Basheikh Mohammed
Department of Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU.
Cureus. 2021 Nov 13;13(11):e19525. doi: 10.7759/cureus.19525. eCollection 2021 Nov.
Objective To explore the preference among the Saudi population regarding breaking bad news (BBN) for the participant cases and their relatives and to determine the associated sociodemographic factors. Method A cross-sectional study was conducted among patients and companions attending inpatient and outpatient clinics of a tertiary care hospital in Western Saudi Arabia from 15 Jan to 30 May 2015. A six-item scale was designed to assess preference regarding diagnosis disclosure in three hypothetical conditions including chronic disease, incurable disease, and cancer if the participant or a close relative is concerned, separately. A BBN preference score (BBN-PS) was computed (range=0-6), with a higher score indicating a greater preference to disclose the diagnosis. Eventual motivations for diagnosis disclosure or withholding were explored. Result Five hundred participants were included; 56.0% were females and 55.0% were aged between 18 and 25 years. Preference to be informed with one's diagnosis varied between 81.8% for incurable disease and 94.2% for chronic disease with complications. Preference to inform a relative with their diagnosis ranged between 69.0% for incurable disease and 86.8% for chronic disease with complications. Preference for diagnosis withholding was lower among participants of the younger age category (38.2% vs 51.2% or higher, p=0.002), with higher education (42.4% vs 60.8%, p=0.001), and working or studying in the medical field (39.7% vs 51.9%, p=0.006), compared to their counterparts, respectively. The most common motivations toward diagnosis disclosure preference were to enable the concerned person participate in their therapeutic decision (36.4%) and cope with the disease (27.4%); while preference toward diagnosis withholding was most commonly motivated by apprehensions regarding the psychological and social impact of the diagnosis (61.6%). Conclusion A non-negligible proportion of individuals prefer concealing a diagnosis of cancer or incurable disease to a relative, with an inter-generational disparity showing a shift to diagnosis disclosure in the young generations. There is an unmet need for evidence-based protocols for BBN based on a comprehensive assessment of patients' expectations and needs, considering their cultural and religious values as well as the specific sociodemographic and clinical factors.
目的 探讨沙特人群对于向患者及其亲属传达坏消息（BBN）的偏好，并确定相关的社会人口学因素。方法 于2015年1月15日至5月30日在沙特阿拉伯西部一家三级护理医院的住院和门诊诊所对患者及其陪同人员进行了一项横断面研究。设计了一个六项量表，分别评估在三种假设情况下（包括慢性病、不治之症和癌症），如果参与者或其近亲患病，对诊断披露的偏好。计算了一个BBN偏好得分（BBN-PS）（范围=0-6），得分越高表明越倾向于披露诊断。探讨了诊断披露或隐瞒的最终动机。结果 纳入了500名参与者；56.0%为女性，55.0%年龄在18至25岁之间。对于不治之症，希望被告知诊断的比例为81.8%，对于伴有并发症的慢性病，这一比例为94.2%。希望告知亲属其诊断的比例，对于不治之症为69.0%，对于伴有并发症的慢性病为86.8%。与同龄人相比，年龄较小的参与者（38.2%对51.2%或更高，p=0.002）、受过高等教育的参与者（42.4%对60.8%，p=0.001）以及在医疗领域工作或学习的参与者（39.7%对51.9%，p=0.006）对隐瞒诊断的偏好较低。对诊断披露偏好的最常见动机是使相关人员能够参与治疗决策（36.4%）和应对疾病（27.4%）；而对隐瞒诊断的偏好最常见的动机是担心诊断对心理和社会的影响（61.6%）。结论 有相当比例的人倾向于向亲属隐瞒癌症或不治之症的诊断，代际差异表明年轻一代倾向于披露诊断。基于对患者期望和需求的全面评估，考虑其文化和宗教价值观以及具体的社会人口学和临床因素，对于基于证据的BBN方案仍有未满足的需求。
