TP8.1.11 Discussing results and breaking bad news in breast video consultations: a pilot questionnaire

Aim Virtual consultations (VC) in Breast Surgery have become well-established during the COVID pandemic. They are successfully utilised in routine follow ups and low-risk new referrals. We aimed to assess the utility of VC in more complex clinical discussions. Methods We collected feedback anonymously via electronic link from 20 consecutive patients who specifically had more challenging video-VC including: 12 diagnostic MDT results (10 patients received bad news of new cancer diagnosis, 2 had benign results); 6 post-operative wound checks with therapeutic MDT outcomes; 2 new consultations for chest wall reconstruction. Results The time saved by patients was between 1 and 3 hours (median=2). All patients felt that booking and joining a VC was either very easy (12) or easy (8). 18 patients were satisfied with the quality of sound and picture and all 18 felt they were able to communicate everything to the clinician during their VCs. Compared to a face-to-face consultation, 14 patients felt that VC was better (70%), 4 felt it was similar (20%) and 2 thought it was worse (10%). Most received comments were themed around VC had allowed patients to get their results, discuss their management plans and ask questions while they were safely at home with other family members, at times when COVID restrictions applied to outpatient clinical settings. Conclusion VC may be utilised selectively to provide complex consultations including discussing results, breaking bad news and wound inspections. Qualitative studies in this field can be beneficial.

Delivering Bad News to Patients: Survey of Physicians, Patients, and Their Family Members’ Attitudes

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 patient’s dissatisfaction, this information should not be given to other family members. Patients’ family members would rather tell lies to the patient about their diagnosis. Conclusions: There is a tendency towards not telling bad news in Iranian culture; Iranian people tend to protect those around them, and the desire to give bad news to those around them is lower than the tendency to hear bad news about one’s own illness. With increasing education, the tendency to telling bad news increases.

Would the Saudi Family Agree to Tell the Truth to Cancer Patient? Exploring Awareness, Perception, and Attitude to Truth Telling.

Aim:To study the differences in attitude and perceptions of patients versus family members with regards to breaking bad news and full disclosure of prognosis to the patients in a tertiary care center in Saudi Arabia. Methods:A survey of patients and their family members was conducted in the oncology outpatient clinics using a structured questionnaire. Based on the existing prevalence of patients who wanted full disclosure, the sample size was calculated to be 143. Demographic details, diagnostic details were collected in addition to responses to questions exploring attitudes towards breaking bad news. A total of 149 patients and family members were interviewed separately. Results:A total of 149 patients and their family members consented to be interviewed. However, only valid responses to each question were analyzed. Overall, 75.2% (109/145) of patients felt that patient should be informed first as compared to 72.9% (102/140) of family members who felt the family should be informed of the bad news first. 24.3% (34) of family caregivers agreed that patients have the right to full disclosure. Both patients and family caregivers were reluctant to know details about the code status. 71.4% (95) of family caregivers and 54.3% (75) of the patients did not want the health care team to discuss details of code status and DNR. Both patients (87.1%) and caregivers (74.3%) agreed that the primary physician is the best person to break the bad news. Family members may be emotionally more affected than patients. They might require as much if not more support as the patients themselves during breaking bad news.Conclusions:There are significant differences between patient and family members regarding full disclosure of diagnosis and prognosis especially, end-of-life issues like DNR and place of death. The most stressful time for the patient was waiting for confirmatory test results. Therefore, breaking bad news support services should systematically begin even before diagnostic investigations begin. Our study points out that the majority of patients want to know the full details of diagnosis and prognosis. Discussion regarding code status has to be more structured in a way that the patient and family do not feel abandoned due to the Do Not Resuscitate status. Further study is needed to study the need and efficacy of a breaking bad news system in the hospital.