Giving bad news : Is there a kinder, gentler way?
✍ Scribed by Jimmie C. Holland; Jesús Almanza
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 41 KB
- Volume
- 86
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
M. D. Anderson Cancer Center is welcome news that more ways to make it easier to deliver bad news to patients with cancer are becoming available to oncologists. 1 Ironically, oncologists perform this painful task more frequently than physicians in nearly any other specialty, yet training in "how to do it" essentially has been absent. We expect our oncologists to be medically competent and yet remain caring and sensitive to patients' feelings as they must repeatedly reveal news of a cancer diagnosis, disease progression, or treatment failure. It is a tall order given the daily diet of such conversations and the range of patients' responses that vary from evidence of courageous and remarkable heroism to emotional outbursts and anger. These difficult encounters cause stress in most oncologists, who feel ill-prepared for these problems for which they were not trained.
Two workshops were held to teach the faculty at the M. D. Anderson Cancer Center how to deliver bad news and how to handle difficult patients. This experience yielded positive results in terms of the participants "feeling more confident" about negotiating these encounters. Although the authors reported data from only 31 physicians studied, and the outcome variables were limited to oncologists' satisfaction, this approach is working at the M. D. Anderson Cancer Center, at which Ͼ150 faculty and fellows have participated in similar workshops. The techniques used are similar to those developed in the U.K. by Fallowfield 2 and Maguire. 3 They also draw on the extensive experience of teaching communication skills to primary care doctors and internists. 3 How to break bad news has been studied more actively in recent years. Our review identified 166 articles published since 1975 on breaking bad news. 4 The majority were written in the past 5 years. This is a healthy sign of the increasing recognition of the importance of the communication process between physician and patient. However, of the studies reviewed, only 14% represented controlled trials of interventions from which evidence-based guidelines for improving communication skills could be derived. This is related in part to the difficulty in developing study designs that utilize replicable interventions with meaningful outcome variables that can demonstrate changes in physicians' attitudes and skills and the ultimately important outcome of their impact on patients' perceptions of their physi-
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