PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

Abstract

Purpose Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. Methods This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. Results Fifty patients (mean age 53.7 years, range 28–76) were included in the study. The average duration of BBN was 6.1 (range 2–11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. Conclusions The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. Trial registration Clinical Trial Registry of India (CTRI/2021/07/034707).

Protocolos de transmissão de más notícias utilizados em contextos de cuidados paliativos: uma revisão de literatura

“…Apesar da variação no número de etapas (4 a 6), quase todos os protocolos incluem três grandes momentos "antes, durante e após", ou seja, a preparação ou o momento que antecede a transmissão da informação, o momento em que é dada a informação e o lidar com o impacto da notícia no doente e/ou familiares. O protocolo PENS (Mailankody et al, 2022) é um dos mais recentes e que inclui menos etapas, sendo o único que não menciona a importância do momento "pré-protocolo", com intervenções relacionadas com a preparação do ambiente, anamnese do doente e a privacidade do mesmo. Nesta abordagem para transmissão de más notícias o "P" diz respeito à importância deve ser dada às preferências do doente; o "E" consiste na explicação da condição clínica/ doença; o "N" corresponde à apresentação dos possíveis tratamentos e por fim, o "S" o representa o suporte fornecido ao doente.…”

“…Nesta perspetiva, nos últimos anos, tem havido uma crescente preocupação para incluir a temática das más-notícias no contexto da formação pré e pósgraduada dos enfermeiros. Apesar da transmissão de uma má notícia ser uma intervenção complexa, é consensual que, os profissionais de saúde, habitualmente não têm treino formal para fazê-lo, o que poderá ter consequências nefastas na prestação dos cuidados (Mailankody et al, 2022). Habitualmente, no contexto de formação, os profissionais de saúde são treinados a utilizar um protocolo de transmissão de más notícias, com um conjunto de etapas sequenciais.…”

Teaching breaking bad news in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students

“…According to the SPIKES protocol, the goals of the informed consent dialogue are to gather information from the patient, provide medical information, offer support to the patient, while developing a plan with the patient at the same time. Other approaches/protocols to deliver bad news are e.g., PENS, BREAKS; ABCDE or EPICES [ 19 ].…”

Teaching Breaking Bad News in a gyneco-oncological setting: a feasibility study implementing the SPIKES framework for undergraduate medical students

“…According to the SPIKES protocol, the goals of the informed consent dialogue are to gather information from the patient, provide medical information, offer support to the patient, while developing a plan with the patient at the same time. Other approaches to deliver bad news are e.g., PENS, BREAKS; ABCDE or EPICES 19 .…”