Italian onco-haematological patients’ preferences in bad news communication: a preliminary investigation

Abstract

Background The manner in which bad news is communicated in oncological contexts can affect patients’ engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients’ experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. Methods In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). Results While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients’ preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. Conclusions The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients’ preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.

Evaluating patient and medical staff satisfaction from doctor–patient communication

“…These discrepancies in perceptions may suggest that patients have higher expectations from doctor/nurse-patient communication, which aligns with the general trend of high consumers' expectations in all markets and particularly in the health industry (Shafei et al, 2019). This study confirms the findings of similar research that not enough satisfaction is reported for important factors in doctor-patient communication and mainly the requirement for using simple terminology (Bongelli et al, 2021;Kha and Piasecki, 2008), the little time devoted to information (Swallmeh et al, 2018;Pun et al, 2015), the non-sufficient dissemination of medical information to patients (Moret et al, 2008) and the lack of genuine interest in patients' health and life (Platonova and Shewchuk, 2015).…”

“…Communication in clinical practice should not only serve as a way for the professional to obtain information from patients about their pathology, IJHCQA 35,1 but also as a means of informing patients about their illness (Kha and Piasecki, 2008). The participants of this study also agree that the use of specialized terminology to convey information that the patient is unfamiliar with is a prohibiting factor to good communication, which may lead to passive behavior from the patient's side (Bongelli et al, 2021;Verlinde et al, 2012). Survey's participants also agree that patients' physical conditions are barriers to communication.…”

“…Specifically patients were less satisfied with the use of non-medical terminology, and the interest of health professionals in their personal and psychological condition and the time allowed for questions. The lack of available time for doctor–patient commination is also acknowledged in the literature (Bongelli et al. , 2021; Lemonidou et al.…”

“…As a result, health professionals provide basic information, dedicate less time to developing interpersonal relationships and empathy with patients. They focus mainly on tackling patients' physical problem without weighting their psychological needs (Pun et al, 2015;Bongelli et al, 2021). Although the respondents of this study did not pinpoint the lack of staff training as a major barrier to communication, it is a fact that health professionals are usually not trained in communication skills during their studies, or at any time during their career, and therefore they are not knowledgeable in tackling patients' biological, psychological, sociological and spiritual views and needs (Ha and Longnecker, 2010).…”

“…, 2000). The tendency for informed patients is also due to the fact that patients themselves seek to have more knowledge about their illness throughout its stages (Ha and Longnecker, 2010; Bongelli et al. , 2021).…”