenge and threat perspective and linked to performance outcomes. If proven effective, the evaluated interventions could be incorporated into the curriculum of medical students and facilitate BBN skills acquisition. TRIAL REGISTRATION ClinicalTrials.gov (NCT05037318), September 8, 2021.
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Affiliation(s)
- Michel Bosshard
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | | | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Urs Markus Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
- University Research Platform "Stress of life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Patrick Gomez
- Center for Primary Care and Public Health (Unisanté), Department of Occupational and Environmental Health, University of Lausanne, Lausanne, Switzerland
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12
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Anestis E, Eccles FJR, Fletcher I, Simpson J. Neurologists' lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis. BMC Neurol 2023; 23:178. [PMID: 37138217 PMCID: PMC10155430 DOI: 10.1186/s12883-023-03233-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/29/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals' experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors' experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists' lived experience of delivering an MNDC diagnosis. METHODS Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews. RESULTS Two themes were constructed from the data: 'Meeting patients' emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors', and 'Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news'. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process. CONCLUSIONS Based on the study's findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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13
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Galal SM, Vyas D, Mayberry J, Caringal C, Bui V, Rogan E, Ndung'u M. Training pharmacy students to deliver bad news using the SPIKES model. Curr Pharm Teach Learn 2023; 15:283-288. [PMID: 37032264 DOI: 10.1016/j.cptl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND AND PURPOSE Delivery of bad news or negative health information is a complex skill critical to the provision of patient care. While counseling models with this focus exist within other health care professions, their use in pharmacy education is lacking. The purpose of this study is to assess pharmacy students' ability to deliver bad news with the implementation of a counseling model titled SPIKES (Setting, Perception, Invitation, Knowledge, Emotions with Empathy, and Strategy/Summary). EDUCATIONAL ACTIVITY AND SETTING First-year pharmacy students attended a one-hour training on the SPIKES model and completed three simulations with its application. Pre- and post-training surveys were administered to assess confidence, attitudes, and perceptions. Student performance during the simulations was evaluated by teaching assistants (TAs) as well as a self-assessment using the same grading rubric. A paired t-test was used to test for significant mean improvement in competency scores, confidence, attitudes, and perceptions from Week 1 to Week 3. FINDINGS One hundred and sixty-seven students were included in the analysis. There was a significant improvement in the student's self-assessment of their performance for each of the SPIKES components and summative scores. For the TA assessment, there was a significant mean improvement in the summative SPIKES score; however, within each component of SPIKES, only the knowledge component showed significant mean improvement. There was also a significant improvement in student confidence in the post-training surveys. SUMMARY Implementation of the SPIKES protocol in the pharmacy curriculum showed an overall improvement in students' self-assessed performance in delivering bad news.
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Affiliation(s)
- Suzanne M Galal
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
| | - Deepti Vyas
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
| | - John Mayberry
- University of the Pacific, Department of Mathematics, 3601 Pacific Ave, Stockton, CA, 95211, United States.
| | - Claire Caringal
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
| | - Vy Bui
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
| | - Ed Rogan
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
| | - Martha Ndung'u
- University of the Pacific, Thomas J. Long School of Pharmacy and Health Sciences, 751 Brookside Road, Stockton, CA, 95211, United States.
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14
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Goumas G, Syrigos N, Fyta E, Dardavesis TI, Simou E. Breaking Bad News During the COVID-19 Pandemic: A Systematic Review of the Literature. Anticancer Res 2023; 43:773-779. [PMID: 36697067 DOI: 10.21873/anticanres.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 01/26/2023]
Abstract
The aim of the present review was to extend research by reviewing international research regarding the communication between oncologists and oncology patients and the communication of bad news to oncology patients during the COVID-19 pandemic. Following the PRISMA guidelines a review of the literature was performed by searching PubMed, Scopus, and EMBASE bibliographic databases from inception to October 10, 2022. The search was limited to articles written in English. Two reviewers independently completed title and abstract, full-text screening, and data extraction. A total of five studies were deemed eligible for this systematic review. A narrative synthesis was undertaken. Of these five articles, three referred to the communication of bad news to patients by medical oncologists during the COVID-19 pandemic, whereas the remaining two referred to the transmission of bad news to patients by surgeons during the pandemic. The COVID-19 pandemic and the social distancing measures imposed caused radical changes in the forms of communication in medical environments. The challenges faced by the oncologist in breaking bad news to cancer patients are highlighted in this systematic review, and the need for physician preparation prior to communication with the patient is emphasized. Overall, new studies are needed on the effects of distance communication on both health professionals and patients. New studies are also needed that would explore the perceptions of physicians and patients in Greece.
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Affiliation(s)
- Georgios Goumas
- Department of Public Health Policy School of Public Health University of West Attica, Athens, Greece; .,Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Kifissia, Greece
| | - Nikolaos Syrigos
- Oncology Unit, 3 Department of Internal Medicine, "SOTIRIA" General Hospital of Chest Diseases, National and Kapodistrian University of Athens, Athens, Greece.,Dana-Farber Cancer Institute, Boston, MA, U.S.A
| | - Eleni Fyta
- Oncology Unit, 3 Department of Internal Medicine, "SOTIRIA" General Hospital of Chest Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros I Dardavesis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Effie Simou
- Department of Public Health Policy School of Public Health University of West Attica, Athens, Greece
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15
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Francis L, Robertson N. Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis. Patient Educ Couns 2023; 107:107574. [PMID: 36459829 DOI: 10.1016/j.pec.2022.107574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To provide an overview of healthcare practitioners' experiences of breaking bad news. METHOD Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis. RESULTS Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised. CONCLUSIONS Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged. PRACTICE IMPLICATIONS Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.
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Affiliation(s)
- Laura Francis
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
| | - Noelle Robertson
- School of Psychology and Vision Sciences, University of Leicester, George Davies Centre, Lancaster Road, Leicester LE1 7HA, UK.
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16
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Mailankody S, Sherigar P, Pai A, Shenoy R, Udupa K, Lewis S, Rao SR. PENS approach for breaking bad news in the oncology outpatient setting: a real-world report. Support Care Cancer 2022; 31:13. [PMID: 36513796 DOI: 10.1007/s00520-022-07458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. METHODS This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. RESULTS Fifty patients (mean age 53.7 years, range 28-76) were included in the study. The average duration of BBN was 6.1 (range 2-11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. CONCLUSIONS The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI/2021/07/034707).
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17
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Anestis E, Eccles FJR, Fletcher I, Triliva S, Simpson J. Healthcare professionals' involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study. Disabil Rehabil 2022; 44:7877-7890. [PMID: 34783624 DOI: 10.1080/09638288.2021.2002436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. MATERIALS AND METHODS 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis. RESULTS Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. CONCLUSIONS BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future.Implications for rehabilitationBreaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions.Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them.Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided.Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task.Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sofia Triliva
- Department of Psychology, School of Social Sciences, University of Crete, Rethymnon, Greece
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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18
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Terrasson J, Rault A, Seigneur É, El Mellah L, Dolbeault S, Brédart A. How do you tell parents whose child has cancer that the treatment has failed: A qualitative study on pediatric oncologists' practices. Pediatr Hematol Oncol 2022; 40:382-394. [PMID: 36094797 DOI: 10.1080/08880018.2022.2120936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Announcing drug resistance is complex for pediatric oncologists because they have to provide a substantial amount of medical information while taking a major emotional impact on the parents into account. This study aimed to understand how these announcements are currently conducted and how pediatric oncologists adapt the information given to each family in situations where there is resistance to treatment. Semi-structured interviews were conducted with 15 pediatric oncologists (66.7% women, aged 44.7 years on average). Interviews were audio-recorded and a thematic content analysis was conducted. Announcements of drug resistance are stressful, as they are not well codified, difficult to anticipate, and pediatric oncologists have many issues about how best to behave and which words to choose. The majority of them believe that the severity, or even the incurability of the disease, and the offer of a therapeutic alternative are essential components of the information to pass on. Pediatric oncologists describe how they adapt their communication to each family, particularly in relation to parents' questions, and also to their reactions during the announcement. They also need to adapt to the prior acquaintance they may have with the families, and to previous exchanges. Finally, pediatric oncologists acknowledge their subjectivity when estimating the parents need in terms of information. Understanding the course of these announcements gives us another point of view at the issues involved in this announcement. Proposals to support pediatric oncologists in this difficult moment can be suggested: communication support tool, work in pairs and discussion group.
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Affiliation(s)
- Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Étienne Seigneur
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Institut Curie, SIREDO Oncology Center, Paris, France
| | - Leïla El Mellah
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Research Center in Epidemiology and Health Population, INSERM, Paris-Saclay University, Villejuif, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Psychopathology and Health Process Laboratory, University of Paris, Boulogne-Billancourt, France
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19
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Karnieli-Miller O, Pelles S, Meitar D. Position paper: Teaching breaking bad news (BBN) to undergraduate medical students. Patient Educ Couns 2022; 105:2899-2904. [PMID: 35710469 DOI: 10.1016/j.pec.2022.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Sharing new medical information that is perceived as seriously effecting people's lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency. The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students. The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients' and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients' care during these difficult, life-changing encounters, and physicians' well-being.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sharon Pelles
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Dafna Meitar
- Mandel School for Educational Leadership, Jerusalem, Israel; Medical College of Wisconsin, Wisconsin, USA
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20
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Terrasson J, Rault A, Seigneur É, Doz F, Dolbeault S, Brédart A. [Announcing treatment resistance in pediatric oncology: A qualitative study of nurses' experiences]. Bull Cancer 2022; 109:1154-1161. [PMID: 35985866 DOI: 10.1016/j.bulcan.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The announcement of treatment resistance is a key moment in the management of children treated for cancer. Although nurses are present at various stages of this announcement, few studies have examined their role and experience. This study proposes to enhance understanding of the experience of nurses at this time of the pediatric cancer trajectory in France. METHOD A qualitative study was conducted in two pediatric oncology departments. Semi-structured research interviews were conducted with seven pediatric nurses (five women) with an average age of 36.9 years. RESULTS Nurses report not being systematically present during announcements of treatment resistance but being present with the families before and after these announcements. Nurses described their role at this point in the management process as multifaceted. The emotional burden associated with these announcements is significant: nurses must manage their own emotions when faced with the discovery of resistance to treatment, those of the families, and must often answer difficult questions about the prognosis or end of life. In this context, teamwork is an important support. DISCUSSION Better awareness and recognition of the role of nurses and the associated emotional burden would enable them to fully carry out their missions.
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Affiliation(s)
- Johanna Terrasson
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France.
| | - Aude Rault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France
| | - Étienne Seigneur
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France
| | - François Doz
- Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; Institut Curie, UMR 144 CNRS, 75005 Paris, France
| | - Sylvie Dolbeault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université Paris-Saclay, centre de recherche en épidémiologie et santé des populations (CESP), U1018, Inserm, 94807 Villejuif, France
| | - Anne Brédart
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université de Paris, laboratoire psychopathologie et processus de santé, 92100 Boulogne-Billancourt, France
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21
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Rockall AG, Justich C, Helbich T, Vilgrain V. Patient communication in radiology: Moving up the agenda. Eur J Radiol 2022; 155:110464. [PMID: 36038410 DOI: 10.1016/j.ejrad.2022.110464] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Optimised communication between patients and the imaging team is an essential component of providing patient-centred and value-based care. Communication with patients can be challenging in the setting of busy radiology departments where there is a focus on efficient and accurate diagnosis. Traditionally, most results are provided directly to the referring clinician. However, the importance of direct communication between the radiologist and patient is increasingly relevant, particularly in the context of face-to-face settings such as rapid assessment and ultrasound clinics, and interventional radiology, as well as in written form through electronic patient portals. Artificial intelligence tools may improve efficiency, allowing more time for radiologists to communicate directly with patients. There is a need for dedicated training in communication skills for imaging professionals. This review considers the topic of patient communication in the setting of imaging departments and discusses the ways that communication skills may be improved through training and through harnessing emerging digital technologies that may enhance the quality of communication.
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Affiliation(s)
- Andrea G Rockall
- Department of Cancer and Surgery, Faculty of Medicine, Imperial College London, UK; Department of Radiology, Imperial Healthcare NHS Trust, London, UK.
| | | | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna & General Hospital, Division of Molecular and Structural Preclinical Imaging, Waehringer Guertel 18-20, Floor 7F, 1090 Vienna, Austria
| | - Valerie Vilgrain
- Université Paris Cité and Department of Radiology, Hôpital Beaujon, APHP.Nord, Paris, France
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22
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Walker L, Sivell S. Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients. Patient Educ Couns 2022; 105:2081-2088. [PMID: 35193783 DOI: 10.1016/j.pec.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques. METHODS BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis. RESULTS Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure. CONCLUSION Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central. PRACTICE IMPLICATIONS BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.
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Affiliation(s)
- Louise Walker
- Cardiff University, Wales, UK; Greys Hospital, Private Bag 9001, Pietermaritzburg 3200, KwaZulu Natal, South Africa.
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
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Bouaoud J, Michon L, Saintigny P. Teaching how to break bad news in Oncology: In-class vs. virtual peer role-plays. Bull Cancer 2022; 109:685-691. [PMID: 35523599 DOI: 10.1016/j.bulcan.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We report two different peer role-play training courses for breaking bad news (BBN) in Oncology, the classic "in-class" model and the "virtual" peer role-play (VPRP) model developed during the SARS-CoV-2 pandemic. METHODS Each session included 20-25 4th year medical students supervised by two practitioners experienced in oncology. After an ice breaking activity to exchange with students on means to promote hope to patients when BBN, peer role-plays started. Pre-and post-session questionnaires were submitted to evaluate students' satisfaction, attitudes, and perceptions. Pre-and post-session knowledge test were realized. Each student has participated to only one peer-role play either "in-class" (2018) or VPRP (2020). RESULTS In 2018, a total of 222 students received the "in-class" training. In 2020, a total 431 students received the VPRP training. For almost all students it was the first peer role-play training session. Before training, reported level of confidence in BBN was low. After training, students of the VPRP group were highly satisfied regarding quality (realism, organization). Students also reported great interest and perceived benefits. Students who underwent "in-class" training course showed a significantly higher improvement (+1.9 points) of their knowledge scores compared to those who underwent the VPRP training course (+0.7 points) (P-value=2e-16). CONCLUSION The two methods seem beneficial to improve knowledge skills in BBN although "in-class" training class seem to be more efficient. To our knowledge, this is the first comparison between virtual and in-class peer-role play training for BBN in oncology.
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Affiliation(s)
- Jebrane Bouaoud
- Université de Lyon, université Claude-Bernard-Lyon-1, faculté de médecine Lyon-Est, 69008 Lyon, France; Centre Léon-Bérard, Department of Translational Medicine, Lyon, France
| | - Lucas Michon
- Centre Léon-Bérard, Department of Translational Medicine, Lyon, France
| | - Pierre Saintigny
- Université de Lyon, université Claude-Bernard-Lyon-1, faculté de médecine Lyon-Est, 69008 Lyon, France; Centre Léon-Bérard, Department of Medical Oncology, 69008 Lyon, France.
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24
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Güven BB, Maden Ö, Satar AD, Ersoy A. Factors affecting the emotional reactions of patient relatives who receive news of death: a prospective observational study. BMC Psychol 2022; 10:58. [PMID: 35260171 PMCID: PMC8903617 DOI: 10.1186/s40359-022-00763-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background Reporting the death of relatives to a family member is a very stressful task for physicians. Grief reactions differ from person to person. Methods Demographic data of 100 patients who died after staying in ICU for more than three days were recorded. For each patient, one of the family members filled a form which contained their own age, gender, education level, marital status, number of children, degree of relationship, psychiatric treatment status, living in the same house as the patient, and whether they had ever visited the ICU before. Grief reactions were evaluated in five different categories: normal grief response, initial shock reaction, denial, feeling guilty and anger. Results When the death was reported, 55.0% of the relatives accepted this situation as normal, 19.0% felt guilty and 14.0% showed an initial shock reaction. The results showed that for a one-unit increase in the patient's age, the probability of the denial reaction among relatives was reduced by 746 times and the probability of feeling guilty was reduced by 698 times. Conclusion The rate of denial and guilt in the grief reactions among patient relatives when given news of death in the intensive care unit increases with the decrease in patient age.
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Affiliation(s)
- Bülent Barış Güven
- Department of Anesthesia and Reanimation, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences Turkey, P.O. Box: 34668, Üsküdar, Istanbul, Turkey.
| | - Özgür Maden
- Department of Psychiatry, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences Turkey, P.O. Box: 34668, Üsküdar, Istanbul, Turkey
| | - Ayşe Dudu Satar
- Department of Nursing Science, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences Turkey, P.O. Box: 34668, Üsküdar, Istanbul, Turkey
| | - Ayşın Ersoy
- Department of Anesthesia and Reanimation, Sultan 2. Abdulhamid Han Training and Research Hospital, University of Health Sciences Turkey, P.O. Box: 34668, Üsküdar, Istanbul, Turkey
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Terrasson J, Seigneur É, Rault A, El Mellah L, Dolbeault S, Brédart A. The announcement of treatment resistance from the pediatric oncologist's point of view: a qualitative study. Pediatr Hematol Oncol 2022; 39:132-144. [PMID: 34392770 DOI: 10.1080/08880018.2021.1956030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Breaking bad news in pediatric oncology covers widely diverse clinical situations. The aim of this study was to highlight the specificities of the announcement of treatment resistance as perceived by pediatric oncologists, particularly in comparison with the disclosure of a cancer diagnosis. Semi-structured interviews were conducted in two pediatric oncology departments in France, with 15 pediatric oncologists (66.7% were women, aged 44.7 years on average). Interviews were audio-recorded and transcribed and a thematic content analysis was conducted. Most pediatric oncologists reported emotional difficulties in announcing treatment resistance. Some of them mentioned a personal need to accept resistance to treatment and to mourn the child's chances of recovery, and reported feelings of medical failure. This disclosure was considered more difficult than the announcement of the cancer diagnosis because it was associated with less optimism and more complex and fewer therapeutic options. The attachment bond created with families in the course of treatment seemed to exacerbate the emotional difficulties associated with this announcement. In conclusion, resistance to treatment has an impact on prognosis. It makes it more uncertain. Its announcement for pediatric oncologists is a turning point that affects their initial optimistic perspective. Their emotional difficulties are accentuated by the attachment that has been created with the families. Focusing on difficulties experienced by pediatricians could help to improve parent-pediatrician communication.
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Affiliation(s)
- Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Étienne Seigneur
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Institut Curie, SIREDO Oncology Center, Paris, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Leïla El Mellah
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Research Center in Epidemiology and Health Population, INSERM, U1018, Paris-Saclay University, Villejuif, France
| | - Anne Brédart
- Psycho-Oncology Unit, Institut Curie, PSL Research University, Paris, France.,Psychopathology and Health Process Laboratory, University of Paris, Boulogne-Billancourt, France
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Sengupta M, Roy A, Gupta S, Chakrabarti S, Mukhopadhyay I. Art of breaking bad news: A qualitative study in Indian healthcare perspective. Indian J Psychiatry 2022; 64:25-37. [PMID: 35400752 PMCID: PMC8992758 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_346_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/09/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Health-care communication is essential for amiable provider-recipient relationship. This study explored various health-care experiences and expectations of service recipients and providers in private clinical establishments of West Bengal, India, while breaking difficult news, bad news, and death. AIM The current study was framed with the following research question: What are the varying perceptions, experiences, and expectations of healthcare recipients and their providers while seeking/delivering support in situations of breaking bad news and communications on death? MATERIALS AND METHODS The data were collected through individual in-depth interviews-31 respondents that included 16 patients and their families (recipient) and 15 medical practitioners (provider). Inductive thematic analysis was used. RESULTS Three main themes and nine sub-themes were identified highlighting livid experiences and perceptions of respondents. The findings suggest that interpersonal communications involve language barriers, health literacy and COVID-19 pandemic, situations of sudden unexplained death, perceptual negativity surrounding healthcare, empathy as well as emotions and multiple affiliations leading to ethical moral conflicts to influence individual perception. Regarding treatment attributes, factors of inaccessibility misconceived as incompetence and waiting and contact time are involved. The behavior and personality dimensions include attitude and robustness of the patient party and capability to handle emotions that affect provider-recipient relationship during communications of bad news and death. CONCLUSION This study provided a local perspective about the experiences and expectations of healthcare recipients and their providers. Understanding this critical realm shall help in bridging the gap between recipient expectations and provider practices. It will also attempt towards possible alignment to improve patient satisfaction.
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Affiliation(s)
- Mitali Sengupta
- Department of Business Administration, University of Engineering and Management, Joka, Kolkata, West Bengal, India
| | - Arijit Roy
- Cradle Fertility Centre, Joka, Kolkata, West Bengal, India.,Chikitsa Medicare Centre Pvt. Ltd., Kolkata, West Bengal, India
| | - Saikat Gupta
- Chikitsa Medicare Centre Pvt. Ltd., Kolkata, West Bengal, India
| | - Satyajit Chakrabarti
- Department of Business Administration, University of Engineering and Management, Joka, Kolkata, West Bengal, India
| | - Indraneel Mukhopadhyay
- Department of Information Technology, Institute of Engineering and Management, Kolkata, West Bengal, India
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Vincent A, Urben T, Becker C, Beck K, Daetwyler C, Wilde M, Gaab J, Langewitz W, Hunziker S. Breaking bad news: A randomized controlled trial to test a novel interactive course for medical students using blended learning. Patient Educ Couns 2022; 105:105-113. [PMID: 33994021 DOI: 10.1016/j.pec.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) is challenging for physicians and patients and specific communication strategies aim to improve these situations. This study evaluates whether an E-learning assignment could improve medical students' accurate recognition of BBN communication techniques. METHODS This randomized controlled trial was conducted at the University of Basel. After a lecture on BBN, 4th year medical students were randomized to an intervention receiving an E-learning assignment on BBN or to a control group. Both groups then worked on an examination video and identified previously taught BBN elements shown in a physician-patient interaction. The number of correctly, misclassified and incorrectly identified BBN communication elements as well as missed opportunities were assessed in the examination video. RESULTS We included 160 medical students (55% female). The number of correctly identified BBN elements did not differ between control and intervention group (mean [SD] 3.51 [2.50] versus 3.72 [2.34], p = 0.58). However, the mean number of inappropriate BBN elements was significantly lower in the intervention than in the control group (2.33 [2.57] versus 3.33 [3.39], p = 0.037). CONCLUSIONS Use of an E-learning tool reduced inappropriate annotations regarding BBN communication techniques. PRACTICE IMPLICATIONS This E-learning might help to further advance communication skills in medical students.
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Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Michael Wilde
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
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Chhabra S, Girija S. Communicating bad news of COVID-19: An empirical study of patients' preferences in India. Health Mark Q 2021; 38:205-221. [PMID: 34652984 DOI: 10.1080/07359683.2021.1987017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study aims to assess patients' preferences regarding physicians communicating bad news of COVID-19. Based on the data collected from 74 patients with COVID-19 in India, this study assesses "how" patients want bad news to be delivered. Key aspects of the physician-patient interaction were identified from the literature. Regression tests proved that three main constructs contribute significantly toward patient outcomes. Content of the message and facilitation were most crucial, however too much emotional support was not desirable by patients. Also, the patient's gender and educational background should be considered before breaking bad news . Thus, to increase patient compliance full disclosure and patient-centered methods of communication can be used.
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Affiliation(s)
| | - Smitha Girija
- Marketing at GITAM University, Visakhapatnam, Andhra Pradesh
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Papadakos CT, Stringer T, Papadakos J, Croke J, Embleton A, Gillan C, Miller K, Weiss A, Wentlandt K, Giuliani M. Effectiveness of a Multiprofessional, Online and Simulation-Based Difficult Conversations Training Program on Self-Perceived Competence of Oncology Healthcare Provider Trainees. J Cancer Educ 2021; 36:1030-1038. [PMID: 32140967 DOI: 10.1007/s13187-020-01729-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Effective communication between healthcare providers (HCPs) and patients is important for HCP well-being, patient engagement, and health outcomes. Yet, HCPs do not receive adequate communication skills training and report feeling unprepared for difficult conversations. A needs assessment of 64 cancer HCP trainees in Toronto, Canada, found that a majority of trainees rated themselves with low competency in communication skills to support patients through difficult conversations, while nearly all rated these skills as important to their practice. A blended multiprofessional communications program was developed including online theoretical learning and reflective practice in addition to in-person simulation with standardised patient actors. Since communication skills mastery is highly unlikely to occur at the termination of a single training program, the goal of the program was to stimulate participants' motivational beliefs about difficult conversations communication skills in order to deepen their commitment to learning and mastery. The motivational beliefs assessed included self-efficacy (self-perceived competence), intent to use techniques learned, and confidence in task mastery. After completing the course, participants' self-perceived competence in dealing with difficult conversations significantly increased by an average of 25 points (p < 0.001) on a rating scale of 1-100 (n = 40). Participants' intent to use techniques did not change significantly and remained high with an overall average of 89 points. After the course, participants rated their confidence in mastering techniques learned at an average score of 71 points. Multiprofessional, simulation-based training is an effective way to improve HCP trainees' motivational beliefs around having difficult conversations.
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Affiliation(s)
- Christine Tina Papadakos
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Patient Education, Cancer Care Ontario, Toronto, Canada
| | - Tylar Stringer
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Patient Education, Cancer Care Ontario, Toronto, Canada
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anne Embleton
- Practice Based Education, Collaborative Academic Practice, Princess Margaret Cancer Centre, Toronto, Canada
| | - Caitlin Gillan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kim Miller
- Department of Supportive Care, Division of Psychosocial Oncology, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Weiss
- Department of Supportive Care, Division of Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, Division of Palliative Care, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
| | - Meredith Giuliani
- Department of Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada.
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada.
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Lin JA, Im CJ, O'Sullivan P, Kirkwood KS, Cook AC. The surgical resident experience in serious illness communication: A qualitative needs assessment with proposed solutions. Am J Surg 2021; 222:1126-1130. [PMID: 34565516 PMCID: PMC9365675 DOI: 10.1016/j.amjsurg.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Background: Serious illness communication skills are important tools for surgeons, but training in residency is limited. Methods: Thirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes. Results: Residents had frequent conversations and employed known communication strategies. Three themes highlighted challenges they face. Illness severity included factors attributed to the illness that made serious illness communication more challenging: symptoms, poor prognosis, and urgency. Knowledge and feelings included the factual understanding and emotional experience of residents, patients, and families. Academic structure included hierarchy and the residents’ dual role as learners and teachers. On reflection, residents identified needing greater experiential practice, analogous to learning procedural skills. Conclusions: Surgical residents regularly face serious illness conversations with little training beyond observation of role models. Dedicated training may help meet this need.
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Affiliation(s)
- Joseph A Lin
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Cecilia J Im
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Patricia O'Sullivan
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Kimberly S Kirkwood
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Allyson C Cook
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA; Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
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Darrason M, Souquet PJ, Couraud S. Standardized vs peer-played patients for learning how to break bad news in lung cancer: A prospective crossover study. Respir Med Res 2021; 80:100856. [PMID: 34481303 DOI: 10.1016/j.resmer.2021.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Residents in respiratory medicine are often confronted with breaking bad news to patients. In communication skill training, a recurring question is whether to use standardized or peer-played patients for simulation METHODS: In this prospective single-center crossover study in pulmonology residents, a range of scenarios were performed during training sessions using standardized or peer-played patients. The aim was to assess whether patient type did alter the quality of the role-play. The residents completed post-scenario questionnaires about the role-play of each scenario, but also pre- and post-session questionnaires about their perception of the effectiveness of both modalities, and pre- and post-testing questionnaires about the psychological impact of the training. RESULTS Collectively, 4 scenarios were performed 52 times and evaluated 208 times by 52 residents. The use of standardized patients appeared to improve the quality of the patient role (8.8 ± 1.0 vs. 8.3 ± 1.1; p = 0.001) and the general quality of role-play (8.8 ± 1.0 vs. 8.2 ± 0.9; p = 0.008), without affecting the quality of the physician role played by the resident. There were no significant differences between standardized and peer-played patients regarding learning interest or psychological impact. Regardless of the modality, the training sessions did appear to significantly affect the residents' evaluations of their ability to break bad news to patients (5.7 ± 1.1 vs. 7.4 ± 1.1; p < 10-4). CONCLUSION Our results did not point to a superiority of either of these modalities for learning how to break bad news. Both may be used, depending on the local resources.
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Affiliation(s)
- Marie Darrason
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France.
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Plateforme Lyon Sud de Simulation en Santé (PL3S), Faculté de médecine et de maïeutique Lyon Sud, Université de Lyon, Lyon, France
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Dos Santos KL, Gremigni P, Casu G, Zaia V, Montagna E. Development and validation of The Breaking Bad News Attitudes Scale. BMC Med Educ 2021; 21:196. [PMID: 33827548 PMCID: PMC8028222 DOI: 10.1186/s12909-021-02636-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.
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Affiliation(s)
- Kátia Laureano Dos Santos
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil
| | - Paola Gremigni
- Department of Psychology, University of Bologna, viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Giulia Casu
- Department of Psychology, University of Bologna, viale Berti Pichat, 5, 40127, Bologna, Italy
| | - Victor Zaia
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil
- Centro Universitário FMABC, Instituto Ideia Fértl de Saúde Sexual e Reprodutiva, Av. Príncipe de Gales, 821, Santo André, 09060-650, São Paulo, Brazil
| | - Erik Montagna
- Centro Universitário FMABC, Faculdade de Medicina do ABC, Av Príncipe de Gales, 821, Santo André, 09060-650, Brazil.
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Hauk H, Bernhard J, McConnell M, Wohlfarth B. Breaking bad news to cancer patients in times of COVID-19. Support Care Cancer 2021; 29:4195-4198. [PMID: 33782762 PMCID: PMC8006640 DOI: 10.1007/s00520-021-06167-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
Breaking bad news is a mandatory provision in the professional life of nearly every physician. One of its most frequent occasions is the diagnosis of malignancy. Responding to the recipients' emotions is a critical issue in the delivery of unsettling information, and has an impact on the patient's trust in the treating physician, adjustment to illness and ultimately treatment. Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, several measures of social distancing and isolation have been introduced to our clinical setting. In the wake of these restrictions, it is important to reexamine existing communication guidelines to determine their applicability to face-to-face counseling in the context of social distancing, as well as to new communication technologies, such as telemedicine. We address these issues and discuss strategies to convey bad news the most empathetic and comprehensible way possible.
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Affiliation(s)
- Helen Hauk
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürg Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Meghan McConnell
- Department of Innovation in Medical Education, Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benny Wohlfarth
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Prince LK, Howle AM, Mikita J, Y'Barbo BC, Maynard SE, Sussman AN, Maursetter LJ, Lenz O, Scalese RJ, Sozio SM, Cohen S, Watson MA, Nee R, Yuan CM. Assessing Nephrology Fellows' Skills in Communicating About Kidney Replacement Therapy and Kidney Biopsy: A Multicenter Clinical Simulation Study on Breaking Bad News. Am J Kidney Dis 2021; 78:541-549. [PMID: 33741490 DOI: 10.1053/j.ajkd.2021.02.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/13/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Interpersonal communication skills and professionalism competencies are difficult to assess among nephrology trainees. We developed a formative "Breaking Bad News" simulation and implemented a study in which nephrology fellows were assessed with regard to their skills in providing counseling to simulated patients confronting the need for kidney replacement therapy (KRT) or kidney biopsy. STUDY DESIGN Observational study of communication competency in the setting of preparing for KRT for kidney failure, for KRT for acute kidney injury (AKI), or for kidney biopsy. SETTING & PARTICIPANTS 58 first- and second-year nephrology fellows assessed during 71 clinical evaluation sessions at 8 training programs who participated in an objective structured clinical examination of simulated patients in 2017 and 2018. PREDICTORS Fellowship training year and clinical scenario. OUTCOME Primary outcome was the composite score for the "overall rating" item on the Essential Elements of Communication-Global Rating Scale 2005 (EEC-GRS), as assessed by simulated patients. Secondary outcomes were the score for EEC-GRS "overall rating" item for each scenario, score < 3 for any EEC-GRS item, Mini-Clinical Examination Exercise (Mini-CEX) score < 3 on at least 1 item (as assessed by faculty), and faculty and fellow satisfaction with simulation exercise (via a survey they completed). ANALYTICAL APPROACH Nonparametric tests of hypothesis comparing performance by fellowship year (primary goal) and scenario. RESULTS Composite scores for EEC-GRS overall rating item were not significantly different between fellowship years (P = 0.2). Only 4 of 71 fellow evaluations had an unsatisfactory score for the EEC-GRS overall rating item on any scenario. On Mini-CEX, 17% scored < 3 on at least 1 item in the kidney failure scenario; 37% and 53% scored < 3 on at least 1 item in the AKI and kidney biopsy scenarios, respectively. In the survey, 96% of fellows and 100% of faculty reported the learning objectives were met and rated the experience good or better in 3 survey rating questions. LIMITATIONS Relatively brief time for interactions; limited familiarity with and training of simulated patients in use of EEC-GRS. CONCLUSIONS The fellows scored highly on the EEC-GRS regardless of their training year, suggesting interpersonal communication competency is achieved early in training. The fellows did better with the kidney failure scenario than with the AKI and kidney biopsy scenarios. Structured simulated clinical examinations may be useful to inform curricular choices and may be a valuable assessment tool for communication and professionalism.
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Affiliation(s)
- Lisa K Prince
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Anna M Howle
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jeffrey Mikita
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brian C Y'Barbo
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | | | | | | | - Stephen M Sozio
- School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Scott Cohen
- George Washington University, Washington, District of Columbia
| | - Maura A Watson
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Robert Nee
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christina M Yuan
- Walter Reed National Military Medical Center, Bethesda, Maryland.
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Terrasson J, Brédart A, El Mellah L, Doz F, Seigneur É, Dolbeault S. [Emotions Associated with Breaking Bad News in Pediatric Oncology and Parents-Pediatrician Communication: A Status Report]. Bull Cancer 2021; 108:399-414. [PMID: 33707034 DOI: 10.1016/j.bulcan.2020.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
This literature review aims to explain how the emotions aroused by the announcement of bad news in pediatric oncology affect communication between parents and pediatric oncologists. In the first part, we summarize the parents' expectations regarding communication with the pediatrician at this critical time in their child's care. Then, in a second part, we specify the influence that the emotions of pediatric oncologists and parents during these announcements can have on parent-pediatrician communication. In this context, the emotions and defense mechanisms of pediatric oncologists, parental distress as expressed by parents and as perceived or feared by pediatricians, are discussed. For this synthesis, we have endeavoured to select studies including both mothers and fathers. On the basis of the observations carried out in this review, we conclude by suggesting avenues for the practical implications and for future research. The continuation of research including both parents appears necessary to allow for a closer adaptation of the reactions and needs of each parent, particularly at key moments in the child's care, such as the announcement of bad news. Encouraging exchanges on the emotions felt within the medical and care team, particularly with the department psychologist, could be an opportunity for pediatricians to question their experience of the announcement of bad news and could promote the circulation of emotions in the parent-pediatrician relationship and communication.
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Affiliation(s)
- Johanna Terrasson
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France.
| | - Anne Brédart
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Laboratoire Psychopathologie et Processus de Santé, Université de Paris, 92100 Boulogne-Billancourt, France
| | - Leïla El Mellah
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France
| | - François Doz
- Centre SIREDO - Soins, Innovation, Recherche, en oncologie de l'Enfant, de l'aDOlescent et de l'adulte jeune, Institut Curie, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; UMR 144 CNRS, Institut Curie, 75005 Paris, France
| | - Étienne Seigneur
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Centre SIREDO - Soins, Innovation, Recherche, en oncologie de l'Enfant, de l'aDOlescent et de l'adulte jeune, Institut Curie, 75005 Paris, France
| | - Sylvie Dolbeault
- Unité de Psycho-Oncologie, Institut Curie, PSL Université Paris, 75005 Paris, France; Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, U1018, Université Paris-Sud, 94807 Villejuif, France
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Anestis E, Eccles FJR, Fletcher I, Simpson J. Neurologists' current practice and perspectives on communicating the diagnosis of a motor neurodegenerative condition: a UK survey. BMC Neurol 2021; 21:34. [PMID: 33482753 PMCID: PMC7821644 DOI: 10.1186/s12883-021-02062-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The communication of a life-changing diagnosis can be a difficult task for doctors with potential long-term effects on patient outcomes. Although several studies have addressed the experiences of individuals with motor neurodegenerative diseases in receiving this diagnosis, a significant research gap exists regarding professionals' perspectives, especially in the UK. This study aimed to assess UK neurologists' current practice and perspectives on delivering the diagnosis of a motor neurodegenerative disease, explore different aspects of the process and detail the potential challenges professionals might face. METHODS We conducted an anonymised online survey with 44 questions, grouped into four sections; basic demographic information, current practice, the experience of breaking bad news and education and training needs. RESULTS Forty-nine professionals completed the survey. Overall, participants seemed to meet the setting-related standards of good practice; however, they also acknowledged the difficulty of this aspect of their clinical work, with about half of participants (46.5%) reporting moderate levels of stress while breaking bad news. Patients' relatives were not always included in diagnostic consultations and participants were more reluctant to promote a sense of optimism to patients with poorer prognosis. Although professionals reported spending a mean of around 30-40 min for the communication of these diagnoses, a significant proportion of participants (21-39%) reported significantly shorter consultation times, highlighting organisational issues related to lack of capacity. Finally, the majority of participants (75.5%) reported not following any specific guidelines or protocols but indicated their interest in receiving further training in breaking bad news (78.5%). CONCLUSIONS This was the first UK survey to address neurologists' practice and experiences in communicating these diagnoses. Although meeting basic standards of good practice was reported by most professionals, we identified several areas of improvement. These included spending enough time to deliver the diagnosis appropriately, including patients' relatives as a standard, promoting a sense of hope and responding to professionals' training needs regarding breaking bad news.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT, UK.
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT, UK
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Szmulewicz C, Rouby P, Boyer C, Benhamou D, Capmas P. Communication of bad news in relation with surgery or anesthesia: An interdisciplinary simulation training program. J Gynecol Obstet Hum Reprod 2021; 50:102062. [PMID: 33453446 DOI: 10.1016/j.jogoh.2021.102062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Disclosure of damage related to care is a difficult area of communication due to the physician's feeling of guilt or the fear of liability. The aim of this study was to develop, and to evaluate the impact of an inter-disciplinary simulation program on communication of damage related to care. METHODS Residents in gynecology/obstetrics and anesthesiology participated in role-playing scenarios of communication of damage related to care. We assessed verbal, non-verbal communication skills and inter-disciplinary relations with a modified SPIKES protocol and with a video analysis with predefined indicators. We evaluated long-term impact of the training at 3-6 months with combining self-assessment and a video analysis on retained knowledge. RESULTS We included 80 residents in 15 sessions of simulation. Satisfaction regarding the simulation training was high (9.1/10 [8.9-9.3]). The part of the SPIKES protocol "setting up the interview" was the more difficult to apply. Empathic attitude was adopted 80 % of the time in the two scenarios with a life-threatening complication but was less common in the anesthetic one (broken tooth). The residents found interdisciplinary disclosure helpful due to support from the other resident. Immediately after the session, residents reported an important improvement in communication skills and that the session would significantly change their practice. At 3-6 months, reports were still largely positive but less than on immediate evaluation. CONCLUSION Residents did not master the most important communication skills. The interdisciplinary method to breaking bad news was felt useful.
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Affiliation(s)
- Claire Szmulewicz
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, Le Kremlin Bicêtre, France
| | - Pascal Rouby
- Unité de Psycho-Oncologie, Institut Gustave Roussy, F- 94800, Villejuif, France
| | - Caroline Boyer
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, Le Kremlin Bicêtre, France
| | - Dan Benhamou
- Département d'Anesthésie-Réanimation, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, Le Kremlin Bicêtre, France; LabForSIMS, Faculté de Médecine Paris Sud, Université Paris Saclay, F-94276, Le Kremlin Bicêtre, France; Unité de Recherche CIAMS EA4532, UFR STAPS Paris Saclay, Orsay, France
| | - Perrine Capmas
- Service de Gynécologie Obstétrique, Hôpital Bicêtre, Groupe Hospitalo-Universitaire Paris Saclay, AP-HP, F-94276, Le Kremlin Bicêtre, France; LabForSIMS, Faculté de Médecine Paris Sud, Université Paris Saclay, F-94276, Le Kremlin Bicêtre, France; Centre de recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, F-94800, Villejuif, France.
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Seddon L, Dick K, Carr SB, Balfour-Lynn IM. Communicating cystic fibrosis newborn screening results to parents. Eur J Pediatr 2021; 180:1313-6. [PMID: 33067713 DOI: 10.1007/s00431-020-03829-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 11/08/2022]
Abstract
The way results of cystic fibrosis (CF) newborn screening are communicated to parents is critical yet is done differently across the globe. We surveyed parents of 101 children in our tertiary London paediatric centre with a 48% response rate. Parental responses were as follows: 40/42 (95%) said the information could not have been given over the phone and 39/43 (91%) said they wanted both partners present; 27/42 (64%) said it was helpful having the health visitor also present; and 37/40 (92%) felt it was acceptable to wait until the next day for the sweat test. We have reduced the time from first contact to arriving in the home to 2-3 h.Conclusion: We believe that this survey backs up our approach of a home visit by a CF nurse specialist with the family's health visitor to break the news. This is challenging in the current COVID-19 pandemic. What is Known: • Breaking bad news can have a lasting impact on parents when not done the right way. • Giving results of cystic fibrosis (CF) newborn screening is done differently within the UK and around the world. What is New: • Our parental survey revealed that the majority (92%) believed this should be done face to face and not over the telephone. • There was a mixed response to whether the parents should be told the genotype (assuming the CF centre knew), and thus the CF diagnosis before the confirmatory sweat test was carried out.
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Karnieli-Miller O, Michael K, Gothelf AB, Palombo M, Meitar D. The associations between reflective ability and communication skills among medical students. Patient Educ Couns 2021; 104:92-98. [PMID: 32624329 DOI: 10.1016/j.pec.2020.06.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.
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Affiliation(s)
- Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Keren Michael
- Department of Human Services, Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel
| | - Ayelet Brand Gothelf
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Palombo
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Family Medicine, Clalit Health Services, Dan-Petah Tikva District, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gueneuc A, Dagher C, Rameh G, Haddad G, Hivernaud D, Mousty E, Favre R, Ville Y, Chalouhi GE. Announcing fetal pathology: Challenges encountered by physicians and potential role of simulation in training for breaking bad news. J Gynecol Obstet Hum Reprod 2021; 50:102044. [PMID: 33346160 DOI: 10.1016/j.jogoh.2020.102044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/29/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Informing couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain. MATERIALS AND METHODS A questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news. RESULTS 193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions. CONCLUSION This survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.
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Pritam A, Kumar M, Choudhary SR. Patient Satisfaction after Antenatal Joint Fetal Medicine and Pediatric Surgery Counseling. J Indian Assoc Pediatr Surg 2020; 25:357-362. [PMID: 33487937 PMCID: PMC7815028 DOI: 10.4103/jiaps.jiaps_154_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/07/2019] [Accepted: 12/28/2019] [Indexed: 11/05/2022] Open
Abstract
Aims and Objectives: The aim of this study was to find out the level of satisfaction among couples receiving antenatal counseling provided jointly by fetal medicine specialists and pediatric surgeons. Materials and Methods: This was a questionnaire-based observational study. A total of 110 consecutive couples who were antenatally diagnosed with fetal structural anomaly and received counseling by fetal medicine specialist and pediatric surgeon together, were given a validated patient satisfaction questionnaire (PSQ-18) after delivery to assess their level of satisfaction regarding the antenatal care they received. Results: A total of 120 couple responded to the questionnaire, mean gestational age at delivery was 33.8 ± 7.14 weeks. In PSQ, 75.8% gave high scores for general satisfaction, maximum subjects provided high scores for interpersonal manner (IM) (77.5%) and communication (77.5%), and the least number gave high scores for time spent with the doctor (50.8%) and accessibility (42.5%). The technical quality (TQ) subscale was significantly high for the stillbirth/abortion group compared to live birth (P = 0.020). Significantly high scores for TQ (P = 0.037) and IM (P = 0.023) were obtained in the <20 weeks group. Conclusion: The joint counseling provided good interaction opportunity to the couple but still fell short of their expectations regarding time spent with the doctor and their accessibility.
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Affiliation(s)
- Anuja Pritam
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
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Hardicre NK, Arezina J, McGuinness A, Johnson J. Managing the unmanageable: A qualitative study exploring sonographer experiences of and training in unexpected and difficult news delivery. Radiography (Lond) 2021; 27:369-76. [PMID: 33077330 DOI: 10.1016/j.radi.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Ultrasound is used to diagnose pregnancy complications such as miscarriage and fetal health conditions. Within the UK, findings identified during ultrasound examination are delivered by sonographers as standard. However, little is known about the experiences of sonographers when delivering unexpected news (DUN), the impact this has on them, or their preferences for training on news delivery. METHODS Qualitative interviews were completed with fourteen sonographers and were analysed using an inductive thematic approach. Key themes were identified. RESULTS Participants said that obstetric ultrasound often involves 'managing' the patient encounter, including: navigating (unrealistic) patient expectations; handling their own responses to unexpected findings; and managing interaction by moderating emotional expression and communication practices to deliver patient-centred and empathic care. Persistent uncertainty of outcomes, prognosis and patient reactions, alongside high workloads, and frequent siloed working, makes DUN challenging for sonographers. DUN was experienced as emotionally burdensome, and sonographers employed personal coping strategies to reduce stress/burnout. However, the greatest mitigation for stress/burnout was support from peers, though accessing this was challenging. Peers were also described as key sources of learning, especially through observation. CONCLUSION Challenges associated with DUN are an enduring experience for sonographers. Facilitating regular ongoing support and training would enable sonographers to cope with negative aspect of the role, including the emotional burden of DUN. IMPLICATIONS FOR PRACTICE Long patient lists are prioritised to deal with high demand for services. However, sonographer wellbeing needs to be a key priority to avoid stress and burnout. This means facilitating protected time to access support from colleagues, multidisciplinary working where possible, and regular access to training to support DUN. Training focusing on communication practices, alongside dealing with emotional burdens of the role would be beneficial.
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Mailankody S, Rao SR. "PENS" approach for breaking bad news-a short and sweet way! Support Care Cancer 2020; 29:1157-1159. [PMID: 33025228 DOI: 10.1007/s00520-020-05807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
India has a distinct pattern of cancer care delivery, with unique sociocultural milieu and patient characteristics. In the current era of patient-centered and personalized care, there is an unmet need for an abbreviated protocol for breaking bad news to cancer patients suitable for the Indian outpatient setting. We propose a short four-step protocol for breaking bad news effectively and caringly, in the outpatient department of oncology clinics.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India. .,Department of Medical Oncology, Manipal Comprehensive Cancer Care Centre, Shirdi Sai Baba Cancer Block, Kasturba Medical College, Madhavnagar, Eshwarnagar, Manipal, 576104, Karnataka, India.
| | - Seema Rajesh Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Lien Collaborative for Palliative Care, Asia Pacific Hospice Palliative Network, Singapore, Singapore.,School of Medicine, Cardiff, UK
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Sherwood M, Rioux D, Knight R, LeBlanc M, Betsch T, Giuliani M, Caissie A. Increasing Undergraduate Exposure to Oncology: the Role of Oncology Interest Groups. J Cancer Educ 2020; 35:997-1001. [PMID: 31165422 DOI: 10.1007/s13187-019-01554-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study describes a medical school oncology interest group (OIG) and assesses its influence on student perceptions of oncology, interest in pursuing oncology as a career, and comfort levels with oncology topics such as breaking bad news. From 2015 to 2017, the OIG annual event took place at a satellite campus of a larger Canadian undergraduate medical school. The event provided a question and answer period with a panel of physicians from multiple oncology specialties-discussions focused around lifestyle, training, clinical work, lifestyle, and career focus. Small physician-led groups taught breaking bad news using the SPIKES framework. The interest group also provided a mentoring and networking opportunity to interested students. Pre- and post-event surveys were distributed to students and physicians. For three consecutive years, the student-run, and physician-mentored OIG successfully recruited student and physician participants, providing a clinical skill teaching session as well as mentorship opportunities to students. Pre-event surveys found that only 20% of students believed their current curriculum was adequate as it relates to oncology education. In pre-session, 13% (6/45) of students indicated comfort with the skill of breaking bad news, compared with that in post-session with 81% (34/42) of students feeling comfortable. When asked "How likely are you to pursue a future elective opportunity in oncology?" 49% (20/41) of students indicated "likely" as their response in the pre-session. This response increased post-session to 70% (28/40). The event highlighted the potential for OIGs to increase student interest in pursuing oncology electives and student-perceived comfort with breaking bad news. OIGs are important in promoting interest in the field of oncology and in improving confidence in breaking bad news. This medical student-created, run and maintained oncology interest group supplemented standard curriculum by providing relevant educational and mentorship opportunities to students. This study highlights the feasibility of implementing a self-sustaining medical school oncology interest group and its potential to positively impact student learning and interest in oncology.
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Affiliation(s)
| | - Danielle Rioux
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | | | - Max LeBlanc
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Taylor Betsch
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
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Matthews T, Baken D, Ross K. Single cases from multiple perspectives: a qualitative study comparing the experiences of patients, patients' caregivers, surgeons, and nurses when bad news is delivered about cancer. ACTA ACUST UNITED AC 2020; 2:e32. [PMID: 34192274 DOI: 10.1097/OR9.0000000000000032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text Background: Qualitative literature on the experiences of those delivering and receiving bad news about cancer has revealed what these parties consider important during the process across many different patient cases. The current study aims to add to this understanding by employing a “linked case" study design to directly compare the perspectives of patients, their caregivers, and health care professionals (HCPs) involved in a series of single-patient cases of breaking bad news. Method: Semistructured interviews were conducted with 13 participants (5 patients, 4 caregivers, 2 surgeons, and 2 nurses) who formed 5 linked cases. Interviews were analyzed using interpretative phenomenological analysis and directly compared within each linked case. Results: Analyses identified 2 main superordinate themes. The first labeled “accurately perceiving and responding to needs," included HCPs recognizing and responding to patients’ and caregivers’ individual emotional and informational needs. The second labeled “carers fulfilling necessary roles," identified the various roles HCPs and patients’ caregivers took to satisfactorily meet patients’ needs. Conclusions: The findings suggest the importance of HCPs accurately perceiving and responding to patients’ and caregivers’ various needs and caregivers ability and willingness to fulfilling support roles in a way that aligns with their own resources and patients’ needs. This highlights the value of HCPs developing and applying interpersonal skills within bad news encounters, working as a team, and exploring caregivers’ resources for patient support.
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Portes M, Mousty E, Grosjean F, Lamouroux A, Faure JM, Fuchs F, Letouzey V. [Training simulation during the announcement of fetal malformation discovered on screening ultrasound: Results of a pilot study]. ACTA ACUST UNITED AC 2020; 49:122-127. [PMID: 32919088 DOI: 10.1016/j.gofs.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Breaking bad news (BBN) to a pregnant woman with fetal abnormalities (FA) on ultrasound (US) examination is a challenge. Announcement technique influences patient reaction. Physicians receive little training in BBN. The simulation and using a BBN protocol as the English SPIKES protocol which guides the announcement consultation according to 6 steps (Setting Up, Perception, Invitation, Knowledge, Emotions and Empathy, Strategy and Summary) can be used for this teaching. The objective was to assess feasibility simulation scenarii of BBN for FA discovered during US and to evaluate the usefulness of SPIKES protocol in this situation. METHODS Two scenarios have been created combining US simulator (US Mentor, Symbionix®) with simulated patient (SP). Scenarii objectives were to diagnose FA and break it to SP. Checklist derived from SPIKES was fulfilled by two investigators thanks to video recording, the SP and every participant (residents, physicians, fetal medicine specialists [FMS]). Participants filled out survey about the usefulness of this exercise too. RESULTS Nine physicians (3 residents, 4 physicians, 2 FMS) produced 18 scenarii. Seventy-eight percent of physicians thought simulation was like real situation of BBN during US examination. Majority of participant (88%) found that this simulation training could help them to increase their ability to BBN and that it can be used to teach residents (89%) or physicians (100%). FMS had better SPIKES checklist than physicians (P<0,05). CONCLUSION Simulation scenario of BBN for FA discovered during US is feasible by combining US simulator and SP. SPIKES protocol can be useful but a validated checklist should be created.
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Affiliation(s)
- M Portes
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France.
| | - E Mousty
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - F Grosjean
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - A Lamouroux
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - J M Faure
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - F Fuchs
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - V Letouzey
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
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Anestis E, Eccles F, Fletcher I, French M, Simpson J. Giving and receiving a diagnosis of a progressive neurological condition: A scoping review of doctors' and patients' perspectives. Patient Educ Couns 2020; 103:1709-1723. [PMID: 32299642 DOI: 10.1016/j.pec.2020.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/04/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Delivering a life changing diagnosis can be a distressing experience for patients and a challenging task for professionals. Diagnosis delivery can be especially difficult for individuals with neurodegenerative diseases such as motor neurone disease (MND), multiple sclerosis (MS) and Parkinson's disease (PD). This review aims to scope the literature on doctors' and patients' perspectives on diagnosis delivery for these conditions in order to enhance our understanding in this area and identify potential research gaps. METHODS A scoping review methodology was used, and data were summarised using content analysis. RESULTS 47 studies fulfilled the inclusion criteria. Studies showed that although patients were generally satisfied with diagnosis delivery, a considerable proportion was still dissatisfied with aspects of the consultation, especially the information and time provided and the doctor's approach. Only six studies addressed doctors' perspectives, which focused more on doctors' practice. CONCLUSION There was a significant research gap in professionals' perspectives. The review also found that although basic standards of good practice were being met, a significant proportion of patients were dissatisfied with diagnosis communication. PRACTICE IMPLICATIONS Professionals delivering such diagnoses need to assess and respond to patients' information needs, provide time for questions and maintain an empathic attitude.
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Affiliation(s)
| | - Fiona Eccles
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Ian Fletcher
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1, UK
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Abstract
Breaking bad news (BBN) is a key advanced communication skill that physicians must learn. Despite the breadth of literature describing patients' preferences and data citing poor physician competency in this arena, there remains significant dissatisfaction with how doctors deliver bad news. One way to solve this dilemma is to ensure that we are using the best evidence-based educational approaches to train the cadre of medical students who graduate from medical school each year. This article provides a 15-year review of articles on BBN in the undergraduate medical education curriculum that have been validated using the Medical Education Research Quality Instrument (MERSQI) (Acad Med 90:1067-76, 2015). This narrative review aims to identify articles which describe undergraduate medical education curriculum that evaluate how to best teach students to communicate bad news to patients. In the process, the authors reviewed 179 abstracts in 118 academic journals. Articles that met the inclusion criteria were evaluated using the MERSQI and those that scored higher than 11.3 were chosen for analysis. This paper summarizes the 15 articles that met the criteria. The review reveals (1) standard components which should be included in an undergraduate BBN curriculum, (2) a pressing need for utilizing a teaching and evaluation tool that incorporates nonverbal communication, and (3) a further need to test long-term curriculum retention.
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Affiliation(s)
| | - Archana Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ USA
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von Blanckenburg P, Hofmann M, Rief W, Seifart U, Seifart C. Assessing patients´ preferences for breaking Bad News according to the SPIKES-Protocol: the MABBAN scale. Patient Educ Couns 2020; 103:1623-1629. [PMID: 32151521 DOI: 10.1016/j.pec.2020.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Quality of breaking bad news can seriously affect the course of disease. A frequently applied guideline is the SPIKES-Protocol that have been designed from the physician's perspective. Little is known about patients' preferences in breaking bad news. Our aim was to develop a questionnaire based on the SPIKES-protocol to detect patients´ preferences for breaking bad news communication. METHODS TheMarburg Breaking Bad News Scale (MABBAN) was developed and administered to 336 cancer patients. We used exploratory factor analysis. To examine potential relationships according to demographic and medical variables, regression analyses were conducted. RESULTS The novel questionnaire supported the six SPIKES-components of breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy. Perception and Invitation clustered together to one subscale. Depending on clinical and demographic variables different components were rated as important. CONCLUSION Communication preferences in breaking bad news can be assessed using a SPIKES-based questionnaire. Physicians should improve the setting, share knowledge in all clarity, involve the patients in further planning, and consider demographical variables. PRACTICE IMPLICATIONS Using SPIKES as a framework can optimize breaking bad news conversations but it seems important to emphasize the individual preferences beyond the six steps and tailor the communication process to the individual.
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Affiliation(s)
- Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
| | - Mareike Hofmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.
| | | | - Carola Seifart
- Institutional Review Board, Clinical Ethics, Philipps-University of Marburg, Marburg, Germany.
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Carrard V, Bourquin C, Orsini S, Schmid Mast M, Berney A. Virtual patient simulation in breaking bad news training for medical students. Patient Educ Couns 2020; 103:1435-1438. [PMID: 32019697 DOI: 10.1016/j.pec.2020.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.
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Affiliation(s)
- Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Céline Bourquin
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sandy Orsini
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marianne Schmid Mast
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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