Walker Louise, Sivell Stephanie
Cardiff University, Wales, UK; Greys Hospital, Private Bag 9001, Pietermaritzburg 3200, KwaZulu Natal, South Africa.
Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
Patient Educ Couns. 2022 Jul;105(7):2081-2088. doi: 10.1016/j.pec.2022.01.007. Epub 2022 Jan 20.
Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques.
BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis.
Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure.
Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central.
BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.
在医疗保健中传达坏消息很常见。相关指南众多，但在非洲背景下的记录却很少。我们想描述说祖鲁语患者的坏消息传达经历，并评估他们对国际推荐技巧的看法。
采用系统综述方法从文献中突出坏消息传达技巧。对说祖鲁语的癌症患者进行了半结构化焦点小组访谈。使用框架分析法对数据进行分析。
语言一致性至关重要——无论这是否需要护士担任翻译。虽然参与者重视不放弃、同理心和保持希望，但对暗示模棱两可的表述，一种常表达的对积极结果的信念导致了混合反应。相比之下，“我希望”这样的表述受到赞赏。沉默的反应不一，人们非常不喜欢用沉默来掩盖不披露信息。
与语言相关的问题主导了大部分参与者对坏消息传达的看法。虽然存在文化和语言差异，但良好的沟通技巧、同理心和保持希望仍然至关重要。
用患者流利的语言传达坏消息，无论是否有中介，都应成为护理标准。必须牢记文化和语言差异，临床医生应熟悉他们所服务社区的偏好。
