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% |