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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