Giving Patients Bad News

Shields, Charles E.

doi:10.1016/s0095-4543(05)70070-1

Cited by 22 publications

(13 citation statements)

References 7 publications

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“…A review of the literature suggests the following general guidelines for physicians communicating a cancer diagnosis to the patient: (1) it is best to let the patient set the pace of the communication, with the physician telling the patient everything he or she wants to know but rarely more; (2) it is useful and necessary to reiterate the important information, thereby ensuring that it is understood in the setting of stress, fear, confusion, or denial; (3) it is best, when addressing the patient's concerns, to determine all concerns before exploring any one in depth [9][10][11][12] ; (4) patients should be reassured that the physician will remain involved; and (5) support should be offered for continuing high-quality medical care, including an emphasis on quality of life. There are important pragmatic, 9 medicolegal, 10 and humanitarian 11 considerations to effective communication.…”

Section: Discussionmentioning

confidence: 99%

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Communication of a cancer diagnosis: Patients’ perceptions of when they were first told they had cancer

Walsh

Nelson²

2003

Am J Hosp Palliat Care

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Fifty consecutive cancer patients cared for by a palliative medicine program were interviewed concerning the initial communication of their diagnosis. The majority of patients were satisfied with the manner and the circumstances in which the information was imparted. A minority of women were significantly more unhappy than men about the manner in which they were told. Sophisticated techniques are available to help physicians impart bad news effectively and humanely.

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Section: Discussionmentioning

confidence: 99%

“…There are important pragmatic, 9 medicolegal, 10 and humanitarian 11 considerations to effective communication. There are well-described techniques available [12][13][14] to improve physicianpatient communication.…”

Section: Discussionmentioning

confidence: 99%

Communication of a cancer diagnosis: Patients’ perceptions of when they were first told they had cancer

Walsh

Nelson²

2003

Am J Hosp Palliat Care

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“…Concordantly clinicians are giving attention to factors in the setting and process of disclosure of "bad news" and characteristics of the family that may contribute to family response, acceptance of, and adaptation to their child's condition. Current guidelines derived from suggestions of physicians and patients emphasize the importance of parents being told closely following birth; the physician's sensitivity and effectiveness in disclosing the nature of the child's condition by planning the setting; assessing the family's background, knowledge, and experience and choosing strategies suited to the family's particular situation; providing clear and detailed information on the condition in a positive fashion, with information on specialty referrals and community resources included; physicians allowing sufficient time for adequate communication, questions, and ventilation; and arranging for both parents or the parents' support network to be present [Turner and Sloper, 1992;Krahn et al, 1993;Sloper and Turner, 1993;Garwick et al, 1995;Girgis and Sanson-Fisher, 1995;Ptacek and Eberhardt, 1996;Chisolm et al, 1997;Shields, 1998]. …”

Section: Lucy Bennettmentioning

confidence: 99%

Parents' responses to their child's diagnosis of neurofibromatosis 1

Ablon

2000

Am. J. Med. Genet.

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Eighteen unaffected families with an affected child were interviewed in their homes to chronicle the experiences of parents in receiving their child's diagnosis of neurofibromatosis (NF) 1. Families were recruited through NF support groups and the Genetics Departments of two metropolitan hospitals in Northern California. Characteristics of disclosures were often at variance with suggestions made in recent years for the giving of "bad news." Disclosures typically were made "helter-skelter" during regular examinations. Parents in 16 of the families described shock, upset, and subsequent depression as their responses to the diagnosis. The overriding issues, which dominated in the disclosure, were the uncertainty of the condition, the possibility of many diverse symptoms, and its historic misdiagnosis as "The Elephant Man's Disease." However, physicians' attention to the setting and style of disclosure, imparting appropriate and positive information, allowance of additional time for careful explanation, and rescheduling a follow-up appointment, may be able to more effectively assist parents in receiving and more positively adapting to their child's diagnosis. How would I handle it? How would I deal with it? With help I finally came to realize that I shouldn't have to deal with it. Matt would have to deal with it. And I had to separate those two things. That's what gave me my sanity back, understanding that it is really going to be his problem in life, if it was going to be a problem. And all I could do is guide or support or help, but it really is not anything I could change for him. That's when I got better and started accepting it. It took between 6 and 9 months before I could talk about it without crying. I stopped wearing mascara when this happened."A substantial literature documents the emotional reactions of parents to the diagnosis and disclosure that their child is physically or mentally different [for detailed reviews, see Bristor, 1984;Blacher, 1984;Fortier and Wanlass, 1984;Ablon, 1988; and for cross cultural reactions, see Krauss-Mars and Lachman, 1994]. Concordantly clinicians are giving attention to factors in the setting and process of disclosure of "bad news" and characteristics of the family that may contribute to family response, acceptance of, and adaptation to their child's condition. Current guidelines derived from suggestions of physicians and patients emphasize the importance of parents being told closely following birth; the physician's sensitivity and effectiveness in disclosing the nature of the child's condition by planning the setting; assessing the family's background, knowledge, and experience and choosing strategies suited to the family's particular situation; providing clear and detailed information on the condition in a positive fashion, with information on specialty referrals and community resources included; physicians allowing sufficient time for adequate communication, questions, and ventilation; and arranging for both parents or the parents' support network to be present [Turner...

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“…Because the vast majority of chronic disease management is typically conducted by the patient in the context of his or her own life, encounters bealizations about communication in health care are inevitably misleading [15,[22][23][24].…”

Section: Introductionmentioning

confidence: 99%