Receiving Bad News: A Thematic Analysis of Stroke Survivor Experiences

Background: Breaking bad news to patients may be required in service provision to stroke survivors. While challenging, it may be critical to the retention of optimism and participation in rehabilitation. Objectives: To explore the experience of stroke survivors when receiving bad news (RBN) from medical practitioners. Methods: Data were obtained via 1:1 interviews conducted at stroke support groups with survivors at least 12 months into recovery and subsequently transcribed for thematic analysis and coded using NVivo. Results: Eight of 10 participants experienced RBN, and 2 participants did not. The themes of being “lucky to be alive” and waiting for “delayed information” were expressed by all participants early in the interviews. Three sub-themes emerged and were labelled alliance, dissent, and dissatisfaction, each with a further 3 contextual themes. The perception of RBN was marked amongst the dissent and dissatisfaction groups, with the latter reporting negative implications for their rehabilitation as well as negative emotions, such as anger and anxiety. The perception of a poor-quality relationship with medical practitioners was said to impede rehabilitation and recovery processes. The dissent group was characterized by initial disbelief after RBN and consequently poorer long-term outcomes, whilst the Alliance group experienced very good quality of care due to existing personal knowledge and therefore did not perceive RBN during their early medical meetings. Conclusions: In the period soon after their stroke, survivors required their medical practitioners to not only communicate knowledge and information, but also needed validation of their hopes and fears for the future from an empathically attuned clinician.

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Exploring the perspectives of stroke survivors and healthcare professionals on the use of mobile health to promote physical activity: A qualitative study protocol

HRB Open Research ◽

10.12688/hrbopenres.12910.1 ◽

2019 ◽

Vol 2 ◽

pp. 9

Author(s):

Daniel D. Carter ◽

Katie Robinson ◽

John Forbes ◽

Jane C. Walsh ◽

Sara Hayes

Keyword(s):

Physical Activity ◽

Focus Groups ◽

Support Groups ◽

Mobile Health ◽

Healthcare Professionals ◽

Ethics Committee ◽

Stroke Survivors ◽

Early Supported Discharge ◽

Promotion Of Physical Activity ◽

Stroke Support Groups

Background: Physical inactivity is both the second-highest population attributable risk factor for and a common consequence of stroke. Despite well-documented health benefits associated with physical activity, its levels typically remain below recommended guidelines in stroke survivors. Consequently, calls have been made for novel interventions targeting the promotion of physical activity in stroke survivors. Mobile health is an emerging field which can offer personalised health interventions through mobile and wireless technology. However, a paucity of research has focused on mobile health to promote physical activity in stroke survivors and, more broadly, this field has been criticised for not incorporating the views of stakeholders. This study aims to explore the perspectives of stroke survivors and healthcare professionals on the development of a mobile health intervention for the promotion of physical activity. Methods: The current study will employ a qualitative descriptive approach using separate, semi-structured focus groups for two key stakeholder groups. Community-dwelling stroke survivors will be recruited through an early supported discharge service for acute stroke and stroke support groups. Healthcare professionals will be recruited through the same early supported discharge service, relevant professional bodies and Twitter. The final number of focus groups will depend on data saturation. Thematic analysis will be conducted using NVivo 12 and findings will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. Conclusion: This study was granted ethical approval from the HSE Mid-Western Regional Hospital Research Ethics Committee and the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Output will consist of recommendations for the development of a mobile health intervention aimed at the promotion of physical activity in stroke survivors. Findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals.

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Abstract TP398: Comparable Internet Access And Usage Among Stroke Survivors And Informal Caregivers

Stroke ◽

10.1161/str.51.suppl_1.tp398 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Imama A Naqvi ◽

Tina A Varughese ◽

Andrea Ancer Leal ◽

Yazan Bittar ◽

Norma Hunter ◽

...

Keyword(s):

Support Groups ◽

Informal Caregivers ◽

Internet Access ◽

Cost Effective ◽

Stroke Recovery ◽

Stroke Survivors ◽

Stroke Risk Factor ◽

Web Based ◽

Risk Factor Management ◽

Stroke Support Groups

Background and Purpose: Web-based interventions have shown promise as a cost-effective and convenient delivery platform for supporting chronic disease self-management. However, studies suggest that web-based interventions are not widely available. The purpose of this study was to describe access and usage of web-based electronics in a cohort of stroke survivors (SS) and their informal caregivers (IC). Methods: A 14-question electronic usage survey was created with input from experts in neurology, nursing and bioinformatics. Two urban sites recruited participants from inpatient stroke centers, outpatient stroke clinics and stroke support groups. Surveys were completed in person or via telephone. Descriptive data were generated to evaluate internet access and usage. Results: Data were analyzed from 251 SS and 127 IC. Participants were primarily recruited from outpatient settings, with inpatient recruits constituting 15%. Internet users were on average 8 years younger than non-users in both groups. African Americans constituted a third in each group and 1 out of 8 were Hispanic. Compared to an estimate that 89% of American adults have internet access, 200 (81%) SS (p < .001) and 123 (97%) IC (p = .005) had internet access. Conclusions: In our diverse cohort of relatively young SS, we found IC had more internet access than SS, and more so than the general population. This study is an important step towards delineating the potential use of web-based environments as a platform for interventions to improve stroke risk factor management and stroke recovery.

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Breaking bad news: consensus guidelines for medical practitioners.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.9.2449 ◽

1995 ◽

Vol 13 (9) ◽

pp. 2449-2456 ◽

Cited By ~ 271

Author(s):

A Girgis ◽

R W Sanson-Fisher

Keyword(s):

Bad News ◽

Breaking Bad News ◽

Consensus Guidelines ◽

Consensus Process ◽

Medical Practitioners ◽

Breaking Bad ◽

Effective Strategies ◽

Medical Oncologists ◽

Conveying Bad News ◽

Clinical Directors

PURPOSE AND DESIGN: One of the more difficult tasks that clinicians must perform as part of their care of patients is that of conveying bad news, such as a severe diagnosis or death. However, there is a paucity of empirically founded information that relates to the specific steps for breaking bad news. We report on a set of guidelines for breaking bad news that was developed using a consensus process and incorporates the views of medical oncologists, general practitioners, surgeons, nurse consultants, social workers, clergy, human rights representatives, cancer patients, hospital interns, and clinical directors of medical schools in Australia. RESULTS AND CONCLUSION: It is recommended that further research be undertaken in a number of areas. First, there is a need to assess patients' versus providers' perceptions of the importance of each of the steps in breaking bad news, in order to define criteria for minimal levels of competence in this area. Second, controlled trials are needed to assess the effectiveness of the guidelines in changing clinical practice, and to identify the most effective strategies for breaking bad news to patients.

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Religion and Spirituality in Oncology: An Exploratory Study of the Communication Experiences of Clinicians in Poland

Journal of Religion and Health ◽

10.1007/s10943-021-01343-1 ◽

2021 ◽

Author(s):

Oliwia Kowalczyk ◽

Krzysztof Roszkowski ◽

Wojciech Pawliszak ◽

Agnieszka Rypel ◽

Szymon Roszkowski ◽

...

Keyword(s):

Stress Reduction ◽

Bad News ◽

Study Cohort ◽

Breaking Bad News ◽

Religion And Spirituality ◽

Medical Practitioners ◽

Breaking Bad ◽

High Level ◽

Cancer Settings ◽

Role Of Religion

AbstractCommunication with patients regarding oncology-related aspects is a challenging experience and requires a high level of skill from the interlocutors. The aim of this study was to verify the influence of religion/spirituality in oncological settings from the health professionals’ perspectives in Poland. It assessed the role of religion/spirituality in patient-clinician communication, death or stress self-management, empathy, and breaking bad news skills. Data collection was carried out through a standardized self-administered questionnaire with varying scales. The study cohort consisted of 60 medical practitioners specializing in oncological radiotherapy treatments. It was observed that strategies used for coping with patients’ death, stress reduction, empathy, communication with patients and/or their relatives, or breaking bad news skills, may be gender-specific or may depend on the length of time employed, as well as experience in a cancer-related work environment. This study shows that spirituality and religiousness can support clinicians in managing challenging or negative emotions related to their work in cancer settings. Religiousness and spirituality can also serve as a potential therapeutic strategies for those exposed to patient suffering and death.

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Effective Ways of Breaking Bad News in Terminal Ill Diagnosis: Focus on Strategies

10.46619/cmj.2020.3-1021 ◽

2020 ◽

Vol 3 (2) ◽

pp. 63-68

Author(s):

Demkhosei Vaiphei Suantak ◽

Keyword(s):

Medical Curriculum ◽

Bad News ◽

Breaking Bad News ◽

Clinical Practices ◽

Medical Practitioners ◽

Breaking Bad ◽

Well Design ◽

Negative Feelings ◽

Terminal Diagnosis ◽

Delivering Bad News

In terminal diagnosis breaking bad news is one of the most difficult tasks for every clinicians working in the palliative endof-life care, but a must in its clinical practices. It requires special skills and the ability to deliver the bad news without hurting the sentiment of the patient and the loved ones. Many clinicians working in the palliative care are incompetent in handling the process of delivering the bad news, mainly due to the lack of effective communication skills and sometime were preoccupied with fear and nervousness. A time of breaking bad news is consider to the most crucial moment where the dying individuals are mostly accompanied with several negative feelings and emotional breakdown, which require a well structure manner and well design techniques to put forward. Yet little of its skills and techniques are known among the medical practitioners as a whole in their medical curriculum during their training period. Delivering bad news requires clinicians advance preparations on how much information the patient and the family would like to acquire, quality therapeutic relationship, and emotionally well prepared. The challenges lies in breaking bad news an important domain in terminal diagnosis, but the clinicians are mostly not aware on how, when, and where to deliver in its clinical practices that usually creates a communication gap between the clinicians and the patient.

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