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Breaking Bad News: Doctors' Feelings and Behaviors

Published online by Cambridge University Press:  10 April 2014

Fernanda Saviani-Zeoti*
Affiliation:
Universidade de São Paulo, Brazil
Eucia Beatriz Lopes Petean*
Affiliation:
Universidade de São Paulo, Brazil
*
Correspondence concerning this article should be addressed to Fernanda Saviani Zeoti, Rua Professor Hoehne, 41. Sumarezinho - CEP: 14055-27. Phone: (55) (16) 3630-9232. E-mail: [email protected]
Eucia Beatriz Lopes Petean, Av. Bandeirantes, 3900. Monte Alegre – Dept° de Psicologia e Educação/FFCLRP-USP- CEP: 14040-901. Phone: (55) (16) 3602-3767. E-mail: [email protected]

Abstract

The announcement about the handicap of a child is communicated to parents by gynecologists or ultrasonographists, in the prenatal period. Often, these professionals are not prepared to communicate this news to the parents, and they have some limitations that lead them to act inappropriately. Therefore, the aims of this research were to identify and to describe the feelings of professionals facing this situation, and to examine their behaviors when they have to inform a couple about the child's anomaly. Ten gynecologists and ultrasonographists were interviewed: five were consultants in Public Health Services and five were private clinicians. Interviews were carried out with a semi-structured script. The results showed that, according to the participants, there is no specific moment, nor a standard behavior, that is most appropriate for making such an announcement. Yet the data show that all the participants feel hurt or frustrated when they must announce this phenomenon, becoming involved with the case. In conclusion, no graduate course has prepared them to deal with this deficiency. Suggestions are made concerning the graduate curriculum in order to improve the preparation of future doctors. A mental health professional is even necessary among the multidisciplinary team formed to deal with the pain produced in the moment of the announcement.

Los ginecólogos o los ultrasonógrafos son los profesionales que deben comunicar a los padres la noticia de la discapacidad de su hijo, en el período prenatal. A menudo, estos profesionales no están preparados para comunicar este suceso a los padres y tienen algunas limitaciones que les llevan a actuar de forma inapropiada. Por ello, los objetivos de esta investigación eran identificar y describir las emociones de los profesionales que afrontan esta situación y conocer sus comportamientos cuando tienen que informar a una pareja de la anomalía de su hijo. Se entrevistaron a 10 ginecólogos y 10 ultrasonógrafos: 5 trabajaban en los Servicios de la Salud Pública y 5 eran clínicos privados. Las entrevistas eran semi-estructuradas. Los resultados muestran que, según los participantes, no hay un momento específico, ni un comportamiento estándar que sea el más apropiado para semejante situación. Sin embargo, los datos muestran que todos los participantes se sintieron dolidos o frustrados cuando tuvieron que informar de este fenómeno, y se involucraron en el caso. Concluyendo, no ha hay ningún curso de la licenciatura que los haya preparado para afrontar esta deficiencia. Se hacen algunas sugerencias acerca del currículo de licenciatura para mejorar la preparación de los futuros médicos. Incluso se necesita un procesional de la salud mental en los equipos multidisciplinarios que se forman para afrontar el dolor que se produce en el momento de semejante noticia.

Type
Articles
Copyright
Copyright © Cambridge University Press 2007

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References

Amaral, M.J.C., Cortez, M.L.S., Hoffmann, V.M.B., & Lyra-Netto, T.C. (1985). Programa de apoio aos pais. Projeto “Momento da Notícia.” São Paulo, Brazil: APAE.Google Scholar
Amiel, G.E., Ungar, L., Alperin, M., Baharier, Z., Cohen, R., & Reis, S. (2006, January) Ability of primary care physician's to break bad news: A performance based assessment of an educational intervention. Patient Education and Counseling, 60, 1015.CrossRefGoogle ScholarPubMed
Assumpção Junior, F.B. (1991). A família e o deficiente mental. São Paulo, Brazil: Ed. Paulinas.Google Scholar
Bellodi, P. L. (2001). O clínico e o cirurgião. Estereótipos, personalidade e escolha de especialidade médica. São Paulo, Brazil: Casa do Psicólogo.Google Scholar
Buckman, R. (1992). How to break bad news: A guide for healthcare professionals. Baltimore: John Hopkins Press.Google Scholar
Buckman, R. (2002). Communications and emotions. Skills and effort are key. Editorials. British Medical Journal, 325, 672.CrossRefGoogle Scholar
Buscaglia, L. (1993). Os deficientes e seus Pais. Um desafio ao aconselhamento. Rio de Janeiro: Editora Record.Google Scholar
Gauderer, E.C. (1981). Reação do profissional frente à doença crônica ou fatal. Jornal Brasileiro de Medicina, 40, 4756.Google Scholar
Han, P.K.J., Keranen, L.B., Lescisin, D.A., & Arnold, R.M (2005). The Palliative Care Clinical Evaluation Exercise (CEX): An experience-based intervention for teaching end-of-life communication skills. Academic Medicine, 80, 669676.CrossRefGoogle ScholarPubMed
Hania, C. (2003). De l'information à la parole. La position du psycologue. Gynécologie Obstetrique & Fertilité, 31, 452455.CrossRefGoogle Scholar
Hertling-Schaal, E., Perrotin, F., de Poncheville, L., Lansac, J., & Body, G. (2001). Maternal anxiety related to prenatal screening and invasive testing: Detection and management. Gynecology Obstetrique & Fertilite, 29, 440446.CrossRefGoogle ScholarPubMed
Hulsman, R.L., Mollema, E.D., Oort, F.J., Hoos, A.M., & De Haes, J.C.J.M. (2006). Using standardized video cases for assessment of medical communication skills: Reliability of an objective structured video examination by computer. Patient Education and Counseling, 60, 2431.CrossRefGoogle ScholarPubMed
Mast, M.S., Kindlimann, A., & Langewitz, W. (2005). Recipients' perspective on breaking bad news: How you put it really makes a difference. Patient Education and Counseling, 58, 244251.CrossRefGoogle Scholar
Minayo, MC. da S. (1993). O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo- Rio de Janeiro: Hucitec – Abrasco.Google Scholar
Noronha, D., & Montgomery, M. (1993). O obstetra, o casal e o recém-nascido malformado. In Noronha, D.T., Lopes, G.P., & Montgomery, M. (Eds.), Tocoginecologia psicossomática (pp. 6370). São Paulo, Brazil: Almed.Google Scholar
Ptaceck, J.T., Ptaceck, J.J., & Ellison, N.M. (2001). “I'm sorry to tell you…” Physicians' reports of breaking bad news. Journal of Behavioral Medicine, 24, 205217.CrossRefGoogle Scholar
Quayle, J. (1997). Óbito fetal e anomalias fetais: repercussões emocionais maternais. In Tedesco, J.J. de A., Zugaib, M., & Quayle, J. (Orgs.). Obstetrícia psicossomática (pp. 216227). São Paulo, Brazil: Ed. Atheneu.Google Scholar
Quayle, J., Brizot, M.L., & Zugaib, M. (1999, November). Psychological aspects associated with ultrasound scan and nuchal translucency. 9th World Congress of Ultrtasound In Obstetrics and Gynecology. Buenos Aires (Argentina).Google Scholar
Ramos, T.C.L., Hoffmann, V.M.B., & Regen, M. (1985). As dificuldades em transmitir a notícia: pesquisa junto a pais de pacientes portadores de Síndrome de Down. Revista Brasileira de Deficiência Mental, 18, 4769.Google Scholar
Redinbaugh, E.M., Sullivan, A.M., Block, S.D., Gadmer, N.M., Lakoma, M., Mitchell, A.M., Seltzer, D., Wolford, J., & Arnold, R.M. (2003). Doctors' emotional reactions to recent death of a patient: Cross-sectonal study of hospital doctors. British Medical Journal, 327, 185190.CrossRefGoogle Scholar
Regen, M., Ardore, M., & Hoffmann, V.M.B (1993). Mães e Filhos Especiais: Relato de experiências com grupos de mães de crianças com deficiência. Brasília: CORDE.Google Scholar
Taanila, A., Järvelin, M-R., & Kokkonen, J. (1998). Parental guidance and counselling by doctors and nursing staff: Parents' views of initial information and advice for families with disabled children. Journal of Clinical Nursing, 7, 505511.CrossRefGoogle ScholarPubMed
Tedesco, J. J. de A. (1997). A humanização da relação obstetra-mãe-filho. In Tedesco, J. J. de A., Zugaib, M., & Quayle, J. (Orgs.), Obstetrícia psicossomática (pp. 271279). São Paulo, Brazil: Ed. Atheneu.Google Scholar
Ungar, L., Alperin, M., Amiel, G.E., Beharier, Z., & Reis, S. (2002). Breaking bad news: Structured training for family medicine residents. Patient Educational and Counseling, 48, 6368.CrossRefGoogle ScholarPubMed
Vaidya, V.U., Greenberg, L.W., Patel, K.M., Strauss, L.H., & Pollack, M. M. (1999). Teaching physicians how to break bad news. A 1-day workshop using standardized parents. Archives of Pediatrics & Adolescent Medicine, 153, 419422.CrossRefGoogle ScholarPubMed
Vicente, A. T. (1994). Pensando o espaço terapêutico a partir dos conceitos de paciente e cliente. In de Macedo, R.M.S. (Org.), Terapia familiar no Brasil: Estado da Arte. Anais (vol.II), 1, Congresso Brasileiro de Terapia Familiar (pp. 5561). São Paulo, Brazil: SP.Google Scholar
Wilheim, J. (1997). Psiquismo pré e perinatal. In Tedesco, J. J. de A., Zugaib, M., & Quayle, J. (Orgs.), Obstetrícia psicossomática (pp. 260267). São Paulo, Brazil: Ed. Atheneu.Google Scholar