Disclosure of terminal prognoses in a general hospital: the nurse's view

May, Carl

doi:10.1046/j.1365-2648.1993.18091362.x

Cited by 28 publications

(17 citation statements)

References 6 publications

(1 reference statement)

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“…Although medical staff are responsible for disclosing a patient's prognosis, nursing staff hold the day-to-day information about a patient's circumstances on which judgements about how best to open up end-of-life discussions can be based. 169 Nurses are also the 'practical managers' of events that follow disclosure of prognosis 169 and so must, by all accounts, be involved in the multidisciplinary effort that keeps patients informed, in unambiguous language, about the likely trajectory of their disease. Knowledge of prognosis is often viewed as uncertain by health professionals and this is used as a reason to defer difficult conversations requiring emotional labour.…”

Section: Discussionmentioning

confidence: 99%

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Gott

Ingleton

Gardiner

et al. 2013

Health Services and Delivery Research

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BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Discussionmentioning

confidence: 99%

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Gott

Ingleton

Gardiner

et al. 2013

Health Services and Delivery Research

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“…Morton (1996) purports that a role of the nurse is to inform the doctor of the patient's awareness of his condition prior to being given a diagnosis. One of the few studies to examine nursing activities during and after the disclosure of a terminal prognosis was conducted by May (1993). The aspect of effective communication with medical staff was highlighted.…”

Section: Introductionmentioning

confidence: 99%

Nurses’ experiences of being present with a patient receiving a diagnosis of cancer

Dunniece¹,

Slevin

2000

Journal of Advanced Nursing

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Nurses' experiences of being present with a patient receiving a diagnosis of cancer This paper reports the findings of a study which describes the experiences of nurses who were present with a patient when they received a diagnosis of cancer, cancer recurrence or prognosis of terminal cancer. Semi-structured interviews were conducted with six nurses who had experience of caring for patients with cancer in an acute surgical setting. Data were analysed using a phenomenological descriptive approach. Participants' descriptions revealed the following seven core themes: 'What if it was me?'; divergent feelings; being there; becoming closer; method of disclosure; time as an influence and learning by reflection. Possible implications for nursing practice and education are discussed and recommendations are made for future research.

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“…Aspects related to the nurse's role in bad news disclosures have been identified as monitoring the patient's awareness of his/her condition prior to disclosure of the cancer diagnosis and communicating this to the doctor (Morton 1996) and understanding the psychological needs of the patient following a diagnosis of cancer (Claxton 1993). Others such as May (1993) describe nurses as, 'practical mangers' of the events which follow disclosure, and also interpret medical information for patients and their families. Thus nurses have a key part to play in the process of disclosing bad news and providing support and information following such news.…”

Section: What Do We Mean By Bad News?mentioning

confidence: 99%

“…The emotional labour around bad news, we suggest, is invisible work that goes unremarked and unrecorded. Nurses' involvement in the breaking of bad news calls for emotional labour, particularly if they have to 'pick up the pieces' when bad news has gone badly (May 1993). Kaye (1996) discusses preparation for giving bad news and preparing the patient by giving a verbal warning shot that bad news is about to be given.…”

Section: '…It Is a Bodily Presence Which Accompanies The Other For A mentioning

confidence: 99%

Breaking bad news revisited: the push for negotiated disclosure and changing practice implications

Arber

Gallagher

2003

Int J Palliat Nurs

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This article revisits the ethical, legal, professional and emotional issues in disclosing bad news. We examine the push for disclosure as coming from a number of areas including ethical and legal challenges in particular the Bristol Royal Inquiry Report, professional codes of conduct, health policy and the expectations of the public. The contribution of nurses to the breaking of bad news appears to be invisible. With the development of new nursing roles and evidence based practice it is timely to consider the impact of nurses within the bad news process. We will highlight some limitations with guidelines for breaking bad news. In particular the limitation that bad news guidelines tend to be constructed from a professional standpoint with a lack of patient centred evidence. We also argue that bad news involves emotional labour and this concerns both professional staff and patients together. We conclude by discussing some of the practice implications regarding the breaking of bad news; the importance of context and continuity; the significance of information and support; desirable qualities of the professional; and issues to consider in determining patient preferences.

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Disclosure of terminal prognoses in a general hospital: the nurse's view

Cited by 28 publications

References 6 publications

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Nurses’ experiences of being present with a patient receiving a diagnosis of cancer

Breaking bad news revisited: the push for negotiated disclosure and changing practice implications

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