Whether and How to Inform Patients of “Bad News,” Family Dynamics at the End of Life

2019 ◽  
pp. 45-63
Author(s):  
H. Russell Searight
Keyword(s):  
End Of Life ◽  
Family Dynamics ◽  
Bad News

Death attitudes and truth disclosure: A survey of family caregivers of elders with terminal cancer in China

2018 ◽  
Vol 26 (7-8) ◽  
pp. 1968-1975 ◽  
Author(s):  
Yong Tang
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Quantitative Method ◽  
Bad News ◽  
Background Information ◽  
Terminal Cancer ◽  
Death Attitudes ◽  
Truth Disclosure ◽  
Primary Family

Background: Although family caregivers play an important role in end-of-life care decisions, few studies have examined the communication between family caregivers and patients at the end of life. Objective: The objective was to describe family caregivers’ attitudes toward death, hospice, and truth disclosure. Research design: A quantitative method was used, and a closed-ended survey of 140 family caregivers was conducted in China. The subjects included 140 primary family caregivers of elders with terminal cancer enrolled at a hospice center from April to August 2017. Participants: 140 primary family caregivers of elders with terminal cancer participated the study. Research Context: A high proportion of cancer patients continue to receive inadequate information about their illness. Family caregivers’ inhibitions about disclosing information to cancer patients have not yet been the objects of research in China. Ethical considerations: This study was reported to and approved by the Regional Ethics Committee in Shenzhen, China. Findings: A questionnaire survey collected information on family caregivers’ background information, emotional state, personal needs, death attitudes, and truth-disclosure opinions. The results revealed that family caregivers’ death attitudes and truth-disclosure opinions played an important role in the process of caring for elders with terminal cancer. Discussion: By adopting a quantitative method, the author revealed not only the general patterns of family caregivers’ attitudes toward cancer diagnosis disclosure but also the reasons for their actions and the practices of family disclosure. Conclusion: The findings suggested that ineffective communication concerning end-of-life issues resulted from family caregivers’ lack of discussion and difficulty in hearing the news. Future studies should examine strategies for optimal communication between family caregivers and patients, especially with regard to breaking the bad news. Professional training in breaking bad news is important and is associated with self-reported truth-disclosure practices among family caregivers.

Communication, Negotiation, and Mediation: Dealing with Conflict in End-of-Life Decisions

2000 ◽  
Vol 16 (1_suppl) ◽  
pp. S17-S23 ◽  
Author(s):  
Kerry W. Bowman
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Cultural Differences ◽  
End Of Life Care ◽  
Family Dynamics ◽  
Life Care ◽  
Health Care Teams ◽  
End Of Life Decisions

In recent years, it has become possible for the end of life to be a negotiated event, particularly in the intensive care unit. A multitude of often unidentified and poorly understood factors affect such negotiations. These include, family dynamics, ever-changing health care teams, inconsistent opinions about prognosis, and cultural differences between physicians, and patients and their families. When these factors converge, conflict may erupt. This article explores the nature, antecedents, and cost of such conflict. Arguments for the importance of balanced communication, negotiation, and mediation in end-of-life care are put forward.

Housestaff perspectives on end-of-life training during medical school and residency.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 27-27 ◽  
Author(s):  
Jessica Marie Schmit ◽  
Lynne Meyer ◽  
Jennifer Michelle Duff ◽  
Julia Lee Close
Keyword(s):  
Medical School ◽  
End Of Life ◽  
Disease Process ◽  
Fellowship Training ◽  
Bad News ◽  
Training Experience ◽  
Classroom Training ◽  
Level Of Training ◽  
Oncology Practice ◽  
Delivering Bad News

27 Background: Participating in end-of-life discussions and delivering bad news is integral to oncology practice. Poor communication skills can negatively impact a patient’s understanding and acceptance of their disease process, increase their anxiety, and lead to anger and depression. Hematology/Oncology fellowship training (HOFT) programs may assume incoming fellows are capable of doing this well. A study by Hebert et al. revealed 37% of HOFT programs provide little to no formal training in this area. Our study sought to assess housestaff preparedness and comfort with end-of-life (EOL) discussions. Methods: An email survey was sent to 787 residents and fellows at a single institution in February 2015. Housestaff were queried as to extent of training, experience, supervision and comfort with EOL communication in both medical school and residency. Results: 176 surveys (22.4 %) were returned.During Medical School: Many housestaff (55.1%) reported “little” to “no” classroom training on EOL discussions. Most, 85.1%, reported having five or fewer EOL discussions. Most encounters (78.6%) were supervised by an attending or resident. Only 45.5% felt “somewhat” to “fully prepared” to have EOL discussions when graduating medical school. During Residency: Housestaff reported even less classroom training on EOL discussions: 88.2% reported “little” to “no training”. EOL discussions were more common: 51% reported more than 10 EOL conversations with patients. The level of supervision decreased: only 38.6% reported encounters were mostly supervised. Most housestaff (75%) feel comfortable with having EOL discussions at their current level of training. Conclusions: Despite increased awareness regarding the importance of EOL discussion education, it remains an area that a significant number of medical students and housestaff receive little to no training. EOL discussions by housestaff are frequently unsupervised, reducing opportunities for improvement via feedback. Competence in delivering bad news is an important skill for hematologists/oncologists. Our findings support the previously published perception of HOFT program directors that additional training and resources in delivering bad news is needed.

The Hands of Time

2021 ◽  
pp. 104990912110242
Author(s):  
Ariane Lewis
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Family Dynamics ◽  
Goals Of Care ◽  
Decision Making Capacity

When making decisions about goals-of-care for a patient who lacks decision-making capacity, surrogates sometimes have internal disagreements, particularly if there are complicated family dynamics. Here, I describe the evolution of end-of-life discussions for a patient who had a catastrophic stroke amongst a family who had preexisting discord.

scholarly journals Perceptions of the parents of deceased children and of healthcare providers about end-of-life communication and breaking bad news at a tertiary care public hospital in India: A qualitative exploratory study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248661
Author(s):  
Manoja Kumar Das ◽  
Narendra Kumar Arora ◽  
Harish Kumar Chellani ◽  
Pradeep Kumar Debata ◽  
K. R. Meena ◽  
...  
Keyword(s):  
End Of Life ◽  
Exploratory Study ◽  
Tertiary Care ◽  
Bad News ◽  
Care Hospital ◽  
Breaking Bad News ◽  
Care Providers ◽  
Unique Challenge ◽  
Breaking Bad ◽  
End Of Life Communication

Background Parents of dying children face unique challenge and expect compassionate support from health care providers (HCPs). This study explored the experiences of the parents and HCPs about the end-of-life care and breaking bad news and related positive and negative factors in Indian context. Methods This qualitative exploratory study was conducted at paediatrics department of a tertiary care hospital in Delhi. In-depth interviews with the parents (n = 49) and family members (n = 21) of the children died at the hospital and HCPs (6 doctors, 6 nurses and 4 support staffs) were conducted. Also events and communication around death of eight children were observed. Data were inductively analysed using thematic content analysis method to identify emerging themes and codes. Results Doctors were the lead communicators. Majority of parents perceived the attitude, communication and language used as by resident doctors as brief, insensitive and sometimes inappropriate or negative. They perceived that the attitude and communication by senior doctor’s as empathetic, positive and complete. Parents recalled the death declaration by resident doctors as non-empathetic, blunt and cold. Most parents received no emotional support from HCPs during and after death of their child. All doctors expressed that death of their patients affected them and their emotions, which they coped through different activities. The overcrowded wards, high workload, infrastructural limitation and no formal communication training added to the emotional stress of the HCPs. Conclusions Majority of the communication by the HCPs during the hospitalisation and end-of-life period were perceived as suboptimal by the parents. The HCPs were emotionally affected and faced end-of-life communication challenges. The study highlights the communication by HCPs and support for parents during the end-of-life communication and breaking bad news. It suggests adoption of context specific communication protocol and materials and training of HCPs in communication to improve the quality of care.

The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis

2021 ◽  
pp. 1-12
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter ◽  
Michael S. Barbagallo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Terminal Care ◽  
Bad News ◽  
Breaking Bad News ◽  
Life Care ◽  
Truth Disclosure ◽  
Breaking Bad

Abstract Objective Disclosing the truth when breaking bad news continues to be difficult for health professionals, yet it is essential for patients when making informed decisions about their treatment and end-of-life care. This literature review aimed to explore and examine how health professionals, patients, and families experience truth disclosure during the delivery of bad news in the inpatient/outpatient palliative care setting. Methods A systemized search for peer-reviewed, published papers between 2013 and 2020 was undertaken in September 2020 using the CINAHL, Medline, and PsycInfo databases. The keywords and MeSH terms (“truth disclosure”) AND (“palliative care or end-of-life care or terminal care or dying”) were used. The search was repeated using (“bad news”) AND (“palliative care or end-of-life care or terminal care or dying”) terms. A meta-synthesis was undertaken to synthesize the findings from the eight papers. Results Eight papers were included in the meta-synthesis and were represented by five Western countries. Following the synthesis process, two concepts were identified: “Enablers in breaking bad news” and “Truth avoidance/disclosure.” Several elements formed the concept of Enablers for breaking bad news, such as the therapeutic relationship, reading cues, acknowledgment, language/delivery, time/place, and qualities. A conceptual model was developed to illustrate the findings of the synthesis. Significance of results The conceptual model demonstrates a unique way to look at communication dynamics around truth disclosure and avoidance when breaking bad news. Informed decision-making requires an understanding of the whole truth, and therefore truth disclosure is an essential part of breaking bad news.

Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model

2015 ◽  
Vol 14 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Su Jin Koh ◽  
Shinmi Kim ◽  
Jinshil Kim
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Quantitative Research ◽  
Hospice Care ◽  
Bad News ◽  
Terminal Cancer ◽  
Communication Model ◽  
Clinical Environment ◽  
Communication Step ◽  
Eol Care

ABSTRACTObjective:In Korea, patients with terminal cancer are often caught out of the loop in end-of-life (EoL) care discussions. Healthcare professionals also have difficulty engaging in such communication in a variety of healthcare contexts. Therefore, the objective of our study was to develop a communication model for EoL care decision making compatible with the clinical environment in Korea.Methods:Using focus-group interview methodology, participants included eight doctors and five nurses who provide EoL care for terminal cancer patients in acute hospital settings or hospice care facilities in various provinces of Korea.Results:Five themes emerged regarding EoL care discussion, which included: (1) timing, (2) responsible professionals, (3) disclosure of bad news, (4) content areas of EoL care discussion, and (5) implementing strategies for EoL care discussions. These themes were based on development of a communication algorithm for EoL discussion among patients with terminal cancer. A structural communication step for delivery of a terminal prognosis was specified at the phase of disclosure of bad news: beginning with determination of a patient's decision-making capability, followed by a patient's perception of his/her condition, a patient's wish to know, family dynamics, and a patient's and/or family's readiness for EoL discussions.Significance of Results:The proposed context-oriented communication algorithm could provide a helpful guideline for EoL communication and, accordingly, facilitate meaningful improvements in EoL care in Korean clinical practice. The feasibility of this algorithm has not yet been determined, and its validation in a larger sample of patients with terminal cancers, using a quantitative research methodology, is a priority of research.

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