Dzierżanowski Tomasz, Kozlowski Michael
Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland.
Clinic of Pain Treatment and Palliative Care, Jagiellonian University Medical College, Krakow, Poland.
Arch Med Sci. 2019 Nov 12;18(6):1505-1512. doi: 10.5114/aoms.2019.85944. eCollection 2022.
Patients with life-threatening disease should be informed about the diagnosis and prognosis of life-expectancy. Breaking bad news (BBN) by a clinician may be affected not only by their lack of communication skills but also their philosophy of life, beliefs, fear of their own death, their length of tenure, and their exposure to dying and death.
This questionnaire-based study aimed to investigate the impact of these factors on BBN in internal medicine practitioners (INT) versus palliative care physicians (PCP), and to detect the possible impediments to the proper communication process and the clinicians' needs regarding their preparation for such a conversation.
Thirty-eight PCPs and 64 INTs responded. Determination of philosophy of life, but not religiousness, positively correlated with the number of working years in palliative care. Two-thirds of the respondents declared fear of death, and it diminishes along with working years, especially in palliative care. For most physicians, BBN appeared difficult; however, less so for PCPs, persons with a high level of determination of philosophy of life, and men. The most frequent impediment was insufficient communication skills. Consistently, the respondents expressed the need for closing the gap in communication skills, especially by mentoring or training on communication.
Fear of death may restrain inexperienced medical professionals from BBN to patients and makes it difficult. Working in palliative care augments the determination of philosophy of life and diminishes fear of death. The higher the determination of philosophy of life, the more likely BBN is to be performed. Philosophy of life, spirituality, and communication skills should be addressed in postgraduate education.
患有危及生命疾病的患者应被告知诊断结果和预期寿命的预后情况。临床医生传达坏消息（BBN）可能不仅受到其沟通技巧不足的影响，还受到其生活哲学、信仰、对自身死亡的恐惧、任职时长以及对濒死和死亡的接触程度的影响。
这项基于问卷调查的研究旨在调查这些因素对内科医生（INT）与姑息治疗医生（PCP）进行BBN的影响，检测在适当沟通流程中可能存在的障碍以及临床医生在为此类谈话做准备方面的需求。
38名姑息治疗医生和64名内科医生做出了回应。生活哲学的确定程度与姑息治疗工作年限呈正相关，而宗教信仰程度则不然。三分之二的受访者表示害怕死亡，且这种恐惧会随着工作年限的增加而减少，尤其是在姑息治疗领域。对大多数医生来说，传达坏消息似乎很困难；然而，对于姑息治疗医生、生活哲学确定程度高的人以及男性来说，困难程度较低。最常见的障碍是沟通技巧不足。一致地，受访者表示需要缩小沟通技巧方面的差距，特别是通过指导或沟通培训。
对死亡的恐惧可能会抑制缺乏经验的医学专业人员向患者传达坏消息，并使其变得困难。从事姑息治疗工作会增强生活哲学的确定程度并减少对死亡的恐惧。生活哲学的确定程度越高，进行传达坏消息的可能性就越大。生活哲学、精神层面和沟通技巧应在研究生教育中得到关注。
