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

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.

Treatment decision-making for older adults with cancer: A qualitative study

2020 ◽  
pp. 096973302094575
Author(s):  
Ni Gong ◽  
Qianqian Du ◽  
Hongyu Lou ◽  
Yiheng Zhang ◽  
Hengying Fang ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Family Members ◽  
Treatment Decision ◽  
Chinese Society ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
The Family ◽  
Older Cancer Patients

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.

Breaking bad news: caring for the family

1995 ◽  
Vol 10 (11) ◽  
pp. 31-33 ◽  
Author(s):  
Sylvia Dear
Keyword(s):  
Bad News ◽  
Breaking Bad News ◽  
Breaking Bad ◽  
The Family

Breaking Bad News in Oncology: A Metasynthesis

2015 ◽  
Vol 33 (22) ◽  
pp. 2437-2443 ◽  
Author(s):  
Guilhem Bousquet ◽  
Massimiliano Orri ◽  
Sabine Winterman ◽  
Charlotte Brugière ◽  
Laurence Verneuil ◽  
...  
Keyword(s):  
Bad News ◽  
Breaking Bad News ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Major Step ◽  
Breaking Bad ◽  
The Family ◽  
Points Of View ◽  
Critical Appraisal Skills ◽  
Physician Patient

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.

Enhancing residents’ compassionate communication to family members: A family systems breaking bad news simulation.

2018 ◽  
Vol 36 (4) ◽  
pp. 523-527 ◽  
Author(s):  
Jacqueline Williams-Reade ◽  
Elsie Lobo ◽  
Abel Arvizú Whittemore ◽  
Laura Parra ◽  
Joanne Baerg
Keyword(s):  
Family Systems ◽  
Family Members ◽  
Bad News ◽  
Breaking Bad News ◽  
Breaking Bad ◽  
Compassionate Communication

Half the family members of intensive care unit patients do not want to share in the decision-making process: A study in 78 French intensive care units*

2004 ◽  
Vol 32 (9) ◽  
pp. 1832-1838 ◽  
Author(s):  
Élie Azoulay ◽  
Frédéric Pochard ◽  
Sylvie Chevret ◽  
Christophe Adrie ◽  
Djilali Annane ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Family Members ◽  
Decision Making Process ◽  
The Family

When bad things happen

2010 ◽  
Author(s):  
Diana C Strange Khursandi
Keyword(s):  
Adverse Outcome ◽  
Clinical Work ◽  
Bad News ◽  
Good News ◽  
Breaking Bad News ◽  
Contributing Factors ◽  
Good Communication ◽  
Her Family ◽  
Staff Members ◽  
Breaking Bad

When bad things happen, good communication skills and honesty are of supreme importance. Breaking bad news to patients, relatives or staff is never easy. Anaesthetists are most familiar with imparting bad news when they are working in a critical care unit, where the possibility of bad news is implicit. The necessity to do so in anaesthetic practice arises relatively infrequently. When patients are acutely unwell, elderly or frail prior to surgery, the patient and his or her family may be met with beforehand to signal a possible or probable unfavourable outcome related to natural disease processes. If the worst does happen, the patients and relatives will be somewhat prepared. Adverse incidents following anaesthesia require anaesthetists to be skilled in communicating honestly to the patient and relatives. These incidents can range from an unanticipated but treatable complication—for example, dural puncture—to an unexpected major mishap in theatre resulting in a serious adverse outcome (disability or death). Effective communication is as important when the issue is a more minor adverse outcome or side effect as it is when an adverse event has had disastrous consequences. Major mishaps in anaesthesia create stressful and difficult situations, since anaesthetists are required to communicate the bad news. Why is one anaesthetist’s day in court another anaesthetist’s invitation to dinner at a patient’s home? The good news is that breaking bad news is a skill that can be learned and taught. The initial ‘breaking bad news’ communication to the patient and/or relatives about the series of events in a serious adverse outcome will be more thoroughly followed up in the subsequent disclosure process. An investigation into the contributing factors in such events (root cause analysis) may need to occur, and staff members involved in the incident must be supported (critical incident support). Each department or group of anaesthetists should consider designating one of their number to respond to major adverse events. The ‘duty anaesthetist’ may be caught up with other clinical duties, and additional senior support will be required. One anaesthetist will be needed to manage ongoing clinical work, while another will be required to manage the aftermath.

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

2021 ◽  
Author(s):  
MOHAMMAD ABOSOUDAH ◽  
Balaji Duraisamy
Keyword(s):  
Family Caregivers ◽  
Family Members ◽  
Bad News ◽  
Confirmatory Test ◽  
Breaking Bad News ◽  
Do Not Resuscitate ◽  
Full Disclosure ◽  
Code Status ◽  
Breaking Bad ◽  
Diagnosis And Prognosis

Abstract 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.

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