Financial toxicity and dialysis: Autonomy and truth-telling in resource-limited settings

From an ethical perspective, resource limitations provide a challenge for healthcare providers. Handling disclosure of the financial details of treatment options in a way that empowers patients, even in the face of extreme poverty, requires careful consideration of the personal preferences and motivations of each patient. This article will consider the high costs of dialysis for patients experiencing extreme poverty in light of various ethical principles, including informed consent and truth-telling. It will conclude that a graduated method of disclosing the physical and financial burdens of each treatment option is the best way forward, particularly for healthcare workers engaged in resource-limited settings.

Assessment of attitude and practices toward breaking the bad news among physicians in a national tertiary government hospital for infectious diseases from October 2020 to October 2021

Background@#Delivering bad news to patients is one of the most difficult tasks of physicians that play a big role in the process of treatment and cooperation of patients. Patients generally have the right to be informed of their condition, but the debate over the importance of the attitude of telling the truth is still an issue. @*Objective@#This study aimed to understand the attitude and practices toward breaking the bad news among physicians in a National Tertiary Government Hospital for infectious Diseases from October 2020 to October 2021.@*Methods@#This cross-sectional study was conducted at the San Lazaro Hospital from October 2020 to October 2021. A self-administered questionnaire was adapted to elicit information on physicians’ knowledge and practices about breaking bad news to patients and their families. Inclusion criteria included all the practicing physicians assigned in the clinical areas either full time or part time medical specialists, residents and fellows and hospitalist in San Lazaro Hospital. Physicians who were assigned in the non-clinical areas and did not see or handle patients and non-employees of the institution and who refused to sign the informed consent were excluded. Total Purposive Sampling was utilized. Data were gathered using a validated 3-part 34 item personally administered questionnaire and was presented in Descriptive Statistics Frequency distribution for the demographics, ANOVA, Linear regression analysis.@*Results@#A total of 100 participants was included and based on socio-demographic characteristics of respondents toward breaking the bad news. Majority of the respondents were aged 35 – 54 years old with 52 or 52%, female with 69 or 69%, were fellows with 41 or 41%, specialty was Family Medicine with 36 or 36%, and majority of the respondent’s qualification was GP with training with 46 or 46%. The study revealed that sex (t = -2.070, p = 0.042) had significant association to the attitude and practices toward breaking the bad news among practicing physicians at 0.05 level of significance. Thus, male respondents has had higher attitude and practices toward breaking the bad news as compare to female respondents. @*Conclusion@#According to the findings of this study, clinicians at San Lazaro Hospital demonstrated a good attitude and practice regarding breaking the bad news between October 2020 and October 2021. The researcher believed want to help their patients, and most of them have the necessary knowledge and skills for breaking bad news.

Dizer a verdade em psicanálise: uma abordagem genealógica a partir de Foucault / Truth-telling in psychoanalysis: a genealogical approach according to Foucault

Resumo: Este artigo aborda a problemática da relação entre sujeito e verdade em psicanálise por uma perspectiva genealógica. Se Lacan recolocou na tradição psicanalítica o antigo problema da espiritualidade, perguntando-se sobre o trabalho do sujeito consigo mesmo e as condições de acesso à verdade, é preciso se perguntar como essa modalidade de dizer a verdade se constituiu historicamente e de que tecnologias é formada. A partir dos estudos de Foucault, examina-se o lugar da sexualidade na enunciação da verdade em psicanálise e de que maneira a relação do sujeito consigo mesmo nessa experiência pode ser atravessada por uma hermenêutica.

Abstract: This article discusses the problem of the relationship between subject and truth in psychoanalysis from a genealogical perspective. If Lacan reposed the old problem of spirituality in the psychoanalytic tradition, wondering about the subject's work on himself and the conditions to access the truth, one must question how this modality of truth-telling was historically constituted and from what technologies it is formed. Based on studies of Foucault, we examine the place of sexuality in the enunciation of truth in psychoanalysis and the way the subject's relationship with himself in that experience can be characterized by a hermeneutic.

Communicating bad news: an integrative review of the nursing literature / Comunicación de malas noticias: revisión integradora de literatura en enfermería / Comunicação de más notícias: revisão integrativa de literatura na enfermagem

ABSTRACT Objectives: describe how the process of breaking bad news is established and identify how nurses approach the task of giving bad news. Method: integrative review of the literature for articles in Portuguese and English published between 1993-2014, in the databases: Bireme, PubMed, Scopus, Web of Science, CINAHL and Embase. Nine articles were included using the selection flow chart. A digital form was completed for each article according to the Consolidated Criteria for Reporting Qualitative Research checklist and the level of scientific evidence was determined. Results: Of the 99 articles in identified, nine were included after applying the selection flowchart. Discussion: breaking bad news is frequent in the area of oncology and palliative care, with a strong cultural influence on the autonomy of nurses in this process. Conclusion: the approach and skills of the nurse during this task influences the patient's reaction to the message. The theme is scarce in the literature and merits further investigation.

RESUMEN Objetivos: Describir como se establece el proceso de comunicación de malas noticias e identificar como el enfermero practica la comunicación de malas noticias. Método: Revisión integradora de la literatura con artículos en portugués e inglés referente al período 1993-2014 en las bases de datos Bireme, PubMed, Scopus, Web of Science, CINAHL y Embase. Se eligió nueve artículos por el flujograma de selección. Para cada artículo fue rellenada una ficha electrónica, elaborado un checklist del Consolidated Criteria for Reporting Qualitative Research y verificado el nivel de evidencia científica. Resultados: Fueron identificados 99 artículos e incluidos nueve por el flujograma de selección. Discusión: Transmitir malas noticias es frecuente en las áreas de oncología y cuidados paliativos, con fuerte influencia cultural en la autonomía del enfermero en ese proceso. Conclusión: El modo y la habilidad del enfermero durante la acción influenciarán la reacción del paciente sobre el mensaje. El tema es escaso en la literatura, necesitando ser explotado.

RESUMO Objetivos: Descrever como se estabelece o processo de comunicação de más notícias e identificar como o enfermeiro pratica a comunicação de más notícias. Método: Revisão integrativa da literatura com artigos em português e inglês referente ao período 1993-2014 nas bases de dados Bireme, PubMed, Scopus, Web of Science, CINAHL e Embase. Elegeram-se nove artigos pelo fluxograma de seleção. Para cada artigo foi preenchida uma ficha eletrônica, elaborado um checklist do Consolidated Criteria for Reporting Qualitative Research e verificado o nível de evidência científica. Resultados: Foram identificados 99 artigos e incluídos nove pelo fluxograma de seleção. Discussão: Transmitir más notícias é frequente nas áreas de oncologia e cuidados paliativos, com forte influência cultural na autonomia do enfermeiro nesse processo. Conclusão: O modo e a habilidade do enfermeiro durante a ação influenciarão a reação do paciente acerca da mensagem. O tema é escasso na literatura, necessitando ser explorado.

Verdade e reconciliação para as "gerações roubadas": revisitando a história da Austrália / Enfrentando la historia de Australia: verdad y reconciliación para las generaciones robadas / Facing Australia's history: truth and reconciliation for the stolen generations

O governo do Estado da Tasmânia e o Senado Federal da Austrália tomaram medidas recentes no sentido de criar um Tribunal de Reparações para os povos Aborígines e Insulares do Estreito de Torres (ATSI). Os ATSI foram separados de suas famílias e comunidades por políticas estatais de remoção forçada do século 20. Este trabalho propõe uma Comissão de Verdade e Reconciliação que incorpore lições internacionais.

The Tasmanian State Government and the Australian Federal Senate have taken recent steps towards setting up a Reparations Tribunal for Aboriginal and Torres Strait Islander (ATSI) people who were separated from their families and communities under State-based forced removal policies of the 20th Century. This paper proposes a Truth and Reconciliation Commission drawing on international lessons.

El Gobierno del Estado de Tasmania y el Senado Federal Australiano están avanzando en la creación de un Tribunal de Reparaciones para los Aborígenes e Isleños del Estrecho de Torres (AIET). Los AIET fueron separados de sus familias y comunidades bajo políticas estatales de separación forzada durante el siglo 20. Este artículo propone la creación de una Comisión de Verdad y Reconciliación que incorpore lecciones internacionales.

Opinions of Students About Terminal Care / 医学教育

The cooperation of health, welfare, and medical staff are essential for terminal care. To clarify the opinions of and experiences with terminal care of students of these professional schools, a questionnaire survey was conducted of 527 students from six schools. All professional school students had little or nc experience with terminal care. Opinions about the importance of terminal care education differed significantly between students of welfare professional schools and students of other medical professional schools. All students of welfare professional schools thought that terminal care education is essential Medical students were significantly more likely than students of other professional schools to agree that patients should be told the truth about their condition by the doctors in charge. Educational programs in which students can gain experience with terminal care are necessary.

The Process of and Factors Influencing the Formation of Doctors' Attitudes Toward Truth-Telling / 医学教育

The process of doctors formulating their attitudes toward truth-telling in the care of dying patients was examined, and factors influencing the process were analyzed based on an interview survey of 38 doctors. Learning of conventional ways of handling information in medicine, clinical experience, and personal beliefs were the major factors found to determine doctors' attitudes toward truth-telling.<BR>Doctors conform to the current practice of not telling the truth to patients because of instructions by superiors, the need for team care, dominant social norms, and the fear of responsibility in initiating new methods. In terms of clinical experience, both interaction with specific patients and the necessity of an efficient routine in case management affect doctor behavior. Since each doctor's personal philosophy is considered to be the basis of his or her attitude toward truth-telling, most doctors avoid interfering with the decisions of other doctors, and view teaching ethics in medicine rather skeptically.