Oikonomidou Despoina, Anagnostopoulos Fotios, Dimitrakaki Christine, Ploumpidis Dimitrios, Stylianidis Stylianos, Tountas Yannis
a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School.
b Department of Psychology , Panteion University of Social and Political Sciences.
Health Commun. 2017 Jun;32(6):657-666. doi: 10.1080/10410236.2016.1167991. Epub 2016 Jul 1.
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
在希腊，关于医生在披露坏消息方面的沟通行为及其显著信念的信息有限。在这项定性研究中，我们调查了医生在传达坏消息方面的自我报告做法、他们对影响此类消息传达的因素的看法，以及他们对最合适披露方式的信念。我们进行了焦点小组讨论和个人访谈。来自初级卫生保健机构和医院的25名住院医生和专科医生参与了研究。我们使用内容分析技术对收集到的数据进行了分析。结果发现，参与者承认适当且有效地传达坏消息的重要性；然而，他们中没有人报告实施过基于实证的沟通做法。他们描述的沟通模式主要由工作经验形成，并且常常受患者家属要求的指导。据报告，医生、患者和家属的特征以及组织特征和资源会影响坏消息的传达。参与者认为最合适的披露方式是针对每个患者独特需求的个性化方法。他们建议对传达过程进行跨学科、协作式管理，并建立正式的支持服务。这些发现可能为制定量身定制的、基于实证的课程干预措施和教育项目提供有用信息，以解决沟通中的若干障碍。应考虑影响披露实践的社会文化特征，以及与最佳信息传递相一致的医生看法。还需要优先考虑以患者为中心的沟通发展的系统层面策略。
