Plain English summary
Background
Methods
Professional category | Obstetrician | Midwife | Nurse | Nursing assistant |
---|---|---|---|---|
Sex | ||||
Male | ||||
Age | ||||
<40 | 2 | 1 | ||
41–45 | ||||
46–50 | ||||
>50 | 2 | |||
Female | ||||
Age | ||||
<40 | 11 | 2 | 2 | 3 |
41–45 | 5 | 1 | 2 | |
46–50 | 2 | 1 | 1 | |
>50 | 2 | |||
Total | 22 | 4 | 3 | 8 |
Mean age (Years) | 39 | 38 | 40 | 44 |
Mean Experience (Years) | 11 | 10 | 16 | 24 |
Results
How to give bad news
Issuers and receivers of bad news
What bad news is communicated and how
AUXE01
Optimum environmental conditions when bad news must be given
The evolution of carer-patient communication
The role of nursing staff
Strategy and summary
Setting of the intervention
Subcategory: issuers and receivers of bad news Verbatim |
OBST S4
: “A woman who is pregnant always expects everything to go well, that the delivery will go well and that a healthy baby will be born; anything that goes wrong is bad news”.
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MID S2
: “Unexpected information that causes sadness and pain and provokes a change in your life”.
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MID S1
: “Something that doesn’t fit what you had expected, that spoils plans and means you have to adapt to a new situation”.
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OBST S17
: “The doctor is the person who can and should communicate bad news”.
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NASST S8
: “The news has to be given by the doctor and we are there to provide support”.
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MID S4
: “Ideally, there should be a multidisciplinary team, including nurses and, if possible, a psychotherapist”.
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NUR S3
: “Although the doctor gives the news, nurses are also involved, because the patients ask us to clarify what they don’t understand”.
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OBST S9
: “Obviously, you have to tell the patient and her partner, if there is one, and then assess the advisability of informing the family”.
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OBST S2
: “According to the rules on patient autonomy, the patient must always be told, and we assume that whoever is with her can also receive the news”.
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NUR S2
: “The patient must be informed because she is the one who is pregnant”.
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MID S2
: “It is very important that the information should also be received by someone the patient trusts (…)”
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Subcategory: what bad news is communicated and how Verbatim |
NASST S6
: “(...) miscarriages, foetal malformations, syndromes, foetal heart disease, proposal to interrupt the pregnancy”.
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NUR S3
: “In the ward, we have patients who decide to abort because of a diagnosis of severe malformation or chromosomal alteration”.
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MID S12
: “Very often, non-viable pregnancies, anomalies detected by ultrasound scan, antepartum deaths, intrauterine growth problems”.
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OBST S8
: “There is no magic formula. Usually the news is given little by little so that the information can be assimilated, but this does not always work, and for some patients it is very painful. Although for others, telling it all at once can be devastating (...)”
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OBST S13
: “(...) using the same means seen to be successful when done by more experienced colleagues”.
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MID S3
: “You create your own style, by doing it over and over again”.
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OBST S13
: “(...) I prefer to be totally frank. Sometimes, only when you say that the foetus is dead or that its situation is incompatible with life does the patient realise the gravity of the news”.
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NUR S3
: “We try to take into account the patient’s socio-cultural level, but we often forget and use too much medical jargon”.
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NASST S4
: “(...) we aren’t very close to the patients, we don’t take their hands, we don’t give them a hug, we avoid looking directly into their eyes, we focus on filling in the report, on the computer and on the ultrasound scan”.
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Subcategory: optimum environmental conditions when bad news must begiven Verbatim |
NUR S1
: “Somewhere private, without interruptions, separated from the maternity area, comfortable and with sufficient natural light”.
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OBST S13
: “(...) knocking at the door, people coming in and out, telephones ringing continually”.
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MID S2
: “The intentions are good, but there is no area specially equipped for this purpose. We try to assign a single room for a pregnancy termination, but it is not always possible”.
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Subcategory: the evolution of carer-patient communication Verbatim |
OBST S8
: “We always have to bear in mind the question of the medical professional’s legal defence. The social situation makes this inevitable, but it makes it very difficult to provide personalised, direct treatment”.
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NUR S2
: “Consent forms, signatures in duplicate, the next appointment with another healthcare professional ... all of this greatly interferes with the doctor-patient relationship”.
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OBST S6
: “We pay more attention to the diagnostics, we’ve gained in technological capabilities and lost in human quality”.
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Subcategory: the role of nursing staff, according to the physician Verbatim |
OBST S11
: “The nurses provide very important support; they help us convey the message we want the patient to receive”.
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OBST S1
: “They can provide support, but diagnosis is the doctor’s job and we have to communicate the message, even if we don’t like it”.
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OBST S12
: “(...) nurses spend many hours at the patient’s bedside, so they are well aware of the patient’s fears and expectations”.
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Subcategory: strategy and summary Verbatim |
OBST S16
: “The extra time you give to one patient is time you’re taking away from another. Ideally, an appointment should be made for another day”.
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NASST S7
: “Patients are seen again at the end of the consultation, to answer their questions”.
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OBST S14
: “At the end of the interview I do not have enough time for the patient to repeat everything I have explained to her and check if she has understood me”.
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Subcategory: setting of the intervention Verbatim |
OBST S10
: “With experience, you usually know what to do, but patients can ask unpredictable questions that you have to address on the spot”.
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OBST 16
: “Prior awareness or otherwise of the diagnosis and of the time available determines whether the talk to the patient can be prepared or must be improvised”.
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OBST S13
: “Inadequate training in communication is a handicap, making it hard to adapt the discourse to meet all the patient’s needs”.
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Communication skills
Training in the communication of bad news
The ability to explore psycho-social issues
Responding to the patient’s emotions
Subcategory: training in the communication of bad news Verbatim |
OBST S14
: “In the 2nd year at university, we did workshops on doctor-patient communication, but little else in the 6 years spent in the faculty.”
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OBST S12
: “During the first year of residency, we had a course on the doctor-patient relationship, in which we discussed the quality of care and the communication of bad news. But nothing since then.”
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NUR S3
: “(...) I’ve had training in helping and in the humanisation of care, but that was a few years ago.”
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MID S3
: “Every year we offer a course on how to respond to perinatal grieving, but hardly any of the medical staff take it.”
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OBST S13
: “We would need to learn communicative techniques and skills through role playing and recordings of our own interventions, and then analyse them.”
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MOBST S1
: “(...) we need advice from a psychotherapist, and medical team sessions to make our criteria consistent.”
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➣Desirable qualities in the person who must transmit bad news: |
OBST S11
: “Sensitivity and humanity, I think.”
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OBST S12
: “Empathy with the patient and showing self-assuredness in what you have to convey.”
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OBST S6
: “Having sufficient knowledge of pathology, of what can and can’t be done, and time in which to carry out possible solutions.”
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NASST S1
: “Closeness, putting yourself in the patient’s place and speaking in terms that she can understand.”
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Subcategory: the ability to explore psycho-social issues Verbatim |
ASST S7
: “This isn’t examined. Some patients will say they’ve had a stressful experience, but the doctor doesn’t go into this question, there isn’t time.”
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OBST S2
: “(...) that isn’t examined. I honestly don’t know what kind of inquiry might be made. If the patient has problems of this type, she usually tells you herself.”
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MID S2
: “The psychological and social aspects aren’t considered due to our feelings of insecurity. We make the excuse that we don’t have time, but it depends to a great extent on each individual’s attitude and personal interest in the matter.”
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MID S4
: “Unless the patient tells you spontaneously (although you might intuitively sense it), you don’t usually go into these areas, you only address the physical side.”
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Subcategory: responding to the patient’s emotions Verbatim |
NASST S1
: “You don’t have the knowledge or skills to deal with certain problems and the easiest thing to do is to avoid them. Without specific and continuous training in the necessary areas, we can’t offer patients comprehensive quality care.”
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OBST S3
: “We don’t have time. To respond properly we’d need a specialised consultation, with the presence of a psychologist.”
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➣Counselling strategies and Models of resilience: |
OBST S4
: “... yes, I’d recommend it, but to help in all these areas, right now I don’t have the tools, nor do we schedule appointments to assess the patient’s evolution, how she’s coping with the bad news or accepting it.”
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OBST S1
: “I don’t know what these strategies consist of.”
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MAT S4
: “What we do is listening, and little else. The patients go home, basically, with nothing.”
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➣Language barriers: |
OBST S2
: “There are language barriers, especially with the Chinese and Arab populations, and this makes you anxious.”
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Professional-patient interaction
Profile of the patients
Reactions to bad news
Demand for information
Influence of professionals on decision-making
Psychosocial support
Influence of technology
Subcategory: profile of the patients Verbatim |
OBST S13
: “Young women, between 16 and 44 years old, generally healthy for pregnancy, childbirth and postnatal care. Regarding socio-cultural level, there are all types, from low socio-cultural level to middle and high levels, immigrants, Spanish natives, Asian, European, African ... a multicultural population.”
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OBST S8
: “Very heterogeneous due to the variety of races.”
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OBST S7
: “Because what I say may lead to the pregnancy being interrupted, it’s necessary to know that not all cultures conceive or face this prospect in the same way.”
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Subcategory: reactions to bad news Verbatim |
MID S3
: “At first there is a state of shock, a sense of unreality.”
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OBST S3
: “They respond with pain, crying, anguish, suffering, and the feeling of enormous disappointment.”
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OBST S8
: “Although the foetus referred to in the bad news is the fruit of two people, the father and the mother, the mother’s response is usually much more emotional, and the role of the father automatically becomes that of consoling the mother.”
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Subcategory: demand for information Verbatim |
NASST S6: “Why? What have I done? Is it common? Finding out the cause and trying to determine if they are responsible. Is it something I took? I made an effort (...)” |
NASST S5: “(...) Now what? What can be done? What do you suggest? What would you do if it happened to you?” |
NUR S1
: “I think a second opinion would be a good idea, but it is very important to know who to ask.”
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OBST S4
: “They resort to the internet, but they don’t know how to filter the information and what information has been scientifically proven.”
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MID S3
: “In the private sector, they think they are better looked after because they are given more time and attention. Perhaps we should improve things in this area.”
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Subcategory: influence of professionals on decision-making Verbatim |
OBST S14
: “(...) you are often recommend what they should do. So, the way we give the news can make their decision go one way or the other.”
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NUR S2
: “The lack of social skills hinders the active participation of these patients in decision making.”
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OBST S13
: “I try to be as aseptic as possible, to respect their autonomy, giving them the consent form to sign …”
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Subcategory: psychosocial support Verbatim |
OBST S10
: “(...) some patients do need it, because they collapse, they go home and for months they feel very bad and don’t know who to turn to.”
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MID S2
: “The psychologist should be part of the team, both to help the women and to guide staff, because burnout does happen.”
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NUR S3
: “We don’t know what techniques we can use to deal with conflicts that may arise during the clinical relationship.”
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Subcategory: influence of technology Verbatim |
OBST S13
: “We spend more time using technology than we do listening, looking into people’s eyes (...)”
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NUR S3
: “An excess of technology can dehumanise the attention we provide.”
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