Pushing up daisies: implicit and explicit language in oncologist–patient communication about death (original) (raw)
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Breaking bad news to cancer patients: survey and analysis
Psycho-Oncology, 2009
To find out how patients perceived the disclosure of news about their cancer as regards the physician counselling and how they perceived the flow of information between hospital-based and family physicians. 272 cancer patients were polled with a 16-item questionnaire. 252 cancer patients, 92.6% of those asked, completed the questionnaire. 37.7% (f:35.4%, m:41.8%) stated that the fact that they had cancer was presented to them 'very empathically' or 'empathically'. 62.3% (f:64.7%, m:58.3%) stated that it was presented to them 'not so empathically' or ' not at all empathically'. When patients had been counselled by family physicians they were more likely to state that it had been done 'very empathically' or 'empathically', in contrast to when they had been counselled by hospital-oncologists or self-employed specialists (81.8% vs. 41.2% vs. 41.2%; p=0.001). Significantly more patients thought that they had been given adequate opportunity to ask the questions they considered important when counselled by a family physician (81.8%) as compared to counselling by a hospital-oncologist (43.5%; p=0.002) or a self-employed specialist (44.3%; p=0.001). 56.8% preferred to discuss the suggested cancer therapies with an oncologist. 87.5% of patients considered the exchange of information between the hospital-based specialists and their family physician 'very important' or 'important'; more than half of all patients stated that this exchange of information was 'rather poor' or 'poor'. Oncologists should involve family physicians in disclosing bad news to patients. There are considerable deficiencies regarding information-exchange in cancer care in Austria.
Assessing Physicians' Performance when Telling the Truth to Patients Diagnosed with Cancer
Zanjan University of Medical Sciences, 2021
Background and Objective: The ability of breaking bad news to patients, especially to patients diagnosed with cancer is one of the challengeable issues in the field of medicine. On this basis, this study was designed to assess physicianschr('39') performance as well as importance of their training on how to deliver bad news to patients diagnosed with cancer. Materials and Methods: This was a prospective cross-sectional study for assessing physicians’ performance in delivering bad news. The hematologists and oncologists from Imam Khomeini and Shariati hospitals, Tehran, Iran, were included in the study. A questionnaire for physicians (SPIKES model) which comprised six statements was used to evaluate their performance. The time of breaking the cancer diagnosis news to the patients by the physicians and educational records were evaluated with the average score of the physicians in relation to each statement. Results: Totally, 12 physicians participated in the study. There was no significant difference between the statements and age or gender (P>0.05); but there was a significant relationship between ending the discussion (conversation), summarizing the content, and using the word "cancer” during the conversation (P<0.05). Additionally, there was significant correlation between the time spent on informing the patient about the cancer diagnosis and concluding the discussion and summarizing the statements (P<0.05). Conclusion: Guidelines which are introducing the most harmless methods for delivering bad news with minimal negative effects on the patients’ mental health can be helpful for the medical staff, so that they can perform this important task with less stress and minimum complications for the patients. Keywords: Bad News, Cancer, Physician Performance
Global Journal of Health Science, 2014
While medical ethics place a high value on providing truthful information to patients, disclosure practices are far from being the norm in many countries. Transmitting bad news still remains a big problem that health care professionals face in their every day clinical practice. Through the review of relevant literature, an attempt to examine the trends in this issue worldwide will be made. Various electronic databases were searched by the authors and through systematic selection 51 scientific articles were identified that this literature review is based on. There are many parameters that lead to the concealment of truth. Factors related to doctors, patients and their close environment, still maintain a strong resistance against disclosure of diagnosis and prognosis in terminally ill patients, while cultural influences lead to different approaches in various countries. Withholding the truth is mainly based in the fear of causing despair to patients. However, fostering a spurious hope, hides the danger of its' total loss, while it can disturb patient-doctor relationship.
Iris Publishers LLC, 2019
It is important to start this article with a vignette that clearly expresses the impetus behind taking the time and effort to do this research work. Two years ago, my mother-in-law was diagnosed with cancer and had to visit a well-known surgical oncologist to confirm the diagnosis. As we walked into the clinic, I noticed the physician’s title in the sign as “Surgeon” without reference to his oncology specialization. After I seated her, I walked to the medical secretary and asked about the reason for not including “oncology” in the doctor’s title. He explained that many families of cancer patients particularly from lower socioeconomic classes, or those coming from rural areas do not disclose the bad news to the patients in fear of damaging their morale. He claimed that this practice works well in several cases and actually helps recovery.
Careful Communication of 'Bad News': The Cancer Experience
2008
The term 'careful' applies to three different objects or areas of interest within the context of communication of 'bad news': being careful with the content of what is said, being careful with the person to whom the information is delivered, and finally being careful with oneself when having delivered bad news. The first two aspects will be dealt with in this article, with the hope that the experience gathered with the delivery of bad news in cancer care might extend to the delivery of genetic information, as well. Taking care, first of all, means to avoid harm (primum nil nocere). Therefore, the question is whether there is anything potentially 'delicate' or even harmful in giving information about a cancer diagnosis or about the hopeless condition of a patient. Every physician has had the experience that no matter how careful he had picked his words, the effect of the news he delivered seemed to be disastrous: Patients-and relatives-reacting with intensive negative emotions, claiming that these news had destroyed all their hope, may leave one doubting whether telling the truth should be as high a goal as avoiding harm. One might say the major risk that lies in knowledge of the 'truth', i.e. the statistically most likely course of a disease, is its potential to destroy illusions. This can, indeed, be viewed as a risk when illusions are to some extent supportive, for example when they keep an individual endeavoring out of the hope (though perhaps illusory) that an improvement could be achieved. Arguing in this way means to accept that the degree of individual freedom that is based upon the knowledge of one's own condition is given a lower priority than the integrity of unrealistic hopes. In clinical practice, however, such an argument is not well supported: even though an immediate negative reaction to bad news sometimes occurs, it often transforms to an active informationseeking position, even within the first session. Patients-often faster than relatives-regain their composure and start asking for concrete details, like whether they will experience pain or shortness of breath, or how long is it going to take. As the 'truth' in a given clinical situation is usually complex and laden with insecurity, it is necessary to communicate the most relevant information appropriate to the moment. Especially in a situation when there is little realistic chance that the patient is going to recover or when it seems likely that she is going to die within a few weeks, it still remains one of the most difficult issues to achieve a balance between telling the truth (being honest) and leaving room for hope (Surbone, 2006, p. 56 ff.). On the other hand, leaving illusions in place by not providing information is, in itself, harmful because illusions are often misleading, and may lead to consequences that prevent an
Cancer, 2021
BACKGROUND: Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives. METHODS: An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered "yes," they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis). RESULTS: Communication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication. CONCLUSIONS: This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.
Psycho-Oncology, 2011
Objective: To evaluate the attitudes of the European Oncologists to information disclosure to patients with advanced cancer, their self-reported behaviors, and the factors that influence both attitudes and behaviors. Methods: ESMO members were invited to complete an online questionnaire to evaluate both attitudes and clinical behaviors relating to the disclosure of information to patients with advanced cancer. Data were analyzed to evaluate demographic, educational and social factors influencing attitudes and behaviors. Results: Two hundred and ninety-eight completed surveys were returned. The survey demonstrated strong internal consistency construct validity. The responses indicate that individual clinicians generally display a range of behaviors including non-disclosive as well as disclosive behaviors depending on the dynamics of individual interactions between oncologist and specific patient. Although regional cultural norms influence oncologists' attitudes toward disclosure and, indirectly, their self-reported behaviors, the impact is influenced by other factors: in particular, perceived institutional professional norms, the degree of training in breaking bad news and the frequency of exposure to requests by family members to withhold information from the patient. Conclusions: Positive attitudes regarding disclosure of information to patients and disclosive behaviors can be encouraged, even in non-Western countries, by the development of strong professional norms and education in breaking bad news and coping with the emotional responses of patients.
Delivering Bad News to Patients: Survey of Physicians, Patients, and Their Family Members’ Attitudes
Shiraz E-Medical Journal
Background: Breaking bad news to patients is an unpleasant process, but it is essential for the medical team, which is giving information about a person’s illness; without proper planning, it leads to a negative impact on people’s feelings and quality of life. Cultural differences can be effective in telling bad news. Objectives: This study aimed to identify the attitudes of physicians, patients, and patients’ families towards breaking bad medical news. Methods: This cross-sectional study was performed among physicians, patients, and their families referred to Namazi Hospital, Shiraz, Iran, during 2016 - 2017. Their attitudes regarding how to tell bad news were evaluated by self-administrated questionnaires. Results: A total of 397 valid questionnaires completed by physicians, patients, and their families were analyzed in this study. All groups of participants preferred telling bad news to patients about the diagnosis of their disease; they also believed that in the case of a patien...
Preferences of cancer patients regarding the disclosure of bad news
Psycho-Oncology, 2007
To understand patients' preferences regarding the disclosure of bad news is important in the clinical oncology setting. The aim of this study was to clarify descriptively the preferences of cancer patients. Five hundred and twenty-nine Japanese cancer outpatients were surveyed regarding their preferences regarding the disclosure of bad news, and several psychosocial and medical demographic variables were analyzed. In a descriptive analysis, more than 90% of the patients strongly preferred to discuss their current medical condition and treatment options with their physician and to have their physicians take the feelings of their family into consideration as well. While half of the patients preferred to receive information regarding their life expectancy, 30% preferred not to receive it. Multiple regression analyses indicated the preferences showing interindividual variations were associated with the level of education and the mental adjustment to cancer scores. A factor analysis revealed four preferences factors: method of disclosure of the bad news, provision of emotional support, provision of additional information, and setting. These four factors had good internal consistency reliability (Cronbach's alpha ¼ 0.93À0.77). Providing emotional support, including the desire for the physician to show consideration for the patient's family, and understanding an individual's communication preferences may be useful for promoting patient-physician communication.