What to do before the encounter |
Summon other people
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“summon family members;” “prepare individual before delivering news together with a team” |
Choose a suitable setting/location
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“have patient come to the doctor´s office;” “invite patient/family member to a reserved space |
Assess whether the moment is appropriate
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“do not deliver the news when the person feels ill” |
Be certain of the diagnosis
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“be certain of the diagnosis before delivering the news;” “wait for confirmation […] and, if uncertain, don´t say it” |
Different perspectives on who to tell |
Family member/companion
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“Summon family members first. Deliver the news explaining things well. Reassure them and inform them well […] so they can tell the patient;” “inform companion if it is serious” |
Most stable person
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“deliver the news to the right person, the most “stable” person, the person who seems to have it “together” |
Patient
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“the first person to know must be the patient, and not the person sitting next to them […] don´t tell others” |
Who should deliver the news |
The physician
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“hear it from the doctor´s mouth, and not from others;” “the patient´s doctor should be the one to deliver the news” |
How to address the patient |
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Address the patient by name
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Invite the patient to sit down
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Look the patient in the eyes
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“look person in the eye;” “look at the patient” |
Listen to the patient
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“be open to listen” |
What to consider before delivering the news |
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Spirituality
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“we are Christians, and this really helps us to cope with situations like these […] only He can give us strength” |
Conversation with the family members
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“clarify things so that the family doesn´t feel guilty;” “the companion should know more than the patient” |
Different perspectives on when to deliver the news |
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After learning whether patient wishes to hear the news
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“if I don´t want to know, don´t tell me,” “[…] unless the person doesn´t want to know” |
After assessing patient´s health condition
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“check everything first, such as blood pressure;” |
After observing patient's psychological condition
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“carefully observe the person before deciding how to say it […] or how much should be said” |
After preparing the patient
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“together with a (medical) team” |
“in a conversation […] don´t show up out of the blue so as not to scare” / “so as not to shock
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the person”; “don´t jump right into it, but be subtle” |
Without preparing the patient
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“you should be direct;” “not beat around the bush;” “go straight to the point;” “don´t be evasive… speaking in circles only makes a person more anxious;” “just spit it out” |
Depends on the:
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- person and culture
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“learn what the person is like […] get to know the person […] anxious or nervous…”; “it depends on the culture” |
- news
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“it depends on the illness;” “it depends on the news, for example, a cancer” |
How to prepare the patient |
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Include other persons such as family members in the conversation
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Sit down and talk
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“sit down, put the person at ease… let´s talk” |
Keep a conversation going
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“prepare the patient psychologically;” “have a conversation first, and finally, when the time is right, deliver the news;” ‘[...] the diagnosis should be put together through words that guide the listener to the delivery of a critical piece of news;” “at first, take your time discussing and going over the diagnosis, little by little… have a conversation to help the person understand what is happening […] ‘it´s necessary to contextualize things;” “… if it´s cancer, report everything that has been discovered before delivering the diagnosis;” “explain what the patient had… which resulted in the current condition… explain sequentially, ask about the patient´s life”
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Have a structured conversation
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“1) have a conversation and appease the shock, 2) the exam results indicate that you have a health condition 3) this is not definitive, your condition is treatable 4) you need to be strong now” |
Give clues
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“say words to prepare the patient;” “begin by giving clues so the person slowly gets what is happening to them;” “hint at the fact that the person may have something serious” |
Different perspectives on how much should be said |
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Everything
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“I want to know everything… you can say it;” “explain details […] whether there´s a solution or not” |
Only parts
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“never deliver the full news” |
Characteristics of communication |
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Verbal language:
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- clear |
“as natural and clear as possible” |
- using appropriate words/ being gentle with the words |
“use appropriate words;” “be careful with the choice of words” |
- without using scientific language/technical jargon |
“without using scientific language;” not using technical jargon” |
- that the patient can understand |
“ease into your speech;” “explain things correctly […] not leaving the person clueless” |
- with little information at a time |
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- in a succinct/objective manner |
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Provide written material
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“furnish a written report of the problem” |
Non-verbal language:
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- speak calmly, slowly, paying attention to the tone of voice |
“things must be said gently;” “pay attention to your voice” / “your tone of voice;” “speak calmly […], slowly;” “explain things slowly” |
- look the person in the eye |
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Attitudes during delivery |
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Presence/ attention
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“the news should be delivered as if that patient were special;” “do not leave someone ‘hanging’ saying you´ll be back later to talk” |
Active Listening
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“listen, be considerate […]” |
Caring
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“put the person at ease;” “don´t scare the person;” “calm the patient, when the patient cries, embrace them” |
Compassion |
“their compassionate gaze said everything […] their expression helped me to realize it was serious […] the look in their eyes said it all…” |
What the physician should say |
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That they do their best to try to solve the disease
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“tell them: we are going to try to solve this in the best way possible”; “say that things are difficult, but that we are going to try”
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That they understand the patient’s perspective
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“say that they understand the patient´s point of view” |
That there is treatment
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“say that treatment exists;” |
That there are resources
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“point out the positive side, that there are available resources” |
Positive things
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say positive things, because one´s self-esteems drops to the floor;” “not discourage;” “just keep going so you don´t get depressed” |
What to address in the conversation |
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Explain the disease/illness
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“explain the illness… what we´ve got… what is happening” |
Explain what is going to happen
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“explain what is going to happen;” “show what is coming ahead… all this will bring about;” “explain things so the patient may rebuild their life” |
Present treatment options and the pros and cons
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“present treatment options”; “present possible treatments;” “explain the pros and cons” |
Explain prognosis
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“present clear expectations;” “present the chances” |
Present a plan
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“explain what the patient should do next;” “say what the next steps are;” “present a plan” |
Provide referrals, including psychological support
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“provide necessary referrals;” “refer (patient/family) to a psychologist” |
Attitudes during encounter |
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Respect
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“take the patient seriously;” “no jokes at this time;” “treat (the patient) like a human being, with respect” |
Be calm, patient
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“be cool […] and calm;” “don´t get annoyed or worked up if the person cries;” “to be patient and impart serenity” |
Categories / Subcategories / sub subcategories*
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Illustrative quotations |
Be considerate
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“be considerate;” “engage with the patient” |
Be loving
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“Treat (patients) with love and care;” “treat (them) in a special way […] being loving” |
Sincerity, honesty
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“be sincere and truthful;” “do not hide anything;” “be frank;” “place all the cards on the table and say what the patient needs to hear;” […] it´s preferable to deal with the truth than lies;” “be realistic […] sometimes we cry, but then we get up again;” “don´t raise false expectations” |
Humbleness, transparence
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“being humble is the most important;” “be transparent;” “be a human being, not imposing oneself as a doctor” |
Compassion, have concern for patient
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“showing compassion”; “show concern for the patient; ”show willingness to help” |
Sensitivity
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“treat (others) like human beings, be sensitive” |
Empathy
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“be empathetic, remember that they are human beings;” “you have to believe what the patient is feeling” |
Be committed to the patient
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“don´t abandon/discontinue patient treatment” |
Be supportive, available
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“be accessible;” “be supportive, help (patient) to move forward” |
Be understanding
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Be non-judgmental
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Be hopeful |
“be hopeful […] you can´t be apathetic when it comes to hope” |
Courage
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“Have the courage to speak” |
Categories / Subcategories / sub subcategories*
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Illustrative quotations |
Professionalism
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“be professional about it, you must love what you do;” “someone who really embodies the role” |
Demonstrate confidence
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