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OBJECTIVES: To analyze the self-reported perception of obstetric medical teams regarding the practice of delivering bad news in public and private hospitals. METHODS: Cross-sectional study considering physicians delivering obstetric care at the Municipal Hospital Vila Santa Catarina, Municipal Hospital Dr. Moysés Deutsch, and Albert Einstein Israelite Hospital, in São Paulo, Brazil. The applied questionnaire reflected the steps of the SPIKES protocol for delivering difficult news, with the questions adapted to obstetric and fetal medicine practice context. RESULTS: Specialists self-reported higher levels of knowledge, better emotional management, and superior strategy planning and summarization skills than residents. Participants with more than five years of experience reported higher knowledge levels, better emotional management, and superior strategy development skills. When comparing professionals from private and public hospitals, no significant differences emerged in self-reported communication aspects. CONCLUSIONS: Experience duration significantly influences professionals' impressions in their ability to provide information, manage emotions, and plan post-diagnosis. Specialists and those with more years of experience self-report enhanced readiness in executing communication steps effectively. PRACTICE IMPLICATIONS: Our findings underscore the importance of tailored training and experience in navigating sensitive medical conversations in the field of Obstetrics.
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Comunicación , Obstetricia , Revelación de la Verdad , Humanos , Estudios Transversales , Femenino , Embarazo , Adulto , Encuestas y Cuestionarios , Brasil , Relaciones Médico-Paciente , Atención Terciaria de Salud , Masculino , Médicos/psicología , Actitud del Personal de Salud , Grupo de Atención al PacienteRESUMEN
OBJECTIVE: This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses. METHODS: A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube. RESULTS: Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased. CONCLUSION: A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative. CLINICAL RELEVANCE: Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.
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ABSTRACT Medical specialties have recognized that breaking bad news assists clinical practice by mitigating the impact of difficult conversations. This scenario also encourages various studies on breaking bad news in ophthalmology since certain ocular diagnoses can be considered bad news. Thus, the objective is to review the scientific literature on breaking bad news in ophthalmology. The literature databases like MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE, and SCIELO, were screened for related research publications. Two independent reviewers read all the articles and short-listed the most relevant ones. Seven articles, in the formats of original article, review, editorial, oral communication, and correspondence, were reviewed. Conclusively it reveals that ophthalmologists are concerned with communicating bad news effectively but lack related studies. Nevertheless, there is a growing realization that training in breaking bad news can increase physicians' confidence during communication, thus, benefiting the therapeutic relationship with the patient and his family. Therefore, it would be valuable to include breaking bad news training in the curriculum of residencies.
RESUMO O reconhecimento sobre a comunicação de más notícias como mitigadora de conversas difíceis por outras especialidades médicas, incentiva o estudo desta temática na oftalmologia. Sendo assim, o objetivo deste estudo é revisar a produção de pesquisas científicas sobre a comunicação de más notícias em oftalmologia. Para isso, foi realizada uma revisão de literatura. As bases de dados utilizadas foram MEDLINE/PUBMED, EMBASE, LILACS, SCOPUS, COCHRANE e SCIELO. Dois revisores independentes leram todos os artigos e selecionaram a amostra final. Sete artigos foram escolhidos nos formatos de artigo original, revisão, editorial, comunicação oral e correspondência. Os oftalmologistas estão preocupados em comunicar as más notícias de forma eficaz, mas faltam estudos sobre o tema. No entanto, há uma crescente percepção de que o treinamento de comunicação de más notícias aumenta a confiança dos médicos na comunicação, beneficiando a relação terapêutica. Portanto, seria valioso incluir este treinamento no currículo das residências.
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Background: Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol defines a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. Some studies support the hypothesis that personality influences the communicative modes; therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods: Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. There was no significant correlation with the personality questionnaire domains. Conclusions: There are certain needs tending towards universality in the communication of bad news that the SPIKES protocol adequately reflects; it can be considered the gold standard. However, it is not possible to establish nuances in it according to personality traits based on the results of this work. In the strategy phase, attention should be paid to life and family planning in the context of oncologic disease.
Introducción: Establecer una adecuada comunicación forma parte del proceso terapéutico y del abordaje integral del paciente oncológico. El protocolo SPIKES emite una serie de recomendaciones generales destinadas a facilitar este proceso. No existe hasta la fecha un cuestionario que permita personalizar de una manera sistematizada la comunicación de malas noticias. Existen estudios que apoyan la hipótesis de que la personalidad influye en los modos comunicativos. Por ello, el objetivo de este trabajo fue intentar establecer matices en el protocolo SPIKES con base en los rasgos de personalidad. Materiales y métodos: Estudio unicéntrico, observacional, prospectivo, descriptivo y correlacional, realizado sobre una muestra de 51 pacientes oncológicos con base en un cuestionario de personalidad y un cuestionario de comunicación, el cual se basa a su vez en el protocolo SPIKES. Resultados: Las puntuaciones registradas en todos los dominios del cuestionario de comunicación fueron elevadas. Ninguna correlación con los dominios del cuestionario de personalidad resultó significativa. Conclusiones: Existen determinadas necesidades tendentes a la universalidad en torno a la comunicación de malas noticias que el protocolo SPIKES recoge adecuadamente, por lo que puede considerarse el gold standard. No se pueden establecer matices en este cuestionario en función de los rasgos de personalidad con base en los resultados de este trabajo. En la fase de estrategia, conviene prestar atención a la planificación vital y familiar en el seno de la enfermedad oncológica. Palabras Clave: protocolo SPIKES, comunicación de malas noticias, psicooncología, medicina personalizada, relación médico-paciente. ABSTRACT Background:Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol issues a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. There are studies that support the hypothesis that personality influences the communicative modes. Therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods:Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. No correlation with the personality questionnaire Irene Solana López* , Manuel Meilan Uzcategui , Elia Martínez Moreno , Ignacio Juez Martel , David Gutiérrez Abad , Elena Lahoz León , Olga Mateo Rodríguez , Jaime Martínez Moreno , Carlos de Zea Luque , Ana Manuela Martín Fernández de Soignie , Fátima Escalona Martín , Isabel Santana Gómez y Juan Antonio Guerra Martínez Servicio de Oncología Médica, Hospital Universitario de Fuenlabrada, Madrid (Spain)Recibido: 05/02/2024Aceptado: 08/03/2024Publicado: 30/04/2024* Autor de correspondencia: Irene Solana López, irene.solana@salud.madrid.orgArtículo / ArticleISSN: 2661-6653DOI:https://doi.org/10.33821/736Cómo citar: Solana Lopez I, Meilan Uzcategui M, Martinez Moreno E, Juez Martel I, Gutierrez Abad D, Lahoz León E, Mateo Rodríguez O, Martinez Moreno J, de Zea Luque C, Martín Fernández de Soignie AM, Escalona Martín F, Santana Gómez I, Guerra Martinez JA. Análisis del protocolo SPIKES desde la perspectiva del paciente oncológico. Estudio prospectivo basado en cuestionarios. Oncología (Ecuador). 2024;34(1): 4-20. https://doi.org/10.33821/736Further exploring the SPIKES protocol from the perspective of oncology patients in terms of personality traitsProspective questionnaire-based study© 2024 Revista Oncología Ecuador. Publicado por la Sociedad de Lucha Contra el Cáncer, Ecuador. Este es un artículo de acceso abierto publicado bajo una licencia CC BY-NC-SA (http://creativecommons.org/licenses/by-nc-sa/4.0/)
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Comunicación , NeoplasiasRESUMEN
Resumo: Objetivo: Analisar o conhecimento que os profissionais de uma equipe que trabalha em Unidade de Terapia Intensiva possuem sobre comunicação de notícias difíceis. Método: estudo de caráter qualitativo e exploratório realizado em um hospital regional do estado do Maranhão no período de maio a novembro de 2019. Participaram do estudo 29 profissionais de nível superior. As informações obtidas foram coletadas por entrevista semiestruturada e tratadas pela análise de conteúdo. Resultados: os dados foram distribuídos em três categorias: percebendo a si durante a comunicação da notícia difícil; percebendo o contexto do processo de comunicação; e percebendo o outro como receptor da notícia difícil. Conclusão: os entrevistados realizavam a comunicação de notícias difíceis de maneira instintiva e sem a adoção de protocolos. Todavia ressaltaram alguns passos do protocolo ao destacarem os cuidados com essa comunicação, e reconheceram a necessidade de preparo adicional da comunicação de notícias difíceis para melhoria do serviço.
Abstract: Objective: To analyze the knowledge of professionals working in an Intensive Care Unit regarding the communication of bad news. Method: A qualitative and exploratory study conducted in a regional hospital in the state of Maranhão from May to November 2019. The study involved 29 higher-level professionals. Data were collected through semi-structured interviews and analyzed using content analysis. Results: The data were categorized into three groups: self-perception during the communication of bad news, perception of the context of the communication process, and perception of the other as the recipient of bad news. Conclusion: The interviewees communicated bad news instinctively and without following protocols. However, some steps of the protocol were highlighted, emphasizing the importance of careful communication in these situations. They recognized the need for additional training in delivering bad news to enhance the service.
Resumen: Objetivo: analizar el conocimiento que tienen los profesionales de un equipo que trabaja en una Unidad de Cuidados Intensivos sobre la comunicación de malas noticias. Método: estudio de carácter cualitativo y exploratorio realizado en un hospital regional en el estado de Maranhão durante el período de mayo a noviembre de 2019. Participaron en el estudio 29 profesionales de nivel superior. Las informaciones compiladas se obtuvieron a través de entrevistas semiestructura- das tratadas por el análisis de contenido. Resultados: los datos se distribuyeron en tres categorías: percepción de uno mismo durante la comunicación de malas noticias; percepción del contexto del proceso de comunicación; y percepción del otro como receptor de malas noticias. Conclusión: los entrevistados realizaban la comunicación de malas noticias de manera instintiva y sin seguir protocolos. No obstante, destacaron algunos pasos del protocolo al resaltar la importancia de cuidar la comunicación en estas situaciones y reconocieron la necesidad de una capacitación adicional en la comunicación de malas noticias para mejorar el servicio.
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Objetivo: Analizar la importancia de la comunicación en la relación médico-paciente y recopilar información sobre la percepción durante su práctica. Método: Se realiza una revisión bibliográfica y una encuesta (participaron 105 médicos en Argentina). Resultados: Los resultados muestran que la mayoría de los profesionales refiere dificultades en la comunicación y que estas dificultan la atención. Los médicos manifestaron dificultades para comunicar malas noticias, mayormente en las áreas clínicas, y que la habilidad de ponerse en el lugar del paciente es fundamental para la comunicación de dichas noticias. Los jóvenes consideran de manera significativa que la comunicación de malas noticias depende de la práctica. Conclusiones: Las habilidades comunicativas son indispensables. Existe evidencia para sugerir que es necesario profundizar en la adquisición de competencias comunicativas y valores éticos.
Objective: To discuss the importance of communication in the doctor-patient relationship and collect information about perception during their practice. Materials and methods: A literature review and a survey were conducted (105 doctors in Argentina participated). Results: Most professionals report communication difficulties, which hinder care. Physicians expressed difficulties communicating bad news, primarily in clinical areas, and the ability to put themselves in the patient's shoes is essential for giving such news. Young people significantly consider that the communication of bad news depends on practice. Conclusions: Communication skills are critical. Evidence suggests that it is necessary to look into the acquisition of communication skills and ethical values.
Objetivo: analisar a importância da comunicação na relação entre médico e paciente, e coletar informações sobre a percepção durante sua prática. Método: são realizados uma revisão bibliográfica e um questionário, do qual participaram 105 médicos na Argentina. Resultados: a maioria dos profissionais refere dificuldades na comunicação e que estas prejudicam o atendimento. Os médicos manifestaram dificuldades para comunicar más notícias, predominantemente nas áreas clíngicas, e que a habilidade de se colocar no lugar do paciente é fundamental para a comunicação dessas notícias. Os jovens consideram de maneira significativa que a comunicação de más notícias depende da prática. Conclusões: as habilidades comunicativas são indispensáveis. Há evidência para sugerir que seja necessário aprofundar sobre a aquisição de competências comunicacionais e valores éticos.
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Abstract Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors' performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty's particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies' results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic.
Resumo Dar más notícias é comum em obstetrícia e ginecologia. Porém, é difícil e poucos médicos recebem treinamento sobre como lidar com essa situação. Esta revisão narrativa tem como objetivo reunir, analisar e sintetizar parte do conhecimento sobre a área, com foco na obstetrícia. Dentre os 16 artigos selecionados, dois são estudos de intervenção randomizados e controlados, e a maioria dos estudos refere-se à obstetrícia. Os resultados encontrados ressaltaram que simulação, feedback/entrevistas, palestras e protocolos podem melhorar o desempenho dos médicos na comunicação de más notícias. Para os pacientes, o contexto e como as informações são transmitidas parecem ter maior impacto do que o conteúdo das notícias. Os obstetras e ginecologistas poderiam se beneficiar de cursos e protocolos específicos, dadas as particularidades da especialidade. Faltam evidências sobre a forma mais eficaz de realizar esse treinamento. Encontrar formas validadas de quantificar e classificar os resultados dos estudos na área, permitindo uma análise objetiva dos resultados, é um dos maiores desafios neste tema.
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Humanos , Relaciones Médico-Paciente , Educación Médica , Comunicación en Salud , Entrenamiento SimuladoRESUMEN
BACKGROUND: Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS: The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS: The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION: The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.
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Relaciones Médico-Paciente , Revelación de la Verdad , Actitud , Brasil , Comunicación , Humanos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Patient user embracement involves behaviours of including and listening to the patient, appreciating their complaints, and identifying their needs, whether individual or collective. The aim of this study was to evaluate the influence of a user embracement protocol (SPIKES protocol) for patients with knee osteoarthritis (OA) immediately before intra-articular injection (IAI) relative to procedure tolerance and its effectiveness in the immediate, short and medium terms. METHODS: This was a randomized controlled trial. Patients received IAIs with triamcinolone hexacetonide (40 mg) preceded or not by the SPIKES protocol. The outcomes measured were: visual analogue scale for pain at rest, pain on movement and joint swelling; morning stiffness; Western Ontario McMaster Universities Index Functional Questionnaire (WOMAC); pain catastrophizing scale; McGill pain questionnaire; SF-36 questionnaire on quality of life; Trace State Anxiety Inventory (IDATE); and a Timed Up and Go functional test. RESULTS: One hundred patients were randomized in the user embracement group (n = 50) or the control group (n = 50); 89% were women and 60% white, mean age was 67.1 (±7.3) years, and mean disease time was 6.3 (±6.2) years. No statistically significant differences were found between the groups for any variables at pre-procedure time, nor did the groups differ in their tolerance to the procedure or during the 12 weeks of follow up for any evaluated variables. CONCLUSIONS: No benefit was identified by applying a user embracement protocol to patients with knee OA prior to IAI with corticosteroid, neither to tolerance at the time of the procedure nor to its effectiveness in the immediate, short, and medium terms.
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Corticoesteroides/administración & dosificación , Osteoartritis de la Rodilla/tratamiento farmacológico , Dolor/tratamiento farmacológico , Relaciones Médico-Paciente , Triamcinolona Acetonida/análogos & derivados , Corticoesteroides/uso terapéutico , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dimensión del Dolor , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Triamcinolona Acetonida/administración & dosificación , Triamcinolona Acetonida/uso terapéutico , Escala Visual AnalógicaRESUMEN
Abstract Communicating bad news is one of the most frequent activities in hospitals, for which some recommendations have been adapted to the needs within the coronavirus-2 disease (COVID-19) context. This document presents nine steps to deliver bad news (face to face or remotely) adapted to the COVID-19 context from two international protocols (SPIKES and GRIEV_ING). The importance of promoting physical and emotional self-care skills in health personnel is also described, as well as psychological first aid strategies to address the emotional response of the family member who receives the news. Finally, the limitations and advantages of the proposal should be considered.
Resumen La comunicación de malas noticias es una de las actividades más frecuentes en los hospitales dentro del contexto de la COVID-19. A pesar de su alta frecuencia, existen pocas recomendaciones adaptadas a las necesidades que el contexto de la COVID-19 demanda. Debido a lo anterior, en el presente escrito se presentan nueve pasos para dar malas noticias (cara a cara o por vía remota) de dos protocolos internacionales (SPIKES y GRIEV_ING) adaptados a las necesidades de transmisión de información de la COVID-19. Se describe también la importancia de promover habilidades de autocuidado físico y emocional en el personal de salud, así como estrategias de primeros auxilios psicológicos para el abordaje de la respuesta emocional del familiar que recibe la noticia. Finalmente, se deben considerar las limitaciones y ventajas de la propuesta.
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Communication challenges related to the delivery of bad news are present in oncologists' daily practice. Hence, communication skills are essential for clinicians to handle these situations as appropriately and compassionately as possible. The aim of this study was to identify Mexican oncologists' perceptions on the most important and hardest issues to discuss with patients and their families, as well as the challenges they most commonly encounter when communicating bad news. Physicians from various oncology centers were invited to anonymously complete an electronical survey designed by our multidisciplinary oncology team. Statistical analysis was performed with the SPSS software v25; descriptive statistics were used for the analysis of the survey's answers. In total, 115 physicians were included; most were medical oncologists. Treatment objectives and prognosis were the topics most of them considered relevant to address; while end-of-life care and treatment objectives were the hardest ones to discuss. The most difficult challenges they faced when breaking bad news were being honest without taking away hope and dealing with patients' emotions. Remarkably, we detected a lack of training in delivering bad news to patients among our participants, as a minority of them had formal training in the matter. However, most desired to receive communication skills training and believed a session of 2-5 h would be sufficient. Mexican oncologists face diverse communication challenges when disclosing bad news to patients. Our findings reveal an opportunity to develop formal training programs tailored for Mexican oncologists and to ultimately improve outcomes and patient-centered care.
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Oncólogos , Relaciones Médico-Paciente , Comunicación , Humanos , México , Revelación de la VerdadRESUMEN
Resumo: Introdução: Comunicação de más notícias refere-se às informações médicas que rompem de maneira adversa e negativa as expectativas de um paciente. Trata-se de um momento delicado da relação médico-paciente. O role playing com pacientes padronizados (PP) é uma alternativa para o ensino da comunicação, porém é desafiador construir roteiros e cenários semelhantes com a realidade, especialmente quando não se dispõe de atores profissionais. Objetivo: Este estudo teve como objetivo descrever a construção de PP a partir da experiência dos estudantes para o treinamento da comunicação com outros discentes de Medicina. Método: Estudantes de Medicina participaram voluntariamente da formação teatral e se dedicaram à construção de PP, com supervisão de docentes médicos e de atrizes, para oficinas de comunicação de más notícias. Para a construção dos PP, criaram-se diagnósticos médicos desfavoráveis, e estabeleceram-se os seguintes tópicos: perfil emocional, historicidade, instruções, progressões e possíveis desfechos, objetivos primário e secundário, e elementos facilitadores das cenas. Ensaiou-se exaustivamente para que os PP apresentassem a mesma reação em diferentes atitudes nas simulações. A participação nas oficinas foi aberta aos estudantes de Medicina interessados. Aferiu-se a qualidade das cenas pela sensação de realidade proporcionada aos participantes das oficinas. Resultado: Dez estudantes com idades entre 19 e 26 anos, de diferentes semestres, participaram do treinamento, do desenvolvimento de PP e das oficinas de simulação. Desenvolveram-se quatro cenas: Mariana recebeu diagnóstico de HIV e revelou violência sexual (60 cenas), Caroline e Marcelo receberam diagnóstico de câncer e necessidade de cirurgia (53 cenas), Thaís recebeu diagnóstico de insensibilidade androgênica e presença de gônadas masculinas (31 cenas), e Roger ou Rosana recebeu diagnóstico de retinose pigmentar e cegueira progressiva (22 cenas). Todos os PP proporcionaram sensação de realidade aos diferentes participantes das oficinas. Conclusão: Foi possível construir PP com estudantes de Medicina, apoiados por docentes, com a finalidade de participação em oficinas de comunicação de más notícias para outros discentes de Medicina que apontaram, em sua maioria, sensação de realidade com as cenas. Os estudantes atores se engajaram no processo e desenvolveram habilidades de comunicação e de empatia, características necessárias para a prática médica.
Abstract: Introduction: Breaking bad news is giving medical information that adversely and negatively disrupts a patient's expectations. This is a delicate moment in the doctor-patient relationship. Role playing with standardized patients (SP) is one method for teaching such communication skills, but it is challenging to construct scripts and scenarios that reflect reality, especially when professional actors are not used. Objective: To describe the construction of SP based on the students' experience for communication skills training with other medical students. Method: Medical students voluntarily participated in theatrical training, and worked on developing SPs, under the supervision of medical professors and actors, for breaking bad news workshops. For the construction of the SPs, unfavorable medical diagnoses were created, establishing an emotional profile, history, instructions, progressions and possible outcomes, primary and secondary objectives, and facilitating elements of the scenes. It was exhaustively tested so that the SP presented the same reaction in different attitudes in the simulations. Participation in the workshops was open to interested medical students. The quality of the scenes was measured by the sense of reality given to the workshop participants. Result: Ten students aged between 19 and 26 years, from different semesters, participated in the training, the SP development and role-play workshops. Four scenes were developed: Mariana was diagnosed with HIV and revealed sexual violence (60 scenes), Caroline and Marcelo who were diagnosed with cancer and needed surgery (53 scenes), Thais received a diagnosis of androgen insensitivity and presence of male gonads (31 scenes) and Roger or Rosana with retinitis pigmentosa and progressive blindness (22 scenes). All the SPs gave a sense of reality to the different workshop participants. Conclusion: It was possible to develop SPs with medical students, supported by professors, with the purpose of participating in workshops to communicate bad news to other medical students who perceived, for the most part, a sense of reality in the scenes. The student actors engaged in the process and developed communication and empathy competencies; characteristics necessary for medical practice.
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INTRODUÇÃO: A Síndrome da Imunodeficiência Adquirida (AIDS) é a apresentação clínica de deficiência imunológica ocasionada pelo Vírus da Imunodeficiência Humana (HIV). A revelação deste diagnóstico é uma comunicação que afeta profundamente a vida das pessoas envolvidas tanto profissionais quanto pacientes. OBJETIVO: Este estudo tem o objetivo de analisar a revelação do diagnóstico de HIV/Aids, considerando seus impactos psicossociais, afetivos e neurocognitivos. MÉTODOS: Para compreender o processo comunicacional foram utilizados estudos de saúde coletiva e os impactos psicológicos, foram analisados à luz dos conceitos psicanalíticos de Donald Winnicott. A metodologia é de caráter exploratório e descritivo, com abordagem mista e predomínio qualitativo. Os instrumentos de coleta dos dados foram: prontuário do paciente; entrevista semiestruturada, que cotejou etapas do Protocolo SPIKES; o Mini Exame do Estado Mental e a Escala Hospitalar de Ansiedade e Depressão. Foi realizada a análise de conteúdo em dez entrevistas, referenciada em Laurence Bardin. RESULTADOS E CONSIDERAÇÕES FINAIS: Os resultados mostraram que a comunicação do diagnóstico apresentou diversos impactos psicossociais nos sujeitos e o acolhimento balizado pelos princípios do protocolo SPIKES demonstrou ser um excelente alicerce para a comunicação diagnóstica, principalmente, quando associado a arranjos ambientais suficientemente bons, tais como apoio familiar e acesso à informação, promovendo assim, maior adesão ao tratamento.
INTRODUCTION: Acquired Immunodeficiency Syndrome (AIDS) is the clinical presentation of immunological deficiency caused by the Human Immunodeficiency Virus (HIV). The disclosure of this diagnosis is a communication that deeply affects the lives of the people involved, both professionals and patients. OBJECTIVE: This study aims to analyze the disclosure of the HIV / AIDS diagnosis, considering its psychosocial, affective and neurocognitive impacts. METHODS: To understand the communicational process, collective health studies were used and psychological impacts were analyzed in the light of Donald Winnicott's psychoanalytic concepts. The methodology is exploratory and descriptive, with a mixed approach and a qualitative predominance. The instruments for data collection were: patient record; semistructured interview, which compared stages of the SPIKES Protocol; the Mini Mental State Examination and the Hospital Anxiety and Depression Scale. Content analysis was carried out in ten interviews, referenced in Laurence Bardin. RESULTS AND FINAL CONSIDERATIONS: The results showed that the communication of the diagnosis had several psychosocial impacts on the subjects and the reception based on the principles of the SPIKES protocol proved to be an excellent foundation for diagnostic communication, especially when associated with sufficiently good environmental arrangements, such as family support and access to information. thus promoting greater adherence to treatment.
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VIH , Cambio Social , DiagnósticoRESUMEN
Communicating bad news is one of the most frequent activities in hospitals, for which some recommendations have been adapted to the needs within the coronavirus-2 disease (COVID-19) context. This document presents nine steps to deliver bad news (face to face or remotely) adapted to the COVID-19 context from two international protocols (SPIKES and GRIEV_ING). The importance of promoting physical and emotional self-care skills in health personnel is also described, as well as psychological first aid strategies to address the emotional response of the family member who receives the news. Finally, the limitations and advantages of the proposal should be considered.
La comunicación de malas noticias es una de las actividades más frecuentes en los hospitales dentro del contexto de la COVID-19. A pesar de su alta frecuencia, existen pocas recomendaciones adaptadas a las necesidades que el contexto de la COVID-19 demanda. Debido a lo anterior, en el presente escrito se presentan nueve pasos para dar malas noticias (cara a cara o por vía remota) de dos protocolos internacionales (SPIKES y GRIEV_ING) adaptados a las necesidades de transmisión de información de la COVID-19. Se describe también la importancia de promover habilidades de autocuidado físico y emocional en el personal de salud, así como estrategias de primeros auxilios psicológicos para el abordaje de la respuesta emocional del familiar que recibe la noticia. Finalmente, se deben considerar las limitaciones y ventajas de la propuesta.
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COVID-19 , Familia/psicología , Autocuidado/psicología , Revelación de la Verdad , Comunicación , Personal de Salud/organización & administración , Humanos , InternacionalidadRESUMEN
Este trabajo tiene como objetivo central, analizar el contexto de la comunicación interpersonal en la relación profesional sanitario-enfermo desde el ámbito de la Intervención Psicológica. Parece imprescindible incorporar a las áreas clínicas-asistenciales la formación necesaria en Técnicas y Protocolos sobre cómo informar y comunicarse con los pacientes en situaciones clínicas cotidianas, y en particular en la transmisión de malas noticias en temas generales de salud, y, específicamente en Servicios hospitalarios como los de Urgencias y Oncología. La formación en técnicas de Counseling es vital para estos profesionales que deberán paliar y potenciar las reacciones psicológicas e interpersonales que se suceden en la relación sanitario-enfermo, de ahí que se haga imprescindible la formación en los contextos universitarios para que los futuros profesionales tenga la capacidad de potenciar habilidades comunicativas que produzcan mayor bienestar personal y social, incrementando el grado de eficacia y eficiencia del Sistema Sanitario
The main objective of this work is to analyze the context of interpersonal communication in the healthcare professional-sick professional relationship from the field of Psychological Intervention. It seems essential to incorporate into the clinical-care areas the necessary training in Techniques and Protocols on how to inform and communicate with patients in everyday clinical situations, and in particular in the transmission of bad news in general health issues, and specifically in Hospital Services such as the Emergency and Oncology. The training in Counseling techniques is vital for these professionals who will have to alleviate and strengthen the psychological and interpersonal reactions that take place in the health-sick relationship, hence the need for training in university contexts so that future professionals have the ability to enhance communication skills that produce greater personal and social well-being, increasing the efficiency and effectiveness of the Health System
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OBJECTIVE: The purpose of this study was to demonstrate effectiveness of an educational training workshop using role-playing to teach medical students in Botswana to deliver bad news. METHOD: A 3-hour small group workshop for University of Botswana medical students rotating at the Princess Marina Hospital in Gaborone was developed. The curriculum included an overview of communication basics and introduction of the validated (SPIKES) protocol for breaking bad news. Education strategies included didactic lecture, handouts, role-playing cases, and open forum discussion. Pre- and posttraining surveys assessed prior exposure and approach to breaking bad news using multiple-choice questions and perception of skill about breaking bad news using a 5-point Likert scale. An objective structured clinical examination (OSCE) with a standardized breaking bad news skills assessment was conducted; scores compared two medical student classes before and after the workshop was implemented.ResultForty-two medical students attended the workshop and 83% (35/42) completed the survey. Medical students reported exposure to delivering bad news on average 6.9 (SD = 13.7) times monthly, with 71% (25/35) having delivered bad news themselves without supervision. Self-perceived skill and confidence increased from 23% (8/35) to 86% (30/35) of those who reported feeling "good" or "very good" with their ability to break bad news after the workshop. Feedback after the workshop demonstrated that 100% found the SPIKES approach helpful and planned to use it in clinical practice, found role-playing helpful, and requested more sessions. Competency for delivering bad news increased from a mean score of 14/25 (56%, SD = 3.3) at baseline to 18/25 (72%, SD = 3.6) after the workshop (p = 0.0002).Significance of resultsThis workshop was effective in increasing medical student skill and confidence in delivering bad news. Standardized role-playing communication workshops integrated into medical school curricula could be a low-cost, effective, and easily implementable strategy to improve communication skills of doctors.
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Relaciones Médico-Paciente , Desempeño de Papel , Estudiantes de Medicina/psicología , Revelación de la Verdad , Adulto , Botswana , Curriculum/normas , Educación/métodos , Femenino , Humanos , Masculino , Grupo Paritario , Encuestas y Cuestionarios , Enseñanza/normasRESUMEN
Objetivo: Desarrollar las habilidades de comunicación, dado que estas pueden producir un impacto positivo tanto en el dador como en el receptor de malas noticias. Conocer, mejorar y reforzar las técnicas en la transmisión de malas noticias. La comunicación de malas noticias es una práctica inherente al acto médico, si bien no nos enfrentamos habitualmente como anestesiólogos, es una de las tareas más difíciles a las que estamos expuestos. El hecho de no estar preparados para ello puede comprometer las competencias que necesitamos para hacerlo adecuadamente, lo que es fundamental conjuntamente con el mantenimiento de una adecuada relación médico paciente. La medicina paternalista ha dejado de ser tal, para dar lugar a nuevas formas de modelos de atención, poniéndose énfasis en la opinión y participación del paciente (empoderamiento) en la toma de decisiones. Transmitir una mala noticia de forma inadecuada, es decir, de forma drástica y sin empatizar con la situación que vive el paciente, hace que el médico ejerza esa tarea de manera áspera y errática. Acercarse a una persona o una familia con una mala noticia, sin un plan adecuado para presentar la información en forma estructurada, es casi una garantía de que se generará mayor dolor emocional y la alteración de los receptores de la noticia. Conclusión: La mayoría de los profesionales médicos no han recibido educación para dar malas noticias, pero casi todos se enfrentan frecuentemente al hecho. De ahí la importancia de estar preparados para esta responsabilidad, por lo que necesitamos formación para hacerlo de manera adecuada y profesional.
Objective: To learn communication skills, as they can have a positive impact on both the donor and the recipient of the bad news. To know, to improve and to reinforce the techniques of transmission of bad news. The communication of bad news is an inherent practice of the medical act, although normally we do not face as anesthetists, it is one of the most difficult tasks to which we are exposed. Not being prepared for it can compromise the human and technical skills we need to do it correctly, which is fundamental in conjunction with maintaining an adequate patient medical relationship. Paternalistic medicine has ceased to be such, to give rise to new forms of models of care, with an emphasis on the opinion and participation of the patient in decision making. To transmit bad news in an inadequate way, that is to say, drastically and without empathizing with the situation that the patient lives, causes the doctor to perform this task in a rude and erratic way. Approaching a person or a family with bad news, without a suitable plan to present the information in a structured way, is almost a guarantee that will generate more emotional pain and alteration of the news recipients. Conclusion: Most medical professionals have not been educated to give bad news, but almost all often face the fact. Hence the importance of being prepared for this responsibility, so we need training to do it properly and professionally.
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Humanos , Relaciones Médico-Paciente , Comunicación en Salud/métodos , Anestesistas/educación , Conocimientos, Actitudes y Práctica en SaludRESUMEN
ABSTRACT Introduction Breaking bad news althoughfrequent among healthcare professionals and their patients is still considered a very difficult task. These communication skill main determinants in the physician-patient relationship. Objective In view of the need to promote academic spaces that provide opportunities to learn breaking bad news , thisstudy aims to evaluate the medical residentsin relation to their interest in learning communication skills, as well as their skills in breaking bad news, before and after a workshop on the topic. Methods All the medical residents in the first year ofnternal edicine of a public general hospital in Belém-Pará, Brazil inwere invited to answer a questionnaire sociodemographic data and questions about their communication skills in clinical practice, as well as the Communication Skills Attitude Scale (CSAS), which addressed their interest in learning communication skills. The questionnaire. This research uses both uantitative and qualitative methods. The quantified data were statisticallyanalyzed by the Wilcoxon test (),Chi-Square test G-test adherence (quantitative variables of the questionnaire on communication skills). The qualitative evaluation Content Analysis based on Bardin. Results Ten residents attended the workshop. The results show that after taking part in the workshop, the resident's perceptions of the practice of breaking bad news had improved (in 80% of the participants), as well as their attitudes to learning communication skills ( CSAS = 99.5 and 105, before and after the course, respectively p = 0.0039). Conclusion Eighty percent of residents (n = 08) considered their communication skills have improved as a result of the workshop (p = 0.0078). Most of the participantsbecame more aware of the importance of considering the patient's perspective, and admitted positive changes following the course. Conclusion A positive effect on the participants' perceptions of communication skills and on their interest in learning these skills, were identified after an intervention focused on the context of breaking bad news.
RESUMO Introdução A comunicação de má notícia, embora frequente entre os profissionais de saúde e seus pacientes, ainda é considerada tarefa extremamente difícil. Essa habilidade de dar informação é um dos principais determinantes da relação médico-paciente. Objetivo Considerando a necessidade de promover espaços acadêmicos que proporcionem a aprendizagem da comunicação de notícia difícil, o presente estudo objetivou avaliar a percepção de um grupo de residentes de Clínica Médica quanto ao interesse pelo ensino e aprendizagem de comunicação, assim como suas habilidades de dar notícia difícil, antes e após uma oficina de comunicação de má notícia. Métodos Todos os médicos residentes do primeiro ano de Clínica Médica de um hospital-geral, em Belém, Pará (Brasil), foram convidados a responder a um questionário composto por dados sociodemográficos e perguntas sobre a sua prática de comunicação, além da versão da Escala de Atitudes e Habilidades de Comunicação (Communication Skills Attitude Scale) que aborda o interesse pela aprendizagem das habilidades comunicacionais. O questionário e a escala foram aplicados em dois momentos: antes e após a oficina teórico-prática de comunicação de má notícia, elaborada para esta pesquisa. Trata-se de uma pesquisa quanti-qualitativa. Os dados quantificados foram tratados estatisticamente por meio do teste de Wilcoxon (avaliação do escore do CSAS) e Qui-Quadrado e Teste G de aderência (variáveis quantitativas do questionário sobre habilidades de comunicação). A avaliação qualitativa foi feita pela análise de conteúdo de Bardin. Resultados Dez médicos residentes participaram da pesquisa. Os resultados demonstraram, após a participação na oficina, melhora na percepção dos residentes quanto à prática de comunicação de notícia difícil (em 80% dos participantes) e nas atitudes relacionadas ao interesse pela aprendizagem de comunicação (CSAS = 99,5 e 105, antes e após a oficina, respectivamente - p = 0,0039). Conclusão Um efeito positivo na percepção dos participantes quanto às habilidades de comunicação e seu interesse pelo aprendizado de tais habilidades foi identificado após uma intervenção focalizada no contexto da comunicação de má notícia.
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La verdad es un valor que necesita ser cultivado, hasta que se transforme en un hábito consuetudinario de trabajo. El uso de la verdad con nuestros pacientes forma parte de la conducta bioética que debemos mantener.
The truth is a value that needs to be cultivated, until it becomes a customary habit of work. The use of the truth with our patients is part of bioethics behavior that we must maintain.