Reflecting on the communication process in health care. Part 1: clinical practice—breaking bad news

2019 ◽  
Vol 28 (13) ◽  
pp. 858-863 ◽  
Author(s):  
Beverley Anderson
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Communication Process ◽  
Bad News ◽  
Nurse Specialist ◽  
Breaking Bad News ◽  
Team Members ◽  
Patient Dissatisfaction ◽  
Breaking Bad ◽  
Optimal Health

This is the first of a two-part article on the communication process in health care. The interactive process of effective communication is crucial to enabling healthcare organisations to deliver compassionate, high-quality nursing care to patients, in facilitating interactions between the organisation and its employees and between team members. Poor communication can generate negativity; for instance, misperception and misinterpretation of the messages relayed can result in poor understanding, patient dissatisfaction and lead to complaints. Reflection is a highly beneficial tool. In nursing, it enables nurses to examine their practice, identify problems or concerns, and take appropriate action to initiate improvements. This two-part article examines the role of a uro-oncology clinical nurse specialist (UCNS). Ongoing observations and reflections on the UCNS's practice had identified some pertinent issues in the communication process, specifically those relating to clinical practice and the management of practice-related issues and complaints. Part 1 examines the inherent problems in the communication process, with explanation of their pertinence to delivering optimal health care to patients, as demonstrated in four case studies related to breaking bad news to patients and one scenario related to communicating in teams. Part 2 will focus on the management of complaints.

A Patient-centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers

2007 ◽  
Vol 35 (2) ◽  
pp. 177-196 ◽  
Author(s):  
Lisa Sparks ◽  
Melinda M. Villagran ◽  
Jessica Parker-Raley ◽  
Cory B. Cunningham
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Bad News ◽  
Breaking Bad News ◽  
Care Providers ◽  
Patient Centered ◽  
Breaking Bad

scholarly journals Barriers and facilitating communication skills for breaking bad news: from the specialists’ practice perspective

1969 ◽  
Vol 40 (2) ◽  
pp. 158-166
Author(s):  
Enna Catalina Payán ◽  
David Andrés Montoya ◽  
John Jairo Vargas ◽  
María Clara Vélez ◽  
Alfonso Castaño ◽  
...  
Keyword(s):  
Action Plan ◽  
Point Of View ◽  
Communication Process ◽  
Bad News ◽  
Breaking Bad News ◽  
Cross Sectional ◽  
Breaking Bad ◽  
Survey Results ◽  
Level Of Knowledge ◽  
Delivering Bad News

Introduction: Breaking bad news is one of a physician’s most difficult duties. There are several studies related to the patient’s needs, but few reflect on the doctors’ experience. Materials and method: A descriptive, cross-sectional research was carried out to study issues related to the process of delivering bad news which might act as barriers and facilitating skills from the doctor’s point of view. These issues were identified through a self-administered survey. Results: Participant doctors use different strategies to communicate bad news to their patients. Examples of these strategies are: to be familiar with the patients’ medical history, to ensure that there is enough time, to know the patient’s caregivers and/or relatives, to determine the patient’s level of knowledge about his/her condition, to use non-technical words, to give information in small pieces, to assess the patient’s understanding, to devise a joint action plan, among others. Conclusion: The communication barriers that were identified focused on the emotional issues of the communication process, particularly those related to the recognition of own emotions, and the limited training about communication strategies available to doctors. Consequently, there is a need to implement training programs that provide doctors with tools to facilitate the bad news communication process.

scholarly journals Perspectives of Protocol Based Breaking Bad News among Medical Patients and Physicians in a Teaching Hospital, Ethiopia

2020 ◽  
Vol 30 (6) ◽  
Author(s):  
Henok Fisseha ◽  
Wudneh Mulugeta ◽  
Rodas A Kassu ◽  
Temesgen Geleta ◽  
Hailemichael Desalegn
Keyword(s):  
Patient Satisfaction ◽  
Patient Preference ◽  
Clinical Care ◽  
Communication Process ◽  
Bad News ◽  
Breaking Bad News ◽  
Medical Patients ◽  
Cross Sectional ◽  
Breaking Bad ◽  
Communication Task

BACKGROUND፡ Discussing potentially bad outcomes is a standard communication task in clinical care. Physicians’ awareness on ways to communicate bad news is considered low. SPIKES protocol is the most popular strategy used by physicians, but its practice and patients' perception are not known. This study attempted to fill the knowledge gap on protocol implementation, patient preference and physician effects.METHODS: Hospital-based descriptive cross-sectional study was conducted at SPHMMC from May 1 to June 30 using structured interviews administered to patients and physicians. Three hundred and sixty patients and 111 physicians were included. Assessment of SPIKES performance, patient satisfaction, patient preference, and physician awareness, attitude and effects were studied.RESULTS: Performance of SPIKES protocol was setting (74.5%), perception (51.1%), invitation (56.3%), knowledge (15.9%), emotion (22.3%) and summary (10.1%). Only 30.6% of the patients were entirely satisfied with the interaction, and 19.2% with knowledge attained. Patient satisfaction was associated with physician asking how much information they like (P=0.025). Patient desire and report showed variation. Eighty-two percent of the physicians were not aware of the protocol, and 83.8% had no training. Half of the physicians feel depressed after disclosure.CONCLUSIONS: Patient satisfaction with communication process and knowledge is poor, as is performance of SPIKES components. Satisfaction is related to being asked how much patients want to know. Patients’ desires on how to be told news is different from how it is done. Breaking bad news increases feeling of depression. Awareness and training on the protocol are deficient; medical schools should incorporate it into their studies and implement proper follow-up. 

scholarly journals Identifying Dostors' Problems In Breaking Bad News: An Initial Step In Developing Recommendations For The Curriculum

2017 ◽  
Vol 6 (2) ◽  
pp. 108
Author(s):  
Miko Ferine ◽  
Gandes Retno Rahayu ◽  
Mora Claramita
Keyword(s):  
Initial Step ◽  
Phenomenological Approach ◽  
Communication Process ◽  
Bad News ◽  
Actual Condition ◽  
Breaking Bad News ◽  
Knowledge And Skills ◽  
Breaking Bad ◽  
Delivering Bad News ◽  
Lack Of Knowledge

Background: The skill of breaking bad news is listed in the 2012 Indonesia’s Doctor Competency Standards so that this becomes one of the skills that must be mastered by all doctors in Indonesia. The curriculum of breaking bad news is much developed in western cultural background. The curriculum may not necessarily be well developed in Indonesia because the communication process is strongly influenced by culture. Therefore, the exploration of the problems faced by the practitioner in delivering bad news in the context of local cultural needs to be done as a first step to develop the right educational curriculum and training.Objective: This study aimed to identify problems of the practicing doctors in delivering bad news to patients or their families in the context of local culture (Banyumas).Methods: This study was a qualitative research with a phenomenological approach. The method used was in-depth interviews to the practicing doctors with experience in delivering bad news selected from various educational backgrounds, sex, and age.Results: This study indicated that the doctors had difficulty in breaking bad news. It was known from the attitude of the doctors who tended to avoid by giving the task to others, to cover the actual condition of the patient or just delivering the bad news to the family. The causes identified were the lack of knowledge and skills, the lack of ability to control emotions, the lack of confidence, the anxiety on the patient’s response, the knowledge gap between doctors and patients, and the limitations of space and time.Conclusion: The main problem of the practicing doctors in delivering bad news was the lack of knowledge and skills. Therefore, it is necessary to develop a training curriculum on breaking bad news adequately for basic and advanced medical education.

scholarly journals La formación médica en comunicación de malas noticias: Una revisión narrativa.

2020 ◽  
Vol 1 (2) ◽  
pp. 32-44
Author(s):  
Luis Alfonso Díaz-Martínez ◽  
Mitzy Helein Cuesta Armesto ◽  
María José Díaz Rojas
Keyword(s):  
Health Care ◽  
Bad News ◽  
Breaking Bad News ◽  
Specific Training ◽  
Health Care Communication ◽  
Breaking Bad ◽  
Training Activities ◽  
Critical Process ◽  
De Medicina ◽  
Do So

Una parte fundamental de la atención en salud es la comunicación con los pacientes y sus familias, proceso crítico a la hora de dar malas noticias. Desafortunadamente, muchos médicos no reciben entrenamiento específico durante su pregrado, desarrollando, muchas veces en forma inadecuada, sus habilidades para hacerlo. Este artículo presenta las bases conceptuales, pedagógicas y didácticas para formular cursos o actividades formales de entrenamiento en dar malas noticias en un programa de Medicina. Se incluye una síntesis de lo que se conoce sobre la percepción que tienen médicos, estudiantes y pacientes sobre el dar o recibir malas noticias, sobre los protocolos existentes y sobre las experiencias documentadas sobre tal entrenamiento. In health care, communication with patients and their families is essential, and a critical process when breaking bad news. Unfortunately, many doctors do not receive specific training during their undergraduate studies, often developing their skills in an empirical way to do so. This article presents the conceptual, pedagogical, and didactic bases for formulating courses or training activities to break bad news in every medicine program. It includes a synthesis of what is known within physicians, students and patients perception about this task, on existing protocols and on documented experiences of such training.

Informed Consent to Breaking Bad News

2002 ◽  
Vol 9 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Abraham Rudnick
Keyword(s):  
Health Care ◽  
Informed Consent ◽  
Future Study ◽  
Patient Autonomy ◽  
Bad News ◽  
Assessment Procedure ◽  
Breaking Bad News ◽  
Detailed Characterization ◽  
Breaking Bad

Informed consent to breaking (or waiving) bad news is an important yet neglected topic. It is distinct from informed consent to diagnosis and to treatment, and may be logically and ethically sound, provided patients are competent and that no considerable harm may be caused to others by breaking or waiving bad news to patients. This requires a differential assessment procedure in order to balance patient autonomy, benefit and justice towards others, preferably exploring patients’ values, expectations and needs with them, so that an acceptable decision can be made on whether to act on their consent to breaking or waiving bad news, or to ignore it and act on informed consent by proxy. Future study should attempt to provide a detailed characterization of procedures for attaining informed consent to breaking or waiving bad news, and to test their success in establishing ethically sound health care.

Barriers to breaking bad news among medical and surgical residents

2001 ◽  
Vol 35 (3) ◽  
pp. 197-205 ◽  
Author(s):  
Sonia Dosanjh ◽  
Judy Barnes ◽  
Mohit Bhandari
Keyword(s):  
Bad News ◽  
Breaking Bad News ◽  
Breaking Bad ◽  
Surgical Residents
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