Breaking Bad News in Oncology: A Metasynthesis

Purpose The delivery of bad news by oncologists to their patients is a key moment in the physician-patient relationship. We performed a systematic review of qualitative studies (a metasynthesis) that focused on the experiences and points of view of oncologists about breaking bad news to patients. Methods We searched international publications to identify relevant qualitative research exploring oncologists' perspectives about this topic. Thematic analysis, which compensates for the potential lack of generalizability of the primary studies by their conjoint interpretation, was used to identify key themes and synthesize them. NVivo qualitative analysis software was used. Results We identified 40 articles (> 600 oncologists) from 12 countries and assessed their quality as good according to the Critical Appraisal Skills Programme (CASP). Two main themes emerged: the patient-oncologist encounter during the breaking of bad news, comprising essential aspects of the communication, including the process of dealing with emotions; and external factors shaping the patient-oncologist encounter, composed of factors that influence the announcement beyond the physician-patient relationship: the family, systemic and institutional factors, and cultural factors. Conclusion Breaking bad news is a balancing act that requires oncologists to adapt continually to different factors: their individual relationships with the patient, the patient's family, the institutional and systemic environment, and the cultural milieu. Extending the development of the ability to personalize and adapt therapeutic treatment to this realm of communications would be a major step forward from the stereotyped way that oncologists are currently trained in communication skills.

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Development and validation of The Breaking Bad News Attitudes Scale

BMC Medical Education ◽

10.1186/s12909-021-02636-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kátia Laureano dos Santos ◽

Paola Gremigni ◽

Giulia Casu ◽

Victor Zaia ◽

Erik Montagna

Keyword(s):

Critical Role ◽

Self Report ◽

Bad News ◽

Breaking Bad News ◽

Physician Patient Relationship ◽

Good Reliability ◽

Breaking Bad ◽

Two Factors ◽

Development And Validation ◽

Physician Patient

Abstract Background Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians’ attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians’ attitudes towards principles of the SPIKES protocol and training on them. Methods The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. Results The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. Conclusion The novel questionnaire is a psychometrically sound measure that provides information on physicians’ agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

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Breaking bad news: caring for the family

Nursing Standard ◽

10.7748/ns.10.11.31.s37 ◽

1995 ◽

Vol 10 (11) ◽

pp. 31-33 ◽

Cited By ~ 7

Author(s):

Sylvia Dear

Keyword(s):

Bad News ◽

Breaking Bad News ◽

Breaking Bad ◽

The Family

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Medical Residents Perceptions of Communication Skills a Workshop on Breaking Bad News

Revista Brasileira de Educação Médica ◽

10.1590/1981-52712015v42n3rb20180047ing ◽

2018 ◽

Vol 42 (4) ◽

pp. 175-183

Author(s):

Laiane Moraes Dias ◽

Ana Emilia Vita Carvalho ◽

Ismari Perini Furlaneto ◽

Camila Guimarães Silva de Oliveira

Keyword(s):

Communication Skills ◽

Qualitative Evaluation ◽

Attitude Scale ◽

Wilcoxon Test ◽

Bad News ◽

Medical Residents ◽

Breaking Bad News ◽

Physician Patient Relationship ◽

Breaking Bad ◽

Before And After

ABSTRACT Introduction Breaking bad news althoughfrequent among healthcare professionals and their patients is still considered a very difficult task. These communication skill main determinants in the physician-patient relationship. Objective In view of the need to promote academic spaces that provide opportunities to learn breaking bad news , thisstudy aims to evaluate the medical residentsin relation to their interest in learning communication skills, as well as their skills in breaking bad news, before and after a workshop on the topic. Methods All the medical residents in the first year ofnternal edicine of a public general hospital in Belém-Pará, Brazil inwere invited to answer a questionnaire sociodemographic data and questions about their communication skills in clinical practice, as well as the Communication Skills Attitude Scale (CSAS), which addressed their interest in learning communication skills. The questionnaire. This research uses both uantitative and qualitative methods. The quantified data were statisticallyanalyzed by the Wilcoxon test (),Chi-Square test G-test adherence (quantitative variables of the questionnaire on communication skills). The qualitative evaluation Content Analysis based on Bardin. Results Ten residents attended the workshop. The results show that after taking part in the workshop, the resident’s perceptions of the practice of breaking bad news had improved (in 80% of the participants), as well as their attitudes to learning communication skills ( CSAS = 99.5 and 105, before and after the course, respectively p = 0.0039). Conclusion Eighty percent of residents (n = 08) considered their communication skills have improved as a result of the workshop (p = 0.0078). Most of the participantsbecame more aware of the importance of considering the patient’s perspective, and admitted positive changes following the course. Conclusion A positive effect on the participants’ perceptions of communication skills and on their interest in learning these skills, were identified after an intervention focused on the context of breaking bad news.

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Informazione e comunicazione in caso di patologia con prognosi grave o infausta: considerazioni etiche e medico-legali

Medicina e Morale ◽

10.4081/mem.2011.173 ◽

2011 ◽

Vol 60 (2) ◽

Author(s):

Paola Delbon ◽

Adelaide Conti ◽

Massimo Gandolfini

Keyword(s):

Decision Making ◽

Family Members ◽

Bad News ◽

Decision Making Process ◽

Breaking Bad News ◽

Sufficient Time ◽

Good Communication ◽

Breaking Bad ◽

The Family

Comunicare “cattive notizie” ai pazienti rappresenta un compito non facile: indubbiamente le modalità ed il contesto in cui tali notizie vengono comunicate hanno importanti implicazioni sia per il medico sia per il destinatario delle informazioni, ovvero assicurare un contesto adeguato (ambiente confortevole e riservato, disponibilità di tempo) per permettere al paziente ed ai familiari di porre domande o esprimere emozioni e paure; la possibilità che un amico o un familiare del paziente sia presente, per assicurare al paziente supporto e la sensazione di non essere solo nella gestione di tale situazione; una buona comunicazione medico-paziente-familiari. In particolare, la comunicazione delle cattive notizie dovrebbe avvenire in maniera tale che il paziente e i familiari comprendano la situazione, anche per poter partecipare al processo decisionale, ma in modo tale da non aggravare il malessere derivante dalla natura delle stesse notizie. ---------- Breaking bad news to patients can be a difficult task: certainly how the news are conveyed and the circumstances surrounding the receipt of the news have implications for the giver and the receiver, i.e. to assure an appropriate setting (comfortable and quiet location, sufficient time) to allow for the patient and the family members to ask questions or express emotions and fears; the possibility for a patient’s friend or relative to be present – to provide the patient with a sense of support and a belief that he/ she does not have to deal with the crisis alone -; a good communication between physician and patient/ family. In particular, breaking bad news process must ensure that the patient or family comprehend the news – to understand the situation and participate in decision-making process – but in ways that not exacerbate the discomfort associated with the news itself.

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