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 fl ow chart. A digital form was completed for each article according to the Consolidated Criteria for Reporting Qualitative Research checklist and the level of scientifi c evidence was determined. Results: Of the 99 articles in identifi ed, nine were included after applying the selection fl owchart. Discussion: breaking bad news is frequent in the area of oncology and palliative care, with a strong cultural infl uence on the autonomy of nurses in this process. Conclusion: the approach and skills of the nurse during this task infl uences the patient's reaction to the message. The theme is scarce in the literature and merits further investigation. Descriptors: Truth-Telling; Communication; Nursing; Family; Information. RESUMO Objetivos: Descrever como se estabelece o processo de comunicação de más notícias e identifi car como o enfermeiro pratica a comunicação de más notícias. Método: Revisão integrativa da literatura com artigos em português e inglês referente ao período 1993-2014 nas bases de dados Bireme, PubMed, Scopus, Web of Science, CINAHL e Embase. Elegeram-se nove artigos pelo fl uxograma de seleção. Para cada artigo foi preenchida uma fi cha eletrônica, elaborado um checklist do Consolidated Criteria for Reporting Qualitative Research e verifi cado o nível de evidência científi ca. Resultados: Foram identifi cados 99 artigos e incluídos nove pelo fl uxograma de seleção. Discussão: Transmitir más notícias é frequente nas áreas de oncologia e cuidados paliativos, com forte infl uência cultural na autonomia do enfermeiro nesse processo. Conclusão: O modo e a habilidade do enfermeiro durante a ação infl uenciarão a reação do paciente acerca da mensagem. O tema é escasso na literatura, necessitando ser explorado. Descritores: Revelação da Verdade; Comunicação; Enfermagem; Família; Informação. RESUMEN Objetivos: Describir como se establece el proceso de comunicación de malas noticias e identifi car como el enfermero practica la comunicación de malas noticias. Método: Revisión integradora de la literatura con artículos en portugués e inglés referente al período 1993-2014 en las bases de datos Bireme, PubMed, Scopus, Web of Science, CINAHL y Embase. Se eligió nueve artículos por el fl ujograma de selección. Para cada artículo fue rellenada una fi cha electrónica, elaborado un checklist del Consolidated Criteria for Reporting Qualitative Research y verifi cado el nivel de evidencia científi ca. Resultados: Fueron identifi cados 99 artículos e incluidos nueve por el fl ujograma de selección. Discusión: Transmitir malas noticias es frecuente en las áreas de oncología y cuidados paliativos, Communicating bad news: an integrative review of th...

Communication in the Management of the Nursing Care Before the Death and Dying Process

“…11,13 While the opposite brings the nurse closer to the care of the patient and their family, making the process of dying more intimate and probably less vicarious. [14][15] Regarding the process of communicating with the patient's family regarding the death and dying process, it was pointed out that some family members questioned nurses and nursing technicians about the possibility of their beloved ones getting better, but they did not usually talk openly about the process of death and dying.…”

“…It was identified that the nursing communication with the relatives of the patients was significantly crossed by the doctor's communication, corroborating other studies. [15][16] Regarding this (inter)action, insensitivity and lack of clarity were listed as communication failures of some attending doctors towards family members. Such behaviors made it difficult for the family members to experience the death and dying process, as well as the health professionals' performance.…”

“…Such behaviors made it difficult for the family members to experience the death and dying process, as well as the health professionals' performance. [15][16][17][18] The characteristics of good communication with the family listed by professionals were: clarification about the patient's condition; clarification of doubts; use of language accessible to family members; empathy; objectivity and clarity; communication about Palliative Care, when the indicated is to hear the opinion of different relatives. 14,17 Some professionals believe that patients do not ask about the severity of their illness by not understanding it or not wanting to know the truth and having to deal with it.…”

“…Regarding the (lack of) knowledge about the diagnosis and prognosis, it is generally believed that families realize that their beloved ones are in terminality, but there are cases in which families are unaware of such a situation or do not manifest their understanding, possibly because of the denial of the situation. 12,[15][16] In addition, relatives often have distinct knowledge about the diagnosis and prognosis of their beloved ones. The (lack of) knowledge of the relatives generates reactions as a constant request of the nursing team and/or requests for transferring the patient to the ICU.…”

“…Finally, it was identified that professionals need to be prepared to communicate difficult news and support patients and family members. 12,[15][16][17] Some evidence-based communication strategies can help communicate difficult news to patients and family members effectively, such as the SPIKES and PEWTER protocols. 1617 It is believed that to think about nursing in a complex way is to see it working as a care system, recognizing the self-organization of this system, interspersed by autonomy, interdependence, interetro-actions among the human beings involved in caring.…”