Breaking Bad News in Oncology: A Metasynthesis

Bousquet, Guilhem; Orri, Massimiliano; Winterman, Sabine; Brugière, C.; Verneuil, L.; Révah-Lévy, Anne

doi:10.1200/jco.2014.59.6759

Cited by 129 publications

(120 citation statements)

References 23 publications

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“…One viable educational intervention, for instance, could be the implementation of discussion groups (such as Balint groups, designed to improve clinicians’ skills by discussing personal cases focusing on patient-doctor interaction) [42]. The effectiveness of these groups has already been shown in several areas, including improving communication skills, dealing more effectively with patient needs, and managing physicians’ involvement in their patient-physician relationships; it also increases physicians’ well-being [43–45]. …”

Section: Discussionmentioning

confidence: 99%

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

et al. 2016

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PurposePatients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives.MethodsMulticenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once).ResultsOur analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians difficulty in coping with patients suffering may limit their access to elements that can improve patients capacity to live as well as possible.ConclusionsDuring cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.

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Section: Discussionmentioning

confidence: 99%

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

et al. 2016

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“…Crossing the perspectives of patients, families, and healthcare providers enables a better understanding of their shared representations of the disease and its treatment. In recent years we have conducted several qualitative studies exploring the intersecting viewpoints around the issues of obesity [21] and attempted suicide [22] in pediatric populations as well as on the topics of cancer [23] and AN [24] in adults.…”

Section: Introductionmentioning

confidence: 99%

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

et al. 2017

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BackgroundAnorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment.MethodsWe performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program.ResultsWe included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool—a relationship, specifically the core concept of the therapeutic relationship.ConclusionOur results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

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“…Clinically, the discussion of a new breast cancer diagnosis is stressful for both patients and clinicians, especially if a patient has received prior information about risk of developing breast cancer and used this information to decide about participating in screening and preventive interventions [29]. Our analysis clarifies the relationship of risk estimates of developing breast cancer and the pathologic features and prognosis of cancers diagnosed.…”

Section: Discussionmentioning

confidence: 99%

Relationship of Predicted Risk of Developing Invasive Breast Cancer, as Assessed with Three Models, and Breast Cancer Mortality among Breast Cancer Patients

et al. 2016

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PurposeBreast cancer risk prediction models are used to plan clinical trials and counsel women; however, relationships of predicted risks of breast cancer incidence and prognosis after breast cancer diagnosis are unknown.MethodsUsing largely pre-diagnostic information from the Breast Cancer Surveillance Consortium (BCSC) for 37,939 invasive breast cancers (1996–2007), we estimated 5-year breast cancer risk (<1%; 1–1.66%; ≥1.67%) with three models: BCSC 1-year risk model (BCSC-1; adapted to 5-year predictions); Breast Cancer Risk Assessment Tool (BCRAT); and BCSC 5-year risk model (BCSC-5). Breast cancer-specific mortality post-diagnosis (range: 1–13 years; median: 5.4–5.6 years) was related to predicted risk of developing breast cancer using unadjusted Cox proportional hazards models, and in age-stratified (35–44; 45–54; 55–69; 70–89 years) models adjusted for continuous age, BCSC registry, calendar period, income, mode of presentation, stage and treatment. Mean age at diagnosis was 60 years.ResultsOf 6,021 deaths, 2,993 (49.7%) were ascribed to breast cancer. In unadjusted case-only analyses, predicted breast cancer risk ≥1.67% versus <1.0% was associated with lower risk of breast cancer death; BCSC-1: hazard ratio (HR) = 0.82 (95% CI = 0.75–0.90); BCRAT: HR = 0.72 (95% CI = 0.65–0.81) and BCSC-5: HR = 0.84 (95% CI = 0.75–0.94). Age-stratified, adjusted models showed similar, although mostly non-significant HRs. Among women ages 55–69 years, HRs approximated 1.0. Generally, higher predicted risk was inversely related to percentages of cancers with unfavorable prognostic characteristics, especially among women 35–44 years.ConclusionsAmong cases assessed with three models, higher predicted risk of developing breast cancer was not associated with greater risk of breast cancer death; thus, these models would have limited utility in planning studies to evaluate breast cancer mortality reduction strategies. Further, when offering women counseling, it may be useful to note that high predicted risk of developing breast cancer does not imply that if cancer develops it will behave aggressively.

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Breaking Bad News in Oncology: A Metasynthesis

Cited by 129 publications

References 23 publications

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

Relationship of Predicted Risk of Developing Invasive Breast Cancer, as Assessed with Three Models, and Breast Cancer Mortality among Breast Cancer Patients

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