Difficult Conversations in Medicine: Professionalism and Humanism in the Art of Breaking Bad News
Published
Dec 16, 2019
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Fritz Eduardo Gempeler
Lilian Torregrosa
https://orcid.org/0000-0002-5392-7083
Jose Miguel Silva
https://orcid.org/0000-0001-5749-6340
https://orcid.org/0000-0002-5392-7083
Jose Miguel Silva
https://orcid.org/0000-0001-5749-6340
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Abstract
The idea of medical communications were related to having “good manners” or the ability to write a medical history, however there has been a re conceptualization of this skill, and it is now considered a fundamental clinical skill that can be developed and measured. The ability to break bad news to patients and relatives is no longer considered an optional skill, on the contrary, undermining its relevance has generated a growing perception of a dehumanized medical care. In order to support doctors, students or other health professionals who undergo anguish or lack of confidence during these situations; new pedagogical strategies and protocols have been developed to strengthen the skills in this matter.
Keywords
Ethics, Medical ; Bioethics ; Physician-Patient relations. Professionalism, HumanismEtica Médica, Bioetica, Relación Medico-Paciente, Profesionalismo, Humanismo
References
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2-Teutsch C. Patient-doctor communication Med Clin North Am. 2003; 87:1115-45.
3-Kavic MS. Competency and the six core competencies. Journal of the Society of Laparoendoscopic Surgeons, 2002 ; 6 : 95–97. https://www.acgme.org/Portals/0/PDFs/Milestones/InterpersonalandCommunicationSkillsPediatrics.pdf consultado el 12 de mayo de 2019
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9-WhippenDA, Canellos GP. Burnout síndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9:1916-1920
10-Morgans AK, Schapira L. Confronting Therapeutic Failure: A Conversation Guide. Oncologist. 2015;20:946-51.
11-Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs. 2017;73:1632-1645.
12-Schildmann J, Cushing A, Doyal L, et al. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med. 2005;19:93-8.
13-Fujimori M, Oba A, Koike M, et al. Communication skills training for Japanese oncologists on how to break bad news, J Cancer Educ 2003; 18 :194-201
14-Baile WF, Lenzi R, Parker PA, et al. Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002; 20: 2189-96
15-Meunier J, Merckaert I, Libert Y, et al. The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task. Patient education and counseling. 2013;93:40-7
16-Buckman R. Breaking bad news: why is it still so difficult?, Br Med J. 1984;288 : 1597-9
17-Takayama T, Yamazaki Y, Katsumata N. Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting, Soc Sci Med 2001;53:1335-50
18-Schofield PE, Butow PN, Thompson JF, et al. Psychological responses of patients receiving a diagnosis of cancer, Ann Oncol , 2003;14 :48-56
19-Morita T, Akechi T, Ikenaga Y, et al. Communication about the ending of anticancer treatment and transition to palliative care, Ann Oncol. 2004; 15: 1551-7
20-Drane JF, Honesty in Medicine: should doctors tell the truth?
http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth
consultado 12 mayo 2019. Ethics at a Glance Veracity
21-Liénard A, Merckaert I, Libert Y, et al. Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program. Br J Cancer 2010;103:171-7
22-Moore PM, Rivera Mercado S, Grez Artigues M, et al. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2013;28:3:CD003751.
23-Karkowsky CE, Landsberger EJ, Bernstein PS. Breaking Bad News in Obstetrics: A Randomized Trial of Simulation Followed by Debriefing or Lecture. J Matern Fetal Neonatal Med. 2016; 20:1-20.
24-Bowyer M, Rawn L, Hanson J, et al. Combining high-fidelity human patient simulators with a standardized family member: a novel approach to teaching breaking bad news. Stud Health Technol Inform. 2006;119:67–72
25-Baer AN, Freer JP, Milling DA, et al. Breaking bad news: use of cancer survivors in role-playing exercises. J Palliat Med. 2008;11:885-92.
26-Skye EP1, Wagenschutz H, Steiger JA, et al. Use of interactive theater and role play to develop medical students' skills in breaking bad news. J Cancer Educ. 2014; 29:704-8
27-Maguire P. Barriers to psychological care of the dying. BMJ 1985;291:1711-1713.
28-Baile WF, Kudelka AP, Beale EA et al. Communication skills training in oncology. Description and preliminary out-comes of workshops in breaking bad news and managing patient reactions to illness. Cancer 1999; 86:887-897
29-Ramirez AJ, Graham J, Richards MA et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995;71:1263-1269
30-Ptacek JT, Eberhardt TL. Breaking bad news. A review of the literature. JAMA 1996;276:496-502.
31-Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992:15. Cap 4 pg 65 - 97
32-Maguire P, Faulkner A. Communicate with cancer patients: 1. Handling bad news and difficult questions. BMJ 1988;297:907-909.
33-Buckman R. Breaking bad news: the S-P-I-K-E-S strategy. Commun Oncol 2005;2:138–142.
34-Miller SM. Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 1995;76:167-177
35-Lind SE, DelVecchio-Good MJ, Seidel S, et al. Telling the diagnosis of cancer. J Clin Oncol 1989;7:583-589
36-Sardell AN, Trierweiler SJ. Disclosing the cancer diagnosis. Procedures that influence patient hopefulness. Cancer 1993;72:3355-3365
37-Matthews DA, Suchman AL, Branch WT. Making “conneixons”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med 1993;118:973-977.
38-Suchman AL. A model of empathic communication in the medical interview. JAMA 1997;277:678-682.
2-Teutsch C. Patient-doctor communication Med Clin North Am. 2003; 87:1115-45.
3-Kavic MS. Competency and the six core competencies. Journal of the Society of Laparoendoscopic Surgeons, 2002 ; 6 : 95–97. https://www.acgme.org/Portals/0/PDFs/Milestones/InterpersonalandCommunicationSkillsPediatrics.pdf consultado el 12 de mayo de 2019
4-Makoul G. Communication Skills Education in Medical School and Beyond. JAMA. 2003;289:93. doi:10.1001/jama.289.1.93
5-Moore PJ, Adler NE, Robertson PA. Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med.2000;173:244-250.
6-Kohn LT, Corrigan JM, Donaldson MS, eds; Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington DC: National Academies Press; 2000.
7-Abbaszadeh A, Ehsani SR, Begjani J, et al. Nurses' perspectives on breaking bad news to patients and their families: a qualitative content analysis. J Med Ethics Hist Med. 2014; 12: 7-18
8-Arbabi M, Roozdar A, Taher M, et al. How to break bad news: physicians' and nurses' attitudes. Iran J Psychiatry. 2010; 5:128-33
9-WhippenDA, Canellos GP. Burnout síndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9:1916-1920
10-Morgans AK, Schapira L. Confronting Therapeutic Failure: A Conversation Guide. Oncologist. 2015;20:946-51.
11-Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs. 2017;73:1632-1645.
12-Schildmann J, Cushing A, Doyal L, et al. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med. 2005;19:93-8.
13-Fujimori M, Oba A, Koike M, et al. Communication skills training for Japanese oncologists on how to break bad news, J Cancer Educ 2003; 18 :194-201
14-Baile WF, Lenzi R, Parker PA, et al. Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002; 20: 2189-96
15-Meunier J, Merckaert I, Libert Y, et al. The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task. Patient education and counseling. 2013;93:40-7
16-Buckman R. Breaking bad news: why is it still so difficult?, Br Med J. 1984;288 : 1597-9
17-Takayama T, Yamazaki Y, Katsumata N. Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting, Soc Sci Med 2001;53:1335-50
18-Schofield PE, Butow PN, Thompson JF, et al. Psychological responses of patients receiving a diagnosis of cancer, Ann Oncol , 2003;14 :48-56
19-Morita T, Akechi T, Ikenaga Y, et al. Communication about the ending of anticancer treatment and transition to palliative care, Ann Oncol. 2004; 15: 1551-7
20-Drane JF, Honesty in Medicine: should doctors tell the truth?
http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth
consultado 12 mayo 2019. Ethics at a Glance Veracity
21-Liénard A, Merckaert I, Libert Y, et al. Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program. Br J Cancer 2010;103:171-7
22-Moore PM, Rivera Mercado S, Grez Artigues M, et al. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2013;28:3:CD003751.
23-Karkowsky CE, Landsberger EJ, Bernstein PS. Breaking Bad News in Obstetrics: A Randomized Trial of Simulation Followed by Debriefing or Lecture. J Matern Fetal Neonatal Med. 2016; 20:1-20.
24-Bowyer M, Rawn L, Hanson J, et al. Combining high-fidelity human patient simulators with a standardized family member: a novel approach to teaching breaking bad news. Stud Health Technol Inform. 2006;119:67–72
25-Baer AN, Freer JP, Milling DA, et al. Breaking bad news: use of cancer survivors in role-playing exercises. J Palliat Med. 2008;11:885-92.
26-Skye EP1, Wagenschutz H, Steiger JA, et al. Use of interactive theater and role play to develop medical students' skills in breaking bad news. J Cancer Educ. 2014; 29:704-8
27-Maguire P. Barriers to psychological care of the dying. BMJ 1985;291:1711-1713.
28-Baile WF, Kudelka AP, Beale EA et al. Communication skills training in oncology. Description and preliminary out-comes of workshops in breaking bad news and managing patient reactions to illness. Cancer 1999; 86:887-897
29-Ramirez AJ, Graham J, Richards MA et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995;71:1263-1269
30-Ptacek JT, Eberhardt TL. Breaking bad news. A review of the literature. JAMA 1996;276:496-502.
31-Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992:15. Cap 4 pg 65 - 97
32-Maguire P, Faulkner A. Communicate with cancer patients: 1. Handling bad news and difficult questions. BMJ 1988;297:907-909.
33-Buckman R. Breaking bad news: the S-P-I-K-E-S strategy. Commun Oncol 2005;2:138–142.
34-Miller SM. Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 1995;76:167-177
35-Lind SE, DelVecchio-Good MJ, Seidel S, et al. Telling the diagnosis of cancer. J Clin Oncol 1989;7:583-589
36-Sardell AN, Trierweiler SJ. Disclosing the cancer diagnosis. Procedures that influence patient hopefulness. Cancer 1993;72:3355-3365
37-Matthews DA, Suchman AL, Branch WT. Making “conneixons”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med 1993;118:973-977.
38-Suchman AL. A model of empathic communication in the medical interview. JAMA 1997;277:678-682.
How to Cite
Gempeler, F. E., Torregrosa, L., & Silva, J. M. (2019). Difficult Conversations in Medicine: Professionalism and Humanism in the Art of Breaking Bad News. Universitas Medica, 61(1). https://doi.org/10.11144/Javeriana.umed61-1.conv
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Section
Short Reviews