Usman Asma, Shah Sameena, Zaki Samar, Nanji Kashmira, Sawani Sobiya, Uneeb Saher Naseeb, Bari Naseem, Ullah Obaid, Abid Sumera
Department of Family Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Department of Family Medicine, North Island Hospital Campbell River and District, Island Health Authority, Campbell River, BC Canada.
J Family Med Prim Care. 2024 Dec;13(12):5491-5499. doi: 10.4103/jfmpc.jfmpc_374_24. Epub 2024 Dec 9.
Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan.
Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A total of 1185 doctors were surveyed. Responses were compared across provinces.
80% of doctors across all specialties considered life-threatening diagnoses like cancer and stroke as equivalent to bad news, whereas less than 50% perceived conditions like malaria and typhoid as bad news. Regarding the level of difficulty encountered in giving bad news on a scale of 0 to 6, over 57% doctors rated it 4 and above. The reasons identified were lack of confidentiality, lack of privacy, lack of time, lack of training, fear of patients' and family reactions, not wanting to hurt the patient or causing more distress, concern of having failed the patient, and their own reactions among others.
Technical proficiency, training, good patient-centered communication, and incorporating socio-cultural aspects are essential for effective disclosure of bad news.
传达坏消息是执业医生面临的最困难任务之一，对于那些日常诊断和治疗危及生命疾病的医疗保健专业人员来说尤其如此。我们的目的是了解医生的知识和实践情况，并确定他们在巴基斯坦各省披露坏消息时面临的障碍。
在巴基斯坦15家政府和私立医院进行的一项由外部资助支持的横断面、多中心研究。共对1185名医生进行了调查。对各省的回答进行了比较。
所有专业的医生中，80%认为癌症和中风等危及生命的诊断等同于坏消息，而不到50%的人认为疟疾和伤寒等疾病是坏消息。在以0至6的等级表示传达坏消息时遇到的困难程度方面，超过57%的医生将其评为4及以上。确定的原因包括缺乏保密性、缺乏隐私、缺乏时间、缺乏培训、担心患者及其家属的反应、不想伤害患者或造成更多痛苦、担心辜负患者以及自身反应等。
技术熟练程度、培训、良好的以患者为中心的沟通以及纳入社会文化方面对于有效披露坏消息至关重要。
