Breaking bad news: a descriptive study of physicians' perspective of Sindh, Pakistan.

OBJECTIVE: To assess the perception and attitude of physicians related to breaking bad news. METHODS: The cross-sectional study was conducted at three teaching hospitals in Karachi and Mirpurkhas, Pakistan, from April 2019 to February 2020, after approval from Hamdard University, Karachi, and comprised physicians of either gender having direct patient contact. Data was collected using a questionnaire based on literature. The questionnaire was pilot-tested before distribution among the subjects. The responses were categorised with respect to age, gender and professional experience. Data was analysed using SPSS 25. RESULTS: Of the 230 subjects, 119(51.7%) were females. The overall mean age was 34.5±8.8 years and mean professional experience was 9.1±8.2 years. Overall, 19(8.3%) subjects believed they had a very good ability to deliver bad news, while 26(11.3%) avoided telling the patient the truth about diagnosis, prognosis and treatment. Age had a significant association with correctly defining breaking bad news (p<0.05). CONCLUSIONS: The skill level related to breaking bad news was found to be deficient.

Comunicação de más notícias como cuidado fundamental à pessoa em situação crítica e família: intervenção especializada de enfermagem / Communicating bad news as fundamental care for people in critical situations and their families: specialized nursing intervention

A comunicação de más notícias em contexto de cuidados à pessoa em situação crítica produz um impacto profundo no bem-estar físico, psicológico e social desta e sua família. Exige uma intervenção humanizada, suportada no conhecimento da singularidade da pessoa cuidada, pois transporta um conjunto de informações que afetam seriamente, e de forma adversa, a visão que a pessoa terá sobre o seu futuro. A comunicação de más notícias assume-se, portanto, como um cuidado fundamental, que impõe uma avaliação sistemática da pessoa/família, sensibilidade ética e moral e a implementação de um conjunto de estratégias de comunicação adaptadas. O conhecimento dos profissionais de saúde sobre como comunicar más notícias é ainda insuficiente, sendo que esta é uma área que, no seio da praxis, carece de formação e modelos de intervenção próprios. Este relatório apresenta uma análise reflexiva sobre o percurso de desenvolvimento de competências como mestre em enfermagem na área de especialização pessoa em situação crítica, guiado pelos objetivos: desenvolver competências de enfermagem especializadas no cuidado à Pessoa em situação crítica e família; aprofundar conhecimentos no âmbito da comunicação de más notícias; e aplicar os princípios da comunicação terapêutica de más notícias. Para tal, realizou-se uma revisão integrativa da literatura, bem como estágio em contexto de Serviço de Urgência e Unidade de Cuidados Intensivos. Este percurso formativo foi acompanhado por momentos de reflexão individual, em conjunto com os enfermeiros orientadores e com o docente-orientador, sobre (e na) prática de cuidados. A teoria do cuidado fundamental de Kitson serviu de fio orientador do pensamento e das intervenções em contexto clínico. Este percurso permitiu mobilizar conhecimentos teóricos e evidência científica para a prática de cuidados e constitui-se num momento marcado pela análise reflexiva sobre as experiências vividas à luz das competências desenvolvidas. Trouxe também a possibilidade de refletir sobre a enfermagem de hoje, valorizando a importância da utilização da comunicação terapêutica na comunicação de más notícias, enquanto cuidado fundamental no processo de cuidar da pessoa em situação crítica e família. O percurso de desenvolvimento competências como mestre em enfermagem na área de especialização pessoa em situação crítica permitiu o desenvolvimento pessoal e profissional, contribuindo para uma prática de cuidados de enfermagem avançada, que põe em evidência a comunicação de más notícias como cuidado fundamental. Este percurso trouxe subsídios para a mestranda integrar grupos de trabalho responsáveis pela melhoria contínua da qualidade dos cuidados, permitindo a divulgação dos resultados obtidos na revisão integrativa da literatura e da valorização da comunicação de más noticias como cuidado fundamental.

The communication of bad news in critical care settings has a profound impact on the physical, psychological and social well-being of the person in critical condition and his/her family. It requires a humanised intervention, supported by the knowledge of the patient's uniqueness, as it carries a set of information that seriously and adversely affects the person's vision of his/her future. The communication of bad news is, therefore, a fundamental care, which requires a systematic assessment of the person/family, ethical and moral sensitivity, and the implementation of a set of adapted communication strategies. Health professionals' knowledge on how to communicate bad news is still insufficient, and this is an area that, within their praxis, lacks proper training and intervention models. This report presents a reflective analysis on the development of competencies as a master's student in nursing in the area of specialisation in critically ill patients, guided by the following objectives: to develop specialist nursing skills in caring for critically ill patients and their families; to deepen the knowledge on the communication of bad news; and to apply the principles of therapeutic communication of bad news. To this end, an integrative literature review was conducted, as well as an internship in the context of the Emergency Department and Intensive Care Unit. This formative journey was accompanied by moments of individual reflection, together with the nurse-supervisor and the teacher-supervisor, on (and in) care practice. Kitson's theory of fundamental care served as a guiding thread for the thinking and interventions in clinical settings. This journey allowed for the mobilisation of theoretical knowledge and scientific evidence for care practice and was a moment marked by the reflective analysis of experiences in the light of the skills developed. It also provided the opportunity to reflect on today's nursing, emphasising the importance of the use of therapeutic communication in the communication of bad news, as a fundamental care in the process of caring for critically-ill patients and their families. The development of competencies as a master's student in nursing in the area of specialisation in critically ill patients allowed for personal and professional development, contributing to an advanced nursing care practice, which highlights the communication of bad news as a fundamental care. This journey allowed the master's student to integrate working groups responsible for the continuous improvement of the quality of care, enabling the dissemination of the results obtained in the integrative literature review and the valorisation of the communication of bad news as essential care.

Behavioral Patterns in Breaking Bad News Communication: An Ethnographic Study with Hematologists.

Hematologists adequately disclosing bad news is a critical point precluding patient-centered communication. Specific courses on communication for hematologists seem to be rare, as well as research exploring their communicative skills and patterns. We aim at describing the hematologists' behavior during difficult conversations to account for behavioral patterns in communication and provide new insights regarding teaching skills to communicate bad news. We employed a focused visual ethnography to answer the following research: "what are hematologists' behavioral patterns in communicating bad news to patients and families?" The collected data included (1) video recordings, (2) observational field notes, (3) interviews with hematologists. The analysis highlighted four patterns: (1) a technical-defensive pattern, (2) an authoritative pattern, (3) a relational-recursive pattern, and (4) a compassionate sharing pattern. Hematologists seem to have difficulty expressing compassionate caring and empathetic comprehension. Communication skills remain a challenge for hematologists. The study of behavioral patterns can lead to increasingly targeted training interventions for this specific learner population.

Breaking bad news skill of postgraduate residents of tertiary care hospital of Lahore, Pakistan: A cross-sectional survey.

OBJECTIVE: To evaluate the skill of postgraduate residents in breaking bad news to the patients in a tertiary care hospital. METHODS: The cross-sectional study was conducted at King Edward Medical university, Lahore, Pakistan, from January to April 2016, and comprised postgraduate residents of different specialties at Mayo Hospital, Lahore. The subjects were examined in terms of their personal experience in breaking bad news to the patients by means of a specifically-designed questionnaire based on six-step protocol of Setting, Perception, Invitation, Knowledge, Empathy and Summarising model. Data was qualitatively and quantitatively analysed using SPSS 22. RESULTS: Of the 200 respondents, 141(70.5%) were males and 59(29.5%) were females. Overall mean age of the sample was 23 } 2.55years. Of the total, 94(47%) respondents were only fairly satisfied with their breaking bad news skill, while 130(65%) were eager to get training in this regard. The knowledge regarding breaking bad news protocols was lacking across all comparisons (p>0.05). CONCLUSIONS: Majority of the residents had little satisfaction regarding their breaking bad news skill. It is necessary to plan special training for the residents in this key area.

Affective communication during bad news consultation. Effect on analogue patients' heart rate variability and recall.

OBJECTIVE: The aim of the study was to investigate the effect of physicians' supportive communication on analogue patients' (APs) heart rate variability (HRV) and recall, while watching a video of palliative treatment being explained to a female patient. METHODS: Sixty healthy women, acting as APs, were randomly assigned to watch one of two versions (standard vs. affective) of a scripted video-vignette of a bad news consultation to a female patient. The physician's communication differed only in the delivery of four supportive comments. Empathy, support and engagement perception were assessed by three questions. APs' HR was recorded during video-observation and recall was assessed immediately after. HRV was determined through measures defined in time and frequency domains. RESULTS: Data of 54 APs (27 + 27) were included. The group with supportive communication perceived the physician as more empathic and supportive. Intra- and Inter-group comparisons suggested a greater sense of stress in the standard communication group. Recall did not differ in the two groups. CONCLUSION AND PRACTICE IMPLICATIONS: Findings show that the use of supportive expressions contribute to the perception of the physician as more empathic, potentially buffer patients' arousal after a bad news announcement, but does not confirm a positive impact on general recall.

A Comunicação da má notícia em contexto de morte inesperada / The Communication of Bad News in the Context of Unexpected Death

A comunicação da má notícia em saúde constitui uma das maiores dificuldades para os profissionais de saúde e nomeadamente para os enfermeiros. Esta dificuldade eleva-se quando o processo de morrer se enquadra num contexto de morte inesperada, não só pela imprevisibilidade deste terrível acontecimento, como pela impreparação não só dos profissionais em lidarem com a situação assim como, dos familiares em receberem a notícia e iniciarem o processo de luto. Pretendemos com este estudo compreender a(s) experiência(s) dos enfermeiros no processo de comunicação da má notícia em contexto de morte inesperada, no serviço de urgência, de modo a contribuir para uma melhor intervenção nesse processo de comunicação. O estudo assenta na investigação qualitativa, com caráter descritivo e de características fenomenológicas e a estratégia de recolha de dados incidiu na entrevista semiestruturada, dirigida a enfermeiros de um serviço de urgência. Os dados foram analisados com o recurso à análise de conteúdo. Os resultados demonstram que os enfermeiros consideram o processo de comunicação da má notícia difícil e constrangedor, salientando no entanto a relevância que deve ser atribuída ao mesmo no contexto dos cuidados. Foram evidenciadas as dificuldades sentidas no processo, centrando-se estas aos níveis do profissional, da dinâmica do serviço e do processo de comunicação, assim como as estratégias que são mobilizadas e que se relacionam sobretudo com o procedimento, a equipa e o profissional. A comunicação da má notícia despoleta diversos sentimentos e reações, inerentes à situação, propriamente dita, e ao ato de comunicar a má notícia.Destacaram-se ainda os fatores facilitadores e dificultadores deste processo de comunicação, os quais se entrecruzam. Emergiram ainda do estudo, um conjunto de sugestões que nos proporcionam novas perspetivas de intervenção, com implicações a nível da organização, da dinâmica da equipa e da formação.

To communicate bad news in health is one of the biggest difficulties for professionals of this sector, particularly to nurses. This difficulty is higher when the death process fits in unexpected context. Due to an unpredictability of this terrible event and lack of professionals preparation, dealing with this situation and the family's reaction when received the news, beginning the grieving process. With this this study, we intend to understand nurse's experience(s) in bad news communication process in the context of unexpected death in the Emergency Room (ER), to contribute to a better intervention in this communication process. The study is based on qualitative research with descriptive and phenomenological characteristics and the strategy of data collection concentrated on the semi-structured interview, aimed to nurses in ER. The data were analyzed using content analysis. The result show that nurses consider bad news communication process is considered difficult, embarrassing and stressing, instead of the relevance that nurses give to it in the context of care. The difficulties were shown in the process, focusing on these levels of professional service, the communication process dynamics and the communication strategies, such as the strategies there are referenced and are related, namely with the procedure, the team and the professional.The communication of bad news triggers different feelings and reactions inherent in the situation itself, and to the act of communicating the bad news. It highlighted as well the factors facilitating and inhibiting of this process of communication, which intersect. From the study, it also emerged, a set of suggestions that give us new intervention perspectives, with implications for the organization, dynamics and team training.