Patient perspectives on healthcare at the time of COVID-19 and suggestions for care redesign after the pandemic: a qualitative study in all six WHO regions

Objective: The COVID-19 pandemic has triggered significant changes in healthcare. As they were mainly driven by professionals and are likely to influence healthcare in the future, it is of utmost importance to consider patients' perspectives equally. We, therefore, explored the lived experiences of patients and patient representatives in all six World Health Organisation (WHO) regions regarding healthcare at the time of COVID-19 and extracted suggestions for care redesign after the pandemic. Methods: We conducted semi-structured interviews until saturation. Thematic analysis followed a modified form of meaning condensation. We established rigour by transcript checking, inter-coder agreement, quote variation and standardised reporting. Results: Disadvantaged people experienced an unprecedented inequity in healthcare due to the pandemic. The main reasons were the reduction in public care services and limited access to information, transportation, technology and income. Stigmatisation from COVID-19 differed between cultural contexts and ranged from none to feeling 'ashamed' and 'totally bashed'. Participants experienced telehealth as indispensable but with limitations. These included giving 'bad news', such as having an eye removed because of melanoma, and the difficulty of providing end-of-life care over the phone. Patient representatives redefined their role and became indispensable influencers throughout the pandemic and beyond. Conclusion: We reached out to individuals with a diversity of perspectives, including minorities and marginalised populations. A systematic exclusion of people with limited technology access increases inequity in healthcare and biases research findings. Since preferences and personal meanings drive behaviour and could be foundations for targeted interventions, they must be considered in all groups of people to increase society's resilience as a whole.

Patients’ Needs In Breaking Bad News For Cancers Diagnosis: Preliminary Result

Introduction: How to perform a breaking bad news consultation properly with the present circumstances and especially it fits the local people. The way to deliver bad news to cancer patients was studied and practiced widely in the world. Some studies were conducted in Vietnam but not yet in central Vietnam. The people here are quite different in thinking and personality. Hence, they may need and expect consultation differently. The study was performed to note the needs of patients in the breaking bad news of cancer and to explore their own experience of giving bad news. Methods: A cross-sectional study was conducted on 44 cancer patients undergoing treatment at the Hue University of Medicine and Pharmacy hospital in July 2020. Results: Of 44 patients, The age average was 56.73. Male was more prevalent in the study with 61.4%. About 45.5% of patients expected to be explained in a private room and most of them desired to hear the truth at the same time with their family (68.2%), only 4.5% of patients wanted the bad news to be delivered only to their families. One hundred percent of patients preferred their oncologists to explain the bad news. More than 80% of patients wanted you received all at once. Patients were interested in getting information about the diagnosis of cancer, stage of cancer, cost of the treatment, treatment option to be selected and results of clinical studies were less important to them. They mostly wanted the truth to be delivered to them than to the family for most of the information contents given by the researchers. Conclusions: Patients in the study wanted to know the truth but some information was more important than others according to them. They mostly satisfied with the breaking bad news that has been done.

What Skills Really Improve After a Flipped Educational Intervention to Train Medical Students and Residents to Break Bad News?

Breaking bad news (BBN) is necessary in medical practice and requires training. The purpose of this study is to evaluate the efficacy and mainly explore the components involved in medical students’ and residents’ performance after a flipped educational intervention to train them to break bad news. A randomized controlled before-after study was conducted with 43 medical students and residents in the intervention group and 41 in the control group. The intervention combined an online multimedia program (DocCom) with a two-hour workshop. BBN performance was assessed at two clinical stations using Objective Structured Clinical Examination and analyzed using a mixed between-within subject analysis of variance. A factor analysis was conducted to analyze the performance by checklist components. The intervention group improved its overall performance in BBN over time (p = 0.000; Eta2 = 0.38) and when compared to the control group (p = 0.01; Eta2 = 0.12). The factor analysis revealed two main components: Factor 1—“giving bad news and responding with empathy”—and Factor 2—“using general communication skills”. Performance analysis by these components revealed that the improvement occurred mainly in Factor 1 (over time, p = 0.000; Eta2 = 0.48, group x time, p = 0.000; Eta2 = 0.38). The intervention combining DocCom Module 33 and a workshop had a moderate effect on the improvement of medical students’ and medical residents’ BBN overall performance in standardized encounters. This improvement was mainly related to communication skills for giving bad news and responding with empathy, in which the intervention effect was large over time and between groups.

The impact of the financial crisis on earnings management: Empirical evidence from Italian and Spanish listed companies

Our study adopts a reliable and widely acknowledged model to detect accounts manipulation in order to assess the impact of the financial crisis on Italian and Spanish listed companies’ propensity to manage their earnings. The analysis is conducted on 565 publicly traded companies on the Italian and Spanish financial markets during the time period 2005-2013. We find a lower propensity to manipulate earnings in both countries during the pre-crisis period (2005-2008) as suggested by a decrease in the number of high-risk manipulators until 2008 included. With the spread of the financial crisis, companies become more manipulators. We believe that the reason for this is to avoid giving bad news to markets, investors, and lenders after that the crisis may have impacted too negatively on firms’ performance indicators and financial equilibrium. Our empirical results provide various implications for further studies related to managements’ incentives concurrently with security offerings.

La atenuación pragmática como estrategia de acercamiento en el Español de la Salud: propuesta didáctica

Resumen: El objetivo de este trabajo es aportar una nueva manera de desarrollar la competencia pragmática de los alumnos de Español de la Salud. Para ello, se propone introducir en el aula el trabajo con una estrategia pragmática concreta para facilitar las relaciones médico-paciente, la atenuación, a través de secuencias didácticas contextualizadas en tres situaciones comunicativas concretas del ámbito hospitalario: la exploración física, la transmisión de malas noticias y la reprobación de malas conductas con consejo médico.Palabras clave: Español con Fines Específicos, atenuación, competencia pragmática, relación médico-paciente. Abstract: The aim of this article is to provide a new way to develop the pragmatic competence in Spanish for Medical Purposes. In order to do this, it is suggested to introduce in the classroom the work with a specific pragmatic strategy, mitigation, in order to make easier the doctor-patient communication by using didactic sequences contextualised in three medical situations of the medical context: medical examination, giving bad news and rejection of misconduct.Keywords: Spanish for Specific Purposes, mitigation, pragmatic competence, doctor-patient relationship

La atenuación pragmática como estrategia de acercamiento en el Español de la Salud: propuesta didáctica

Resumen: El objetivo de este trabajo es aportar una nueva manera de desarrollar la competencia pragmática de los alumnos de Español de la Salud. Para ello, se propone introducir en el aula el trabajo con una estrategia pragmática concreta para facilitar las relaciones médico-paciente, la atenuación, a través de secuencias didácticas contextualizadas en tres situaciones comunicativas concretas del ámbito hospitalario: la exploración física, la transmisión de malas noticias y la reprobación de malas conductas con consejo médico.Palabras clave: Español con Fines Específicos, atenuación, competencia pragmática, relación médico-paciente. Abstract: The aim of this article is to provide a new way to develop the pragmatic competence in Spanish for Medical Purposes. In order to do this, it is suggested to introduce in the classroom the work with a specific pragmatic strategy, mitigation, in order to make easier the doctor-patient communication by using didactic sequences contextualised in three medical situations of the medical context: medical examination, giving bad news and rejection of misconduct.Keywords: Spanish for Specific Purposes, mitigation, pragmatic competence, doctor-patient relationship

Clinical approach

This chapter addresses consultation management and clinical method. It describes how to put families at ease and enable them to get all they hope from the encounter. It suggests an approach and language to use in difficult situations: the dying child, giving bad news, and bereavement. It offers guidance on clinical examination of central and peripheral nervous systems in newborn and older children. A real-world approach to quick neurological examinations is given. It encourages a synthesis of historical and clinical findings into a differential diagnosis, first siting the lesion, then defining the cause. This promotes the formulation of efficient and effective investigation and treatment plans as the essence of the clinical process.

Communicating bad news: an integrative review of the nursing literature

ABSTRACT Objectives: describe how the process of breaking bad news is established and identify how nurses approach the task of giving bad news. Method: integrative review of the literature for articles in Portuguese and English published between 1993-2014, in the databases: Bireme, PubMed, Scopus, Web of Science, CINAHL and Embase. Nine articles were included using the selection flow chart. A digital form was completed for each article according to the Consolidated Criteria for Reporting Qualitative Research checklist and the level of scientific evidence was determined. Results: Of the 99 articles in identified, nine were included after applying the selection flowchart. Discussion: breaking bad news is frequent in the area of oncology and palliative care, with a strong cultural influence on the autonomy of nurses in this process. Conclusion: the approach and skills of the nurse during this task influences the patient’s reaction to the message. The theme is scarce in the literature and merits further investigation.

Breaking bad news

Bad news is any information that adversely and seriously changes the patient’s and family’s view of the future. Factors that influence disclosure include the type of communication (e.g. diagnosis, treatment failure, medical error disclosure), cultural, ethnic and family factors, and clinician attitudes and skills. Patients in general wish to have as much information as possible, but important individual and situational differences exist. Disclosure can help patients and families cope and initiate appropriate goals of care. Barriers to giving bad news include lack of training, fear of one’s own and patient/family emotions, and concerns about destroying hope. While best practice guidelines exist, effective training using simulation, coaching, and practice is sporadic. Dealing with emotions (both the clinician’s and patient/family’s) are difficult challenges, and defensive behaviours such as avoidance of discussions, premature reassurance, and patient abandonment prove common. Controlled clinical trials of teaching bad news reveal that skills can be acquired.