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Table 2 Physicians’ communication preferences

From: Investigating the association between physicians self-efficacy regarding communication skills and risk of “burnout”

  IMAa HOAb SAc TOT IMA % HOA% SA % TOT %
Planning the encounter
1. How do you prepare for breaking bad news encounters?
  Have a consistent plan or strategy 40 32 14 86 37% 43% 32% 38%
  No consistent approach to task 42 30 15 87 39% 41% 34% 39%
  Use my experience 19 5 3 27 18% 7% 7% 12%
  Follow my emotions 7 6 7 20 7% 8% 16% 9%
  Plan to provide all relevant information at once then respond to questions 22 17 13 52 21% 23% 30% 23%
2. In your opinion, would a strategy or approach to breaking bad news be important?
  Yes 67 47 25 139 63% 64% 57% 62%
  No 10 1 4 15 9% 1% 9% 7%
  Maybe 28 20 13 61 26% 27% 30% 27%
  Don’t know 2 6 2 10 2% 8% 5% 4%
3. In your opinion, why physicians do not use a strategy or approach to breaking bad news?
  Lack of time 32 27 17 76 30% 36% 39% 34%
  Not necessary 26 22 10 58 24% 30% 23% 26%
  Can’t say 20 13 9 42 19% 18% 20% 19%
  Not to put distance between themselves and the patient 23 15 7 45 21% 20% 16% 20%
  Don’t consider breaking bad news a clinical skill 19 9 4 32 18% 12% 9% 14%
Breaking bad news
4. What does breaking bad news mean for you?
  Discussing diagnosis 22 17 5 44 21% 23% 11% 20%
  Telling patient he/she is terminally ill 45 29 11 85 42% 39% 25% 38%
  Discussing a poor prognosis 71 47 27 145 66% 64% 61% 64%
  Talking about end of active treatment 57 47 16 120 53% 64% 36% 53%
  Discussing diagnosis of cancer 35 25 5 65 33% 34% 11% 29%
5. In an average month, how often do you have to break bad news to a patient/family?
  Never 6 0 10 16 6% 0% 23% 7%
  1 to 5 times 69 33 21 123 64% 45% 48% 55%
  5 to 10 times 26 21 7 54 24% 28% 16% 24%
  More than 10 times 6 20 6 32 6% 27% 14% 14%
6. Which one do you think is the most difficult task of breaking bad news?
  Discussing prognosis 60 45 20 125 56% 61% 45% 56%
  Telling patient about recurrence 19 26 15 60 18% 35% 34% 27%
  Discussing transition to palliative care 30 42 15 87 28% 57% 34% 39%
  Encouraging and dealing with family involvement 15 10 5 30 14% 14% 11% 13%
  Discussing diagnosis 22 11 6 39 21% 15% 14% 17%
7. How would you describe the part of your job in which you break bad news?
  Stimulating 4 5 2 11 4% 7% 5% 5%
  Stressful 36 33 14 83 34% 45% 32% 37%
  Emotionally engaging 78 60 30 168 73% 81% 68% 75%
  Worrisome 6 4 2 12 6% 5% 5% 5%
  Depressing 9 5 3 17 8% 7% 7% 8%
8. What do you feel is the most difficult part of breaking bad news?
  Being honest but not taking away hope 75 55 32 162 70% 74% 73% 72%
  Dealing with the patient’s emotions 27 26 6 59 25% 35% 14% 26%
  Spending the right amount of time 8 15 9 32 7% 20% 20% 14%
  Involving friends and family of the patient 3 3 0 6 3% 4% 0% 3%
  Involving patient or family in decision making 13 5 5 23 12% 7% 11% 10%
Discussing prognosis
9. What does discussing prognosis mean for you?
  Information about illness trajectory and outcome 56 42 19 117 52% 57% 43% 52%
  Success/failure rates of treatment options 61 49 24 134 57% 66% 55% 60%
  Mean survival time for patients affected by the same disease and undergoing the same treatment 20 14 6 40 19% 19% 14% 18%
  Chances of cure 27 13 5 45 25% 18% 11% 20%
  Success rates of treatment options 37 32 11 80 35% 43% 25% 36%
10. Would you inform patient and family about prognosis?
  Yes, certainly 67 44 28 139 63% 59% 64% 62%
  No 3 1 2 6 3% 1% 5% 3%
  Patient no, family yes 13 11 5 29 12% 15% 11% 13%
  Family no, patient yes 5 1 2 8 5% 1% 5% 4%
  Only if patient/family asks about it 12 20 5 37 11% 27% 11% 16%
  Only under certain circumstances 3 1 1 5 3% 1% 2% 2%
11. If yes, for which reason?
  Ethical reasons 14 10 6 30 13% 14% 14% 13%
  Foster therapeutic compliance 21 13 6 40 20% 18% 14% 18%
  Improve patient’s awareness of treatment plan 23 22 17 62 21% 30% 39% 28%
  Make patient aware of illness trajectory, therapeutic choices and optimize adjustment to new conditions 65 42 20 127 61% 57% 45% 56%
12. If not, for which reason?
  Physicians are not updated about diseases prognosis 2 0 0 2 3% 0% 0% 1%
  Physicians do not know how to discuss prognosis 1 2 1 4 2% 3% 5% 3%
  Lack of time 0 1 0 1 0% 2% 0% 1%
  Not to take away hope 10 13 5 28 16% 22% 24% 20%
  Not to scare patients 4 7 0 11 7% 12% 0% 8%
  Patients might not be ready 12 13 6 31 20% 22% 29% 22%
  Patients might not be able to handle emotions 16 13 6 35 26% 22% 29% 25%
  Physicians cannot know every single patient’s prognosis 12 5 1 18 20% 8% 5% 13%
  Physicians do not ask how patients want to discuss prognosis 5 5 2 12 8% 8% 10% 9%
Sharing decision making
13. Do you usually ask patients how much they want to know before breaking bad news?
  Yes 23 25 11 59 21% 33% 25% 26%
  No 84 50 33 167 79% 67% 75% 74%
14. In your opinion, why do not physicians ask patients how much they want to know?
  They can understand it all by themselves 23 19 5 47 21% 26% 11% 21%
  Physicians always tell what they consider necessary 30 27 16 73 28% 36% 36% 32%
  Patients might get scared by that question 45 27 12 84 42% 36% 27% 37%
  Patients are always informed by physicians 28 17 19 64 26% 23% 43% 28%
15. In an average month, how often do you talk to patients who do not want to receive information about their disease?
  Less than 5 times 100 54 42 196 93% 74% 95% 87%
  5 to 10 times 4 17 1 22 4% 23% 2% 10%
  10 to 20 times 2 1 1 4 2% 1% 2% 2%
  More than 20 times 1 1 0 2 1% 1% 0% 1%
16. What do you offer when discussing treatment options?
  The best treatment for the patient, to the best of my knowledge and belief 72 52 33 157 67% 70% 75% 70%
  To choose between all the available treatment options 17 5 8 30 16% 7% 18% 13%
  To share decision with me 45 36 8 89 42% 49% 18% 40%
  To trust my opinion 0 0 1 1 0% 0% 2% 0%
  The most innovative treatment option 1 0 0 1 1% 0% 0% 0%
17. At the end of a visit, how often do you check for patient understanding?
  Every time 43 22 16 81 40% 30% 36% 36%
  Never 2 1 1 4 2% 1% 2% 2%
  Every time I think patient is not understanding 61 50 24 135 57% 68% 55% 60%
  Every time I notice patient has limited health literacy 12 5 2 19 11% 7% 5% 8%
  When patient asks me weird questions 13 9 4 26 12% 12% 9% 12%
Tracking and responding to emotions
18. Which of the following emotions do patients show you more often?
  Fear 76 58 30 164 71% 78% 68% 73%
  Anger 14 24 3 41 13% 32% 7% 18%
  Sadness 34 31 16 81 32% 42% 36% 36%
  Disgust 0 1 1 2 0% 1% 2% 1%
  Happiness 6 5 0 11 6% 7% 0% 5%
  Disappointment 13 15 5 33 12% 20% 11% 15%
19. What do you do when patients show you their feelings?
  Talk about the benefits of therapy 12 6 8 26 11% 8% 18% 12%
  Remain silent waiting for the end 15 15 4 34 14% 20% 9% 15%
  Address patients’ emotions with empathic responses 74 49 22 145 69% 66% 50% 64%
  Highlight what is positive 41 27 18 86 38% 36% 41% 38%
  Interrupt the visit then start again when patients are more relaxed 1 1 0 2 1% 1% 0% 1%
Communication skills training
20. How did you develop your communication skills?
  Observing mentors and older colleagues 78 61 31 170 73% 82% 70% 76%
  Experience 58 41 17 116 54% 55% 39% 52%
  Communication skills training courses 8 7 0 15 7% 9% 0% 7%
  Textbooks and scientific literature 6 4 4 14 6% 5% 9% 6%
  Medical school 3 6 5 14 3% 8% 11% 6%
21. Would a strategy or approach to breaking serious news be helpful in your practice?
  Yes, certainly 76 60 34 170 70% 81% 77% 75%
  No 3 0 0 3 3% 0% 0% 1%
  It is not possible to determine in advance a way to do it regardless of the situation and the individual needs. 29 14 10 53 27% 19% 23% 24%
Self-evaluation
22. How do you feel about your own ability to break serious news?
  Very good 2 0 2 4 2% 0% 5% 2%
  Good 32 26 16 74 30% 35% 36% 33%
  Fair 57 32 21 110 53% 43% 48% 49%
  Poor 8 9 2 19 7% 12% 5% 8%
  Very poor 9 7 3 19 8% 9% 7% 8%
23. In a qualitative study on patient-physician relationship, patients have been asked to “classify” their physicians basing on the attitudes and skills physicians showed them during treatments.[26] Which kind of physicians do you think you are?
  Unskilled 25 14 6 45 24% 21% 14% 21%
  Emotionally overwhelmed 4 2 1 7 4% 3% 2% 3%
  Tough but skillful 6 4 6 16 6% 6% 14% 8%
  Insensitive but skillful 4 1 2 7 4% 1% 5% 3%
  Detached 6 1 1 8 6% 1% 2% 4%
  Empathic and professional 59 45 26 130 57% 67% 62% 61%
  1. Abbreviations: IMA Internal Medicine Area, HOA Haematology/Oncology Area, SA Surgical Area