Search

During the current thesis, the effect of female directors on the informativeness of stock prices and specifically on the tendency to delay the release of bad news will be examined. The existing literature has been examined and it seems that there is evidence that the female presence on the board of directors has a positive effect on various financial and market characteristics. Based on this, we expect that female directors are associated with weaker market reaction to the release of bad news. For the analysis, we used daily data on announcements and forecasts and have only used the observations that have negative values, which reflect the bad news. Then, the effect of women directors will be examined over the bad news and will then proceed with the conclusions of this research. In contrast with the existing literature, it seems that we find in all models used for the purposes of the analysis that the presence of female directors in the boardroom has a negative effect, which suggests that in the presence of female directors, firms do not disclose their bad news timely enough.

Breaking bad news is common in obstetrics and gynecology (ob-gyn). However, it is difficult, and few doctors receive training on how to deal with this situation. This narrative review aims to gather, analyze, and synthesize part of the knowledge on the area, focused on Ob-Gyn. Among the 16 selected articles, two are randomized controlled intervention studies, and most studies refer to obstetrics. The results found by us pointed out that simulation, feedback/debriefing, lectures, and protocols could improve doctors’ performance in communicating bad news. For patients, the context and how the information is transmitted seem to impact more than the content of the news. Ob-Gyn doctors could benefit from specific protocols and education, given the specialty’s particularities. There is a lack of evidence about the most effective way to conduct such training. Finding validated ways to quantify and classify studies’ results in the area, which would allow for the objective analysis of outcomes, is one of the biggest challenges concerning this topic. Resumo Dar más notícias é comum em obstetrícia e ginecologia. Porém, é difícil e poucos médicos recebem treinamento sobre como lidar com essa situação. Esta revisão narrativa tem como objetivo reunir, analisar e sintetizar parte do conhecimento sobre a área, com foco na obstetrícia. Dentre os 16 artigos selecionados, dois são estudos de intervenção randomizados e controlados, e a maioria dos estudos refere-se à obstetrícia. Os resultados encontrados ressaltaram que simulação, feedback/entrevistas, palestras e protocolos podem melhorar o desempenho dos médicos na comunicação de más notícias. Para os pacientes, o contexto e como as informações são transmitidas parecem ter maior impacto do que o conteúdo das notícias. Os obstetras e ginecologistas poderiam se beneficiar de cursos e protocolos específicos, dadas as particularidades da especialidade. Faltam evidências sobre a forma mais eficaz de realizar esse treinamento. Encontrar formas validadas de quantificar e classificar os resultados dos estudos na área, permitindo uma análise objetiva dos resultados, é um dos maiores desafios neste tema.

Aim: In 2020, due to the pandemic, the lack of specific knowledge on breaking bad news over the phone became apparent. This study aims at assessing the differences, or lack thereof, in satisfaction reported by participants in the different formats of a course in telephone communication for breaking bad news to families of patients, developed based on the previous experience of a team dedicated to this task during the peak of the pandemic. Methods: Four courses were delivered, two in a fully streamed format and two in a blended format, part pre-recorded, part streamed. There were 41 attendants, mostly doctors, but also nurses, social workers, occupational therapists, and administrative staff who deal with families. Subsequently, a survey was conducted to assess the degree of satisfaction of the participants. Results: Both formats scored very positively, with small advantages for the fully streamed format, mainly due to the difference in interaction activities. Conclusions: The main conclusion is the need for these courses, which are demanded by the professionals themselves, without forgetting the benefit obtained from interprofessional education that enriches interaction and learning. Innovation: The inclusion of administrative staff allows for a global vision of care for family members, which improves it.

In oncology, research remains unclear as to whether physician empathy is associated with patient outcomes. Our goal was to answer this question and explore potential moderators of the association. In this meta-analysis on adult cancer care, we excluded randomised controlled trials, and studies of survivors without active disease or involving analogue patients. Eight databases were searched, in addition to reference lists of relevant articles and grey literature. Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence by using the AXIS tool. Effect size correlations (ESr) were chosen and pooled by using a random effect model. Subgroup analyses were performed, and statistically significant variables were introduced in a meta-regression. Several methods were used to explore heterogeneity and publication biases. We included 55 articles, yielding 55 ESr (n = 12,976 patients). Physician empathy was associated with favourable patient outcomes: ESr = 0.23, 95% confidence interval (CI) (0.18 to 0.27), z = 9.58, p < 0.001. However, heterogeneity was high, as reflected by a large prediction interval, 95% (-0.07 to 0.49) and I 2 = 94.5%. The meta-regression explained 53% of variance. Prospective designs and physician empathy assessed by researchers, compared with patient-reported empathy, decreased ESr. Bad-news consultations, compared with all other types of clinical encounters, tended to increase ESr. Patient-reported physician empathy is significantly associated with cancer patient outcomes. However, the high heterogeneity warrants further longitudinal studies to disentangle the conditions under which physician empathy can help patients. Recommendations are proposed for future research.

ÖZETKötü haber; bireyin yerleşik hayat biçimini altüst etme riski olan, ümit etme duygusunun olmadığı, içeriğinde yaşamdaki seçimleri azaltma yönünde anlam taşıyan mesajdır. Hekimlik mesleği zaman zaman hastalara ve yakınlarına kötü haber verme görevini zorunlu kılar. Kötü haber verme becerisi; kötü haberin uygun bir dille verilmesini ifade eden, belirli gereklilikleri olan bir iletişim becerisidir. Bu becerinin hekimde olması, kötü haber vermenin zor sürecini, hekim hasta ve hasta yakını için kolaylaştırır ve daha kolay kabul edilebilir hale getirir., Bad news; it is a message that has the risk of upsetting the settled life style of the individual, that there is no sense of hope, and that means reducing the choices in life. From time to time, the profession of medicine makes it necessary to give bad news to patients and their relatives. Ability to breaking bad news; It is a communication skill with certain requirements that expresses the delivery of bad news in an appropriate language. Having this skill in the physician makes the difficult process of giving bad news easier and more acceptable for the physician, patient and patient relatives.

Background The manner in which bad news is communicated in oncological contexts can affect patients’ engagement, their coping strategies and therapeutic compliance. Although this topic has been broadly investigated since the nineties, to the best of our knowledge, little has been written about Italian patients’ experiences and preferences concerning what the oncologists should disclose and how they should intimate patients about their health conditions in different stages of oncological disease. Methods In an attempt to fill this gap, an online self-report questionnaire was administered to a sample of Italian onco-haematological patients. Data were analysed both qualitatively (by a content analysis) and quantitatively (by descriptive analysis and Generalized Linear Mixed Model). Results While the majority of patients elected to know the truth during their clinical course, a polarisation between those arguing that the truth be fully disclosed and those claiming that the truth be communicated in a personalised way was observed at the attitude level. Among demographic variables accounted for, age seems to most affect patients’ preferences. Indeed, younger Italian patients decidedly reject concealment of the truth, even when justified by the beneficence principle. This result could be a reaction to some protective and paternalistic behaviours, but it could even reflect a relation according to which the more the age increases the more the fear of knowing rises, or an intergenerational change due to different ways of accessing the information. The qualitative analysis of the final open-ended question revealed three main sources of problems in doctor-patient encounters: scarcity of time, absence of empathy and use of not-understandable language that makes it difficult for patients to assume a more active role. Conclusions The results of the present study, which represents a preliminary step in the subject investigation, will be deployed for the construction and validation of a more sophisticated questionnaire. Better awareness of the Italian onco-haematological patients’ preferences concerning bad news communication and truth-telling could be useful in adopting more suitable medical practices and improving doctor-patient relationships.

Resumen: Introducción: La comunicación de los profesionales de salud se asocia a mejores resultados en pacientes. El Programa para Mejorar las Habilidades Relacionales y de Comunicación (Program to Enhance Relational and Communication Skills [PERCS]) ha sido adaptado a otras culturas. El objetivo de este estudio es describir la efectividad de la versión en español del programa PERCS, desde la perspectiva de los participantes, al término y a los 6 meses del curso. Métodos: Se realizó un proceso de adaptación cultural y epidemiológica del programa PERCS a la realidad de Perú. Para evaluar el impacto educacional del programa se utilizó una aproximación cualitativa y cuantitativa. Resultados: Participaron voluntariamente 39 profesionales. Los participantes consideraron que era más difícil comunicar diagnósticos ominosos (48,15%). La ansiedad es la emoción más frecuente al enfrentar comunicaciones difíciles (77,78%). El 92% declararon que el curso mejoró su preparación y el 88,9% que redujo su ansiedad. A los 6 meses los participantes reconocieron la importancia de la honestidad y la empatía, así como algunas etapas para conducir la entrevista centrada en el paciente. Discusión: Un programa intensivo de entrenamiento en comunicación difícil puede ser adaptado al español e impactar positivamente en las habilidades, la autoconfianza y la autopercepción de aprendizaje en profesionales peruanos, en relación con la promoción de la comunicación enfocada en las necesidades del paciente y su familia. Abstract: Introduction: Good communication by health professionals is associated with better patient outcomes. The Program to Enhance Relational and Communication Skills (PERCS) has been adapted to other cultures. The objective of this study is to describe the effectiveness of the Spanish version of the PERCS program, from the perspective of the participants, at the end of the course and 6 months after the course. Methods: A process of cultural and epidemiological adaptation of the PERCS program to the reality of Peru was carried out. A qualitative and quantitative approach was used to evaluate the educational impact of the program. Results: Thirty-nine professionals participated voluntarily. Participants found it more difficult to communicate ominous diagnoses (48.15%). Anxiety is the most frequent emotion when faced with difficult communications (77.78%). Almost all (92%) stated that the course improved their preparation, and 88.9% that it reduced their anxiety. At 6 months, participants recognised the importance of honesty and empathy, as well as some steps in conducting the patient-centred interview. Discussion: An intensive training program in difficult communication can be adapted to Spanish, and positively impact the skills, self-confidence, and self-perception of learning in Peruvian professionals, in relation to promoting communication focused on the needs of the patient and family.

This study examines the influence of financial statement transparency, institutional investor stability, audit tenure, and conservatism on stock price crash risk. Using firms listed on the Indonesia stock exchange from 2011 to 2015 as research samples, 748 firm-year observations are available for data analysis and hypotheses tests. Employing multiple regressions analysis, the results show that institutional investor stability, audit tenure, and conservatism have a significant effect on stock price crash risk. However, a positive association between audit tenure and stock price crash risk is not supported in this study. Meanwhile, the transparency of financial statements has no significant effect on stock price crash risk. It may indicate that Indonesian investors tend to overlook the issues of financial report transparency while making equity investment decisions.

Cet article veut définir ce qu’est une mauvaise nouvelle en médecine, expliquer pourquoi il est si difficile pour un médecin de l’annoncer et présenter le programme Comment annoncer une mauvaise nouvelle élaboré par le Collège des médecins du Québec et le Collège québécois des médecins de famille., This article acts as a definition of what bad news means in medicine and as an explanation of why it is so difficult for a doctor to break it and show the program How to Break Bad News put together by the Québec Doctors’ College and the Québec College of Family Doctors.

Background There is growing recognition that a diverse range of healthcare professionals need competence in palliative approaches to care. Effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions. Methods The current rapid review updates findings of a 2014 systematic review, focussing more specifically on evidence related to illness progression and end-of-life conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies. Results Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in discussions about illness progression and end-of-life. Conclusion The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life.

In dealing with terminal ill patients the ability to communicate effectively is the most important among all the various existing skills needed in palliative end-of-life care. Being with terminal illness is a time when patients were overwhelmed with several emotional feelings and unwanted thoughts. The health care providers at this point need to listen to the wishes of the dying individuals by communicating with them in the most appropriate way. Effective communication is the fundamental component in building the physicians and patient’s relationships and in building a trust towards one another for quality decision making at the end of life. However, due to the lack or absence of good communication in the Indian health care setting, most of the terminally ill patients received unwanted life-sustaining treatments alongside the inappropriate care, which they may not prefer, if they were asked about their preferences of care in their dying process. It is to be noted that, effective communication enables patients and family to make quality treatment decision and to meet their preferences for end of life care. Especially, when it comes for breaking the bad news to the patient’s and their family, effective communications plays an important role in the face of many barriers. Thus, the present study is form with the aim to improve quality of life through effective communication skills. The study highlights some guiding principles and objectives for physicians and other care providers when, how, and whom to communicate and break the bad news without hurting the sentiment of the dying patient and family.

[O]ne of the dead was an 8-year-old boy from Dorchester who had gone out to hug his dad after he crossed the finish line. The dad walked on; the boy went back to the sidewalk to join his mom and hi...

Background & Aims: Communication skills are the foundation of clinical capabilities in healthcare providers. The process of delivering bad news is one of the most challenging aspects of clinical communication in health care, which has subtle psychological details. The present study aimed to assess the knowledge of nursing students regarding the conveying of bad news to patients and their companions in the hospitals affiliated to Bushehr University of Medical Sciences, Iran. Materials & Methods: This cross-sectional, descriptive-analytical study was conducted in 2017 in order to assess the knowledge of nursing students at Bushehr University of Medical Sciences regarding the delivery of bad news to patients and their companions. Data were collected using a valid and reliable researcher-made questionnaire. Data analysis was performed in SPSS version 18 using descriptive and analytical statistics. Results: The nursing students had moderate to high knowledge of delivering bad news to patients. In addition, significant associations were observed between the knowledge level, passing the courses of nursing ethics and professional communication (P=0.011), and academic year of education (P=0.037), so that the students who had passed the courses and were in inferior academic years had higher knowledge levels in this regard. However, no significant correlation was observed between the knowledge level, gender (P=0.550), and interest in the academic discipline (P=0.546). Conclusion: Adequate knowledge of professional ethics and effective communication is an advantage for healthcare providers. Based on the obtained results, presenting additional courses on professional ethics and communication skills in nursing education, as well as related training programs, by medical education authorities could lead to better outcomes in this regard.

Objective: This study examines the effect of inter-industry bankruptcy contagion on earnings informativeness of surviving firms between 2011 – 2015. Methods: In this regard, we test the informativeness of 123 companies listed in the Tehran stock Exchange among 19 industries by abnormal return – unexpected earning regression. Results: Statistical results demonstrate that a firm probability of bankruptcy is negatively associated with informativeness of good news earnings, whereas it has no negative effect on in formativeness of bad news earning. Furthermore, until one bankrupt company exists, earnings in formativeness reduction of good news is more than when a number of bankrupt companies exist. Conclusion: The result shows that bankruptcy contagion through inter-industry reduces the earnings informativeness of surviving firms. Based on conservatism and Asymmetric profit sustainability, in these companies earning response coefficient is asymmetric for good news compared to bad news.

Background: Significant conversations with parents are a necessary and important part of healthcare. The delivery of bad or difficult news, such as the diagnosis of a chronic health condition, requires key communication skills. This is especially true for communication between healthcare professionals and parents in paediatric settings. It is important to understand parental experiences of these conversations and what can be done to help support and improve skills in this area. Method: A systematic review evaluates studies assessing the effectiveness of interventions in improving breaking bad news skills. An empirical study uses Interpretative Phenomenological Analysis of interviews with parents to gain an in-depth understanding of parental experiences of receiving a newborn diagnosis of cystic fibrosis (CF). Results: The systematic review identified ten quantitative studies assessed to be of either moderate or high quality. Significant improvements in communication skills were found following nine of the ten interventions. These interventions shared some common features. In the empirical study, three superordinate themes emerged following interview analysis: Cognitive and Emotional Experiences; Connection; and Knowledge. Conclusions: Findings from the review suggest that there are interventions that can improve communication skills in delivering bad news in paediatric settings. Parents in the empirical study clearly recalled the period of receiving a newborn diagnosis of CF as an emotional time. Health professionals’ communication and interpersonal skills seemed to play an important role in providing containment for families. Clinical implications and directions for future research are discussed.

Clinicians notify positive results of the severe acute respiratory syndrome coronavirus-2 polymerase chain reaction to patients and/or relatives, whilst short message service (SMS) has been adopted as a means of disseminating negative results. Therefore, clinicians should be adequately equipped to provide telephonic consultation whilst delivering a positive test result to patients. The news of the coronavirus disease 2019 (COVID-19) test result often invokes fear of impending death in patients, especially the elderlies and those with comorbidities. In addition, several survivors have reported persistent symptoms and COVID-19-related stigma, which precludes them from immediate re-integration into their workplaces. Consequently, COVID-19 results are perceived as bad news by the members of the public. This article justifies why COVID-19 test results are bad news and also discusses the notification steps to follow when delivering COVID-19 results, whilst also addressing patients' immediate concerns. The article concludes by highlighting an important safety net for COVID-19 patients and the attending clinician.

Breaking bad news is a key component of the physicians' work. Traditionally, breaking bad news has been encouraged to be performed in person whenever possible (Monden et al. Proc (Bayl Univ Med Cent) 29(1):101-102, 2016; Nickson 2019). The common practice prior to the pandemic can be summarized by "The first rule of breaking bad news is: do not do it over the phone." It is important to be present with the family and provide support through compassion and empathy. Until recently, virtual communication technology for serious medical discussions was rare and primarily used when compelled by circumstances such as distance. The COVID-19 pandemic has transformed our ability to deliver news in person and has required the medical community to increase the utilization of telephone and video conferencing to communicate with patients and their family members. Breaking bad news through virtual media is a new skill in need of further guidance and education regarding how to set up the conversation, provide empathy, and lend support (Wolf et al., Oncologist 25(6):e879-e880, 2020). Therefore, we have created a teaching toolbox to help educate healthcare providers on how to deliver bad news by phone or video.

Online misinformation is a pervasive global problem. In response, psychologists have recently explored the theory of psychological inoculation: If people are preemptively exposed to a weakened version of a misinformation technique, they can build up cognitive resistance. This study addresses two unanswered methodological questions about a widely adopted online “fake news” inoculation game, Bad News. First, research in this area has often looked at pre- and post-intervention difference scores for the same items, which may imply that any observed effects are specific to the survey items themselves (item effects). Second, it is possible that using a pretest influences the outcome variable of interest, or that the pretest may interact with the intervention (testing effects). We investigate both item and testing effects in two online studies (total N = 2,159) using the Bad News game. For the item effect, we examine if inoculation effects are still observed when different items are used in the pre- and posttest. To examine the testing effect, we use a Solomon’s Three Group Design. We find that inoculation interventions are somewhat influenced by item effects, and not by testing effects. We show that inoculation interventions are effective at improving people’s ability to spot misinformation techniques and that the Bad News game does not make people more skeptical of real news. We discuss the larger relevance of these findings for evaluating real-world psychological interventions.

Malgrat considerar-se una pràctica clínica de menor rellevància, la comunicació de males notícies en context sanitari és una de les tasques més difícil si amb major impacte emocional tant per a la persona atesa i els familiars propers com per al mateix metge. Si bé el pacient és, en aquest cas, l'eix central de la situació, tots els interlocutors experimenten dificultats pròpies que poden impedir una comunicació eficient, comportar conseqüències emocionals negatives i, en última instància, deteriorar la relació sanitària. En aquest sentit, és important reconèixer les veus de tots els protagonistes d'aquesta interacció i identificar quins són els reptes que cal afrontar a cada cas per poder atendre les seves necessitats i aconseguir una comunicació satisfactòria., A pesar de considerarse una práctica clínica de menor relevancia, la comunicación de malas noticias en contexto sanitario es una de las tareas más difíciles y con mayor impacto emocional tanto para la persona atendida y sus allegados como para el propio médico. Si bien el paciente es, en este caso, el eje central de la situación, los dos interlocutores experimentan dificultades propias que pueden impedir una comunicación eficiente, acarrear consecuencias emocionales negativas y, en última instancia, dañar la relación sanitaria. En este sentido, es importante reconocer las voces de todos los protagonistas de esta interacción e identificar cuáles son los desafíos que afrontan en cada caso para poder atender a sus necesidades y conseguir una comunicación satisfactoria., Despite being considered a less-relevant clinical practice, the communication of bad news is one of the tasks that is the most difficult and has the greatest emotional impact on the person being treated and their relatives, and the doctor themselves. Although the patient plays the most important role in this situation, the two interlocutors Comunicació de males notícies en context sanitari Marta Consuegra-Fernández, Alejandra Fernández-Trujillo (2021) Llengua, Societat i Comunicació, núm. 19 http://revistes.ub/index.php/LSC/ lsc@ub.edu http://creativecommons.org/licenses/by-nc-nd/4.0 doi:10.1344/LSC-2021.19.8 67each experience their own challenges, which can impede efficient communication. Eventually, this may have negative emotional consequences and ultimately damage the patient-provider relationship. In this sense, it is important to recognise the voices of all actors in this interaction and to identify the challenges they face. Achieving satisfactory communication means first recognising that the needs of each speaker have to be met.

Despite the fact that patient accessible electronic health records (PAEHRs) have been around for many years in several countries, there is a lack of research investigating patient’s preferences for receiving bad news, including through PAEHRs. Little is also known about the characteristics of the patients who prefer to receive bad news through the PAEHR in terms of, for example medical diagnosis, age and educational level. This study, based on a national patient survey in Sweden (N = 2587), investigated this. Results show that, generally, receiving bad news by reading in the PAEHR is still among the least preferred options. Additionally, a higher proportion of men want to receive bad news in the PAEHR compared to women (p = 0.001), and the same goes for those who are not working/have worked in healthcare (p = 0.007). An effect of disease groups was also found, showing that diabetes patients in particular, want to receive bad news through the PAEHR. CC BY 4.0© The Author(s) 2021Corresponding author: Jonas Moll, Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, 701 82 Örebro, Sweden.

Children with hearing loss are now identified early through newborn hearing screening. The announcement of the diagnosis to the parents is a variable communication process that takes place at different times and sites. In many cases, the communication of diagnosis is experienced as a long-lasting process being delivered first through screening methods, or when the collection of medical reports is discussed before introducing families to early intervention programmes. There is still considerable uncertainty about how and when exactly the communication of the diagnosis takes place. Until now, there has been relatively little research attention regarding the announcement of the diagnosis to the parents of a child who is hard of hearing. The aim of this study was to gain insights into the parents’ experiences in being told a diagnosis and to outline helpful aspects for delivering these emotional facts in a most sensitive and acceptable way. The research design was the qualitative content analysis according to Mayring. (2015) Individual semi-structured interviews were conducted with eight parents of children with hearing loss. A theoretical model that discusses the current research area served as a guideline for the interview questions. After analysing the transcripts using a constant comparative method, five themes emerged from the data: general information about the child’s diagnosis, the communication of the diagnosis, the process after getting the diagnosis, the current situation of the families and an abstract reflection of parents‘ perspectives. From the parents’ perspective, it might be helpful to see the diagnosis as a longer process and to point out the duration as something that is normal. Author Julia Sophia Öllinger Masterarbeit Universität Linz 2021

Адекватно организованная коммуникация между врачом, пациентом и его семьей в педиатрии определяет очень многое в лечебном процессе и судьбах людей. Коммуникации, как и другие навыки врача, можно совершенствовать, что, к сожалению, на деле происходит редко. В данной статье идет речь об общих принципах педиатрической коммуникации, рекомендациях по проведению рутинных процедур, сообщению плохих новостей, общению в реанимации, родильном отделении, посмертному общению с семьей умершего ребенка. Отдельное внимание уделяется разным подходам и коммуникативным пробелам, существующим в экономически развитых странах и на территории бывшего СССР., Adequately organized communication between the doctor, the patient and their family in pediatrics determines a lot in the treatment process and the fate of people. Communication, like other skills of a doctor, can be improved, which, unfortunately, is rarely practiced. This article deals with the general principles of pediatric communication, recommendations for routine procedures, reporting bad news, communication in intensive care unit, maternity ward, posthumous communication with the family of a deceased child. Special attention is paid to different approaches and communication gaps that exist in economically developed countries and on the territory of the former USSR., Психиатрия, психотерапия и клиническая психология, Выпуск 4 2021, Pages 812-820

Background Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. Methods Fifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. Results Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members. Conclusions When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.

Background: Based on the patients’ and relatives’ views on the level of preservation of privacy rights of individuals, we propose a way to reduce problems and disagreements about the competence of the provider and recipient of bad news. Methods: In the current cross-sectional study, the participants were recruited from the main northwest hospital of Iran. It was also conducted to study the scope of medical privacy and competence of bearers or receivers of bad news. After the literature review, two questionnaires were designed and administered. They contained items pertinent to the scope of medical privacy and competence of bearers and receivers of bad news. Each item of the original questionnaire was scored on a 5-point Likert scale. Results: The model quality and significance level were obtained using KMO and Bartlett tests. The results (patient’s attitudes questionnaire: KMO=0729 and P

O enfermeiro na sua prática diária depara-se diversas vezes com a necessidade de comunicar más notícias, notícias essas que causam constrangimentos e angústia a quem a comunica, assim como aos recetores. O projeto de intervenção desenvolvido durante o estágio final foi baseado nessa prática, dando visibilidade ao tema “Comunicação de Más Notícias em contexto de Morte Súbita no Serviço de Urgência”, através de uma Scoping Review, uma sessão de formação sobre a temática e a elaboração de um Poster Científico realizados durante o estágio. Ainda a elaboração de um protocolo “Comunicação de Más Notícias no contexto de Morte Súbita no Serviço de Urgência Médico Cirúrgica: Protocolo SPIKES” e a realização de um cartão de bolso acerca desse protocolo por forma a facilitar a transmissão dessas notícias. Com este relatório foi possível descrever e analisar criticamente o percurso efetuado nos estágios e o projeto de intervenção, comprovando com base na teoria e evidência científica as competências do enfermeiro especialista em médico-cirúrgica na vertente de Pessoa em Situação Crítica e de Mestre em Enfermagem, decorrendo ainda a reflexão crítica sobre a aquisição dessas competências, com o objetivo de desenvolver também saberes teórico-práticos da enfermagem nesta área Nurses in their daily practice are faced with the need to communicate bad news several times, news that causes embarrassment and anguish to those who communicate it, as well as to the recipients. The intervention project developed during the final stage was based on this practice, giving visibility to the theme “Communication of Bad News in context of Sudden Death in the Emergency Service”, through a Scoping Review, a training session on the theme and the elaboration of a Scientific Poster made during the internship. Still the elaboration of a protocol “Communication of Bad News in the context of Sudden Death in the Medical Surgical Emergency Service: SPIKES Protocol” and the realization of a pocket card about this protocol in order to facilitate the transmission of these news. With this report it was possible to describe and critically analyze the path taken in the internships and the intervention project, proving, based on theory and scientific evidence, the skills of the specialist nurse in medical-surgical in the aspect of People in Critical Situation and Master in Nursing, there is also a critical reflection on the acquisition of these skills, with the objective of also developing theoretical and practical knowledge of nursing in this area

Comunicar más notícias à família do doente crítico internado numa unidade de cuidados intensivos é uma tarefa complexa, mas essencial, quando se pretende o bem-estar do doente e família. Sendo uma prática que pode ter impacto negativo quer no enfermeiro que tem de comunicar a informação, quer na família que a recebe, é fundamental identificar e desenvolver estratégias facilitadoras do processo para os envolvidos. Desta forma, durante o Estágio final deste mestrado, foi desenvolvida uma intervenção major centrada nesta temática, com vista a promover a segurança e qualidade dos cuidados prestados ao doente crítico e família a vivenciar uma situação complexa, onde as más notícias são uma realidade constante e imprevisível. Este relatório destaca essa intervenção, integrando também uma análise reflexiva e fundamentada sobre o processo de aquisição e desenvolvimento de competências comuns e específicas do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica, e Mestre em Enfermagem Communicating bad news to the family members of a critically ill patient admitted to an intensive care unit is a complex but essential task when the well-being of the patient and family is the main priority. This is a practice that can have a negative impact on both the nurse who must communicate information and on the family that receives it, therefore it is essential to identify and develop strategies that facilitate the process for those involved. In this way, during the final stage of this master's degree; a major intervention was developed and focused on this theme with a view to promoting the safety and quality of care provided to critically ill patients and families experiencing a complex situation where unavoidable bad news is a constant reality. This report highlights this intervention and also integrates a reflective and reasoned analysis on the process of acquisition and development of common and specific skills of the Specialist Nurse in Nursing in a Critical Situation, and Master of Nursing

The communication of the diagnosis of HIV infection should be initiated in childhood with the follow-up of a multidisciplinary team in a health service. However, there is no theoretical and practical support for monitoring the communication of HIV diagnosis for children. The objectives are: to identify the scientific evidence of the elements of bad news communication in pediatrics; build the content of the communication follow-up guide for the diagnosis of HIV infection in childhood; evaluate the content of the communication follow-up guide for the diagnosis of HIV infection in childhood. This was a participatory research, based on the theoretical model of Knowledge Translation into Action, carried out in two stages. In the first, the cycle of creation of the theoretical model involving knowledge research, 2nd generation knowledge and knowledge products/tools were applied, originating the content of the technology entitled Communication of HIV diagnosis in childhood: guide for professionals who care for children. The content of the technology was created from the development of review studies, from which evidence was extracted according to the elements of communication. In the second stage, participants were selected using Fehring criteria and a committee of expert judges was set up to develop the evaluation through an online platform in the first half of 2020. The Content Validity Index (CVI) was applied and the minimum index of 0.80 was established. The ethical aspects were respected according to resolution 466/12, as well as the principles of bioethics, and the project was approved by the proposing institution. The consent of the participants was obtained through a digital ICF, also on the online platform. Judges from Brazilian states participated, composing a total of 26 judges. The technology was evaluated with global CVI of 0.94. The judges’ suggestions were met according to the technology’s objective. The content of this guide might support the care practice of professionals who care for children living with HIV, and can be incorporated by health services. From the evaluation of the content of the guide, this content is expected to base and qualify the other steps, with layout evaluation and application with the target audience. At the end of the creation of the guide, it is possible that professionals can follow the communication of HIV diagnosis to the child, supported by national and international evidence and the evaluation of renowned judges. Moreover, nursing is strengthened as a science, producing technological innovation, involving itself in monitoring the communication of HIV diagnosis to the child. A comunicação do diagnóstico de infecção pelo HIV indica-se ser iniciada na infância com acompanhamento de uma equipe multiprofissional em serviço de saúde. No entanto, não há subsídios teórico-práticos para acompanhamento da comunicação do diagnóstico de HIV para crianças. Tem-se como objetivos: identificar as evidências científicas dos elementos da comunicação de más notícias em pediatria; construir o conteúdo do guia de acompanhamento de comunicação do diagnóstico de infecção pelo HIV na infância; avaliar o conteúdo do guia de acompanhamento de comunicação do diagnóstico de infecção pelo HIV na infância. Tratou-se de uma pesquisa participativa, fundamentada no modelo teórico da Tradução do Conhecimento em Ação, realizada em duas etapas. Na primeira, foi aplicado o ciclo de criação do modelo teórico que envolve pesquisa do conhecimento, conhecimento de 2ª geração e produtos/ferramentas do conhecimento; originando o conteúdo da tecnologia intitulada Comunicação do diagnóstico de HIV na infância: guia para profissionais que atendem crianças. O conteúdo da tecnologia foi criado a partir do desenvolvimento de estudos de revisão, dos quais foram extraídas evidências segundo os elementos da comunicação. Na segunda etapa, foram selecionados os participantes por meio dos critérios de Fehring e constituiu-se um comitê de juízes especialistas que desenvolveu a avaliação por meio de plataforma online, no primeiro semestre de 2020. Foi aplicado o Índice de Validade de Conteúdo (IVC) e estabelecido o índice mínimo de 0,80. Os aspectos éticos foram respeitados de acordo a resolução 466/12, assim como os princípios da bioética, sendo o projeto aprovado pela instituição proponente. O consentimento dos participantes foi obtido por meio de TCLE digital, também na plataforma online. Participaram juízes dos estados brasileiros, compondo um total de 26 juízes. A tecnologia foi avaliada com IVC global de 0,94. As sugestões dos juízes foram atendidas de acordo ao objetivo da tecnologia. O conteúdo deste guia poderá subsidiar a prática assistencial dos profissionais que atendem crianças que vivem com HIV, podendo ser incorporado pelos serviços de saúde. A partir da avaliação do conteúdo do guia, espera-se que esse conteúdo fundamente e qualifique as demais etapas, com avaliação de face e aplicação com o público-alvo. Ao final da criação do guia, vislumbra-se que os profissionais possam acompanhar a comunicação do diagnóstico de HIV a criança, com respaldado em evidências nacionais e internacionais e na avaliação de renomados juízes. E, que a enfermagem se fortaleça enquanto ciência, produzindo inovação tecnológica, envolvendo-se no acompanhamento da comunicação do diagnóstico de HIV a criança.

Resumen En el campo de la salud, las malas noticias se definen como cualquier información que altere drástica y negativamente la visión del paciente sobre su futuro. La comunicación de malas noticias es de gran relevancia en la práctica clínica; sin embargo, a pesar de su importancia, la formación de los profesionales de salud frente a la adquisición de esta habilidad es deficiente. La entrega hábil de malas noticias puede proporcionar comodidad para el paciente y su familia; no obstante, una mala comunicación puede generar reacciones emocionales negativas, perspectivas erróneas sobre el pronóstico clínico e incluso tener implicaciones legales. La literatura describe varios protocolos y herramientas que favorecen la adecuada entrega de malas noticias, así como estrategias académicas que facilitan su aprendizaje. Este artículo propone una reflexión sobre el uso de escenarios simulados para el entrenamiento de profesionales de la salud, en comunicación de malas noticias, utilizando el protocolo SPIKES. Abstract Bad news in the health care environment are defined as pieces of information delivered to patients, that can drastically (and often negatively) modify their life course and expectations for the future. Even though communicating bad news has great relevance in the clinical scenario, the training health care professionals need to acquire this skill is often deficient or overlooked. Skilfull delivery of bad news can provide confort for patients and their families, while poor communication of such information can generate negative emotional reactions, wrong perspectives about clinical prognosis and even lead to legal troubles for practitioners. Many protocols and tools for successfully delivering bad news have been described in literature, as well as diverse academic strategies for teaching such tools. The present article proposes a reflection about the use of simulated scenarios for training of health care professionals in bad news delivery, using the SPIKES protocol.

Brži tehnološki razvitak u društvu, nastanak novih medija i društvenih mreža utjecao je na stil i način komuniciranja u zdravstvenim organizacijama. Liječnici, medicinsko osoblje i drugi dionici suočeni su s povećanjem informacija pacijenata i u skladu s tim prisiljeni su na brze promjene u komunikaciji. Nove tehnike komuniciranja postale su izazov zdravstvenim djelatnicima. Utjecalo je to na promjenu programa u akademskom izučavanju ove interdisciplinarnosti, ali i na pojavu brojnih drugih oblika komunikacije. Uspješno liječenje danas i u budućnosti temeljit će se na uspješnoj komunikaciji s pacijentima. Taj odnos postaje izazov zdravstvenim ustanovama, medicinskom osoblju, ali i cijelom društvu., Quick technological development in the society, the appearance of new media and social networks has influenced the style and ways of communication in the health-care organizations. Doctors of medicine, medical staff and other participants are faced with a larger amount of information about the patients and therefore are forced to quick changes in communication. New techniques of communication have become a challenge for the health-care workers. This has influenced the change of programmes in the academic study of this interdisciplinary subject but also the appearance of numerous other forms of communication. A successful cure today and in the future is and will be based on a successful communication with the patients. That relationship is a challenge to the health-care institutions, medical staff, but also to the whole society.

Background: Breaking bad news to patients may be required in service provision to stroke survivors. While challenging, it may be critical to the retention of optimism and participation in rehabilitation. Objectives: To explore the experience of stroke survivors when receiving bad news (RBN) from medical practitioners. Methods: Data were obtained via 1:1 interviews conducted at stroke support groups with survivors at least 12 months into recovery and subsequently transcribed for thematic analysis and coded using NVivo. Results: Eight of 10 participants experienced RBN, and 2 participants did not. The themes of being “lucky to be alive” and waiting for “delayed information” were expressed by all participants early in the interviews. Three sub-themes emerged and were labelled alliance, dissent, and dissatisfaction, each with a further 3 contextual themes. The perception of RBN was marked amongst the dissent and dissatisfaction groups, with the latter reporting negative implications for their rehabilitation as well as negative emotions, such as anger and anxiety. The perception of a poor-quality relationship with medical practitioners was said to impede rehabilitation and recovery processes. The dissent group was characterized by initial disbelief after RBN and consequently poorer long-term outcomes, whilst the Alliance group experienced very good quality of care due to existing personal knowledge and therefore did not perceive RBN during their early medical meetings. Conclusions: In the period soon after their stroke, survivors required their medical practitioners to not only communicate knowledge and information, but also needed validation of their hopes and fears for the future from an empathically attuned clinician.

Ahmad S Alzahrani,1 Abdullah Alqahtani,1 Maher Alhazmi,1 Rehab Gaafar,2 Doaa Bajabir,1 Ibtehaj M Alharbi,3 Ashwaq MF Alharbi,3 Ghufran Kheshaifaty,1 Aamer Alzahrani4 1Mental Health Department, Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia; 2Ministry of Health, Riyadh, Saudi Arabia; 3College of Medicine, Qassim University, Buraydah, Saudi Arabia; 4College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia Objectives: Particularly in the Middle East, few studies have explored the attitude of cancer patients and their families toward cancer diagnosis disclosure (CDD). This study was conducted to investigate the preference and attitude of a sample of cancer patients and their families in Saudi Arabia toward CDD. Methods: We constructed a questionnaire based on previous studies. The questionnaire assessed preference and attitude toward CDD. Participants were recruited from the King Abdullah Medical City, which has one of the largest cancer centers in Saudi Arabia. Results: Three hundred and four cancer patients and 277 of their family members participated in the study. The patient group preferred CDD more than the family group (82.6% vs 75.3%, P

Objective: The purpose of this study is to investigate the effect of financial constraint on stock price crash risk with an emphasis on discretionary accruals in listed companies in the Tehran Stock Exchange. Methods: In this regard, 110 companies were selected for the period of 2010-2016. A panel data approach has been used to test of research hypotheses. Results: The results show that financial constraints affect stock price crash risk. This means that financial constraints related to stock price crash risk with bad news hording and eventually stock price crash risk. Also, the sample companies were divided into groups of companies with discretionary accruals, up and down. Finally, the results show that positive impact of financial constraints on stock price crash risk is higher in companies with high accruals. Conclusion: According to the findings, the results are consistent with the agency theory.

One of the most sensitive moments during communication between the patient and the physician is the moment that the pysician gives bad news to his patient. If bad news is not given properly, the principle of being beneficial or harmless to the patient in terms of ethics is violated; inadequate information do harm the autonomy of the patient by negatively affecting the right decision of the patient. For this reason improperly breaking bad news to patient pose an ethical and legal problem. As a result of the recent advances in prenatal diagnostic tools, especially in ultrasound technology, it is now possible to diagnose many fetal and gynecologic pathologies during pregnancy. Therefore, the responsibility of breaking bad news about these pathologies has also been added to the clinical practice of antenatal care. Education about breaking bad news is generally not given during medical faculty or speciality and subspeciality training or it is provided in a limited way. Nowadays in which ethical concepts and individual rights are increasingly becoming important, it is not a correct approach breaking bad news for a diagnosed serious pathology without training in this regard. In this article, it was aimed to inform and raise awareness of related medical personnel, especially physicians, regarding the issue of breaking bad news during pregnancy.

Management in line with achieving persistent earnings tries to remove periodical fluctuations of earnings and attempts to present an appropriate picture of the performance of the firm. While according to the economic theories, the effective factor in assessing the performance of the firms are major and rather persistence factors in industry.The present study investigates the difference in the persistency of earnings in industry, firms and their elements. The data under investigation include 238 firms between 1387 and 1394. The results indicate more persistent earnings in industry and its elements than the earnings in the firm. Also business shocks are effective factors in reducing the persistence of earnings and accruals industry is more stable than company-specific accruals. However, bad news cannot significantly affect the persistence of earnings.

Effectiveness of the earnings reporting process as one of the most important elements of shareholders' decision making depends on the information extent this process provides for the capital market. Elements such as information asymmetry and news in the company have impact on earnings reporting process and its earnings informativeness. The main objective of this study is to analyze the impact of information asymmetry and bad news on quarterly Earnings Informativeness of firms listed in Tehran Stock Exchange. The sample consists of 75 firms listed in Tehran Stock Exchange during the period from 2010 to 2015 and the hypothesis is tested using the panel fixed effects regression method. The results indicate that an increase in information asymmetry and bad news at the end of a quarter has a positive significant effect on the Earnings Informativeness of that quarter.

Aim: Although various studies in the literature have focused on the delivery of bad news, data originating from the emergency services about the factors influencing relatives’ reactions are insufficient. To evaluate the reactions of patients’ relatives to the receipt of bad news in the emergency department and the factors influencing these reactions.Materials and Methods: The study was performed in the Gaziantep University Faculty of Medicine Department of Emergency Medicine (Group 1) and the emergency departments of state hospitals in Gaziantep (Group 2) between May 2014 and May 2015. The physicians in Group 1 had received training in communicating bad news to relatives. The physicians in Group 2 had not received such training. The approaches of the physicians to the delivery of bad news and the reactions of the patients’ relatives were recorded in prepared forms.Results: Each group included 100 patients who underwent resuscitation. The rates of briefing relatives and information provision about the possibility of arrest were higher in Group 1. The main reaction of the relatives in Group 1 was crying, whereas the relatives in Group 2 had multiple negative reactions. Many of the relatives in Group 2 committed violence in order to see their loved ones during Cardiopulmonary Resuscitation (CPR). When the data for both groups were combined, the rates of negative responses were highest for cases of unexpected death and male patients.Conclusion: The degree of affinity to the patient, the frequency and type of information provided to relatives during and after resuscitation, and informing relatives after allowing them into the resuscitation room to see their loved ones affected relatives’ reactions.

У савременом свету све се више говори о потреби развоја сарадничког односа родитеља и школе, при чему су још увек присутна традционална схватања овог односа. У недостатку поверења између родитеља и школе, као једно од важних питања поставља се проблематика саопштавања лоших вести родитељима о успеху и понашању детета од стране наставника, при чему конкретна истраживања ове појаве недостају. Актуелно истраживање имало је за циљ долажење до сазнања о карактеристикама ове појаве, а пре свега како наставници доживавају саопштавање лоших вести, као и да се утврди евентуално постојање потребе за додатним едукацијама наставника у овој области. Резултати показују да наставници имају тешкоће у саопштавању лоших вести о успеху, понашању и напретку ученика родитељима, при чему углавном примењују адекватне начине, док је њихово мишљење о потреби за додатном едукацијом о овој проблематици подељено. In the modern world, there is an increasing talk on the need to establish a collaborative relationship between parents and school, but traditional understandings of this relationship are still present. In the absence of trust between parents and school, one of the important questions is the problem of the teacher's communication of bad news to parents about the child. The current research aimed to determine the characteristics of this phenomenon, and above all how teachers brake the bad news to parents and in what ways, as well as to investigate the possible need for additional teacher education in this field. The results show that teachers have difficulty communicating bad news about students' success, behavior, and progress to their parents, using mostly adequate methods, while their opinion on the need for additional education on this issue is divided.

Einleitung: Durch den medizinischen und technischen Fortschritt geraten genetische Beratungen immer weiter in den Fokus. Deshalb müssen sich Angehörige der Medizinal- und Gesundheitsberufe vermehrt soziale und kommunikative Eigenschaften aneignen bzw. diese ausbauen. Dies stellt im Zusammenhang[zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsame Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA), des Arbeitskreises zur Weiterentwicklung der Lehre in der Zahnmedizin (AKWLZ) und der Chirurgischen Arbeitsgemeinschaft Lehre (CAL)

This study tests both information contagion and the rationality of investors in P2P lending markets and discusses who pay the burden for information contagion. This can be done by exploring the effect on Renrendai, which runs a totally different business model, of reports about Ezubao a company which created fake financial products and took large amounts of money from investors. Through an examination of data from Renrendai, one of the largest P2P lending platforms in China, from the period between October 31st 2015 and February 2nd 2016, we find that the volume on Renrendai experienced no significant change but its interest rate increased suddenly and continuously after the announcement of the bad news concerning Ezubao. This indicates that the failure of one platform can easily influence other platforms regardless of their business models. We also find that who suffered from the shock of other platform’s bad news were the borrowers, especially those with high credit grade and long-term loans, instead of the platform itself.

Background: Telling bad news to the patients after a diagnosis of breast cancer is one of the most important duties of a physician. The aim of this study was to explore breast cancer patient's preferences regarding how to receive bad news. Methods: A group of 15 women with breast cancer were purposively recruited to this qualitative study. Semi-structured in-depth interviews were conducted to identify the patients' preferences through content analysis. Results: The age of participants ranged between 28 and 58 years. Nine patients had undergone mastectomy and the remaining 6 had received conservative surgery. The minimum time between the diagnosis and receiving the news of cancer was 1 month, the maximum 15. Altogether, 250 codes were extracted after content analysis and categorized into 7 categories and 43 subcategories. The main categories were the method of disclosure of bad news, medical information, communication skills, emotional support, family involvement, the setting, psycho-spiritual care, and the word “cancer.” Conclusion: Knowing about patients' preferences regarding the methods of breast cancer diagnosis disclosure can help physicians to effectively deliver bad news. Therefore, it is necessary that the clinicians be informed about the themes that the patients consider important while delivering bad news to patients.

Dissertação de mestrado em Cuidados Paliativos apresentada na Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo Comunicar é parte integrante da vida, é uma partilha do que somos e do que idealizamos ser. Envolve troca de informações e utiliza sistemas simbólicos como suporte para este fim. A habilidade para estabelecer uma boa comunicação é parte essencial em todas as áreas dos cuidados de saúde. Para existir uma boa comunicação é necessário: criar relações, dar valor à outra pessoa, reduzir o isolamento, recolher informações, transmitir informações, permitir a expressão de sentimentos, reduzir a incerteza. Pensamos muitas vezes que comunicar é apenas transmitir a nossa mensagem, a verdade é que ouvir é tão importante quanto falar, sobretudo em áreas como a saúde. O reconhecimento destes aspectos, assume especial relevância quando se trata de comunicar uma má notícia, considerada uma das tarefas mais difíceis e complexas que os profissionais de saúde têm que enfrentar no contexto das relações interpessoais com o doente/família. Neste contexto surge este estudo que tem como principal objectivo conhecer a perspectiva do Enfermeiro de uma Unidade de Cuidados Continuados Integrados face á comunicação de más notícias, de modo a suscitar nos profissionais de saúde a necessidade de desenvolvimento de competências nesta área e contribuir para uma melhor intervenção a este nível. Metodologia: O estudo insere-se num paradigma qualitativo, de natureza descritiva e exploratória. A estratégia de recolha de dados foi a entrevista semiestruturada dirigida a Enfermeiros de uma Unidade de Cuidados Continuados Integrados na zona norte do país. A análise de conteúdo segundo Bardin (2008) foi a técnica utilizada para o tratamento de dados. Principais resultados: Os resultados obtidos através da análise dos discursos dos enfermeiros que participaram neste estudo permitiram-nos concluir que estes consideram que uma má notícia é uma informação desagradável, que tem um impacto emocional no doente e nas actividades quotidianas e informação de uma condição diferente. São tipos de más notícias a morte, doença grave, agudização da situação clínica e a perda de autonomia. A comunicação de más notícias gera nos enfermeiros sentimentos como tristeza, ansiedade, angustia, medo, insegurança ou frustração. Várias foram as estratégias referidas pelos profissionais para facilitar a comunicação de más notícias, destacando-se a necessidade de criar empatia, ser objectivo e utilizar um tom calmo. Como factores que interferem no processo de comunicação de más notícias foram referidos, factores relacionados com o modo de comunicação, com a situação de doença, com o doente/família e com o próprio profissional. A existência de formação contínua na área e reuniões com os familiares foram sugestões apresentadas para melhorar a comunicação de más notícias. Communicating is a integrating part of life, it is a share of what we are and of what we see ourselves as. Involves an exchange of informations and uses symbolic systems as a support for that end. The ability for establishing a good communication is an essential part in all health care areas. For a good communication to exist it’s necessary: create relations, give value to other person, reduce isolation, collect informations, transmit informations, allow feelings expression, reduce uncertainty. We think many times that communicating is just transmitting our message, the truth is that listening is as important as speaking, especially in areas as health. The acknowledge of this aspects, takes on special relevance when it comes to communicating a bad news, considered one of the most hard and complex that the health professionals have to deal with in the context of interpersonal relations with the patient/family. In this context comes up this study that has as primary objective knowing the Nurse of a Integrated Continued Care Unit perspective facing the communication of bad news, in a way that it will raise in the health professionals the need to develop skills in this areas and contribute to a better intervention to this level. Methodology: The study inserts in a qualitative paradigm, of descriptive and exploratory nature, being the direct care to the patient prestating nurses in an Integrated Continued Care Unit in the north area of the country, for at least a year, the target population, excluding the nurses that are on prolonged license situation when the data was collected. For the data collection we used the interview. Principal Results: The results obtained through the analysis of the speech of the nurses who participated in this study allow us to conclude that they consider that a bad news is an unpleasant information, that as an emotional impact on the patient and in the daily activities and an information of a different condition. Bad news types are death, serious illness, worsening of clinic situation and loss of autonomy. The communication of bad news generates on the nurses feelings like sadness, anxiety, anguish, fear, insecurity or frustration. Several are the strategies referred by the professionals to ease the communication of bad news, highlighting the need to create empathy, being objective and using a calm tone. As factors that interfere in the process of communication of bad news were referred, factors related to the way of communicating, with the disease situation, with the patient/family and with the professional himself. The existence of continuous formation in the area and reunions with the family members is some of the suggestions presented to improve the communication of bad news.

El objetivo del presente artículo es analizar la manera como algunos de los principales medios de comunicación colombianos han abordado el tema del proceso de paz y la implementación de los acuerdos logrados con la extinta guerrilla de las FARC. En la primera sección, se hace un abordaje del sentido informativo de la noticia como marco conceptual general que permite identificar sus dimensiones y características. En la segunda, se aborda el clima de opinión que se ha configurado en Colombia tras la toma de posesión del presidente Iván Duque. Por último, en la tercera sección, a partir de una perspectiva fundamentada en los métodos mixtos, se analizan las principales tendencias informativas reproducidas por los medios de comunicación sobre el proceso de paz y la implementación de los acuerdos durante los primeros meses del nuevo Gobierno. El artículo termina con unas conclusiones, en las que se presentan algunas de las posibles consecuencias de las malas noticias en los procesos de formación de opinión pública en Colombia en la actualidad. The objective of this article is to analyze the way in which some of the main Colombian media have addressed the issue of the peace process and the implementation of the agreements reached with the extinct FARC guerrilla. The first section deals with the informative dimension of news, as a general conceptual framework that allows identifying its dimensions and characteristics. In the second section, the climate of opinion that has been created in Colombia after the taking-up of President Iván Duque is addressed. Finally, in the third section, and from a perspective based on mixed methods, we analyze the main information trends reproduced by the Colombian media with respect to the peace process and the implementation of the agreements during the first months of the new government. The article ends with some conclusions, which present some of the possible consequences of bad news in public opinion processes in Colombia today. L’objectiu del present article és analitzar la manera en què alguns dels principals mitjans de comunicació colombians han abordat el tema del procés de pau i la implementació dels acords assolits amb l’extinta guerrilla de les FARC. En la primera secció, es tracta del sentit informatiu de la notícia, com a marc conceptual general que permet identificar les seves dimensions i característiques. En la segona, s’aborda el clima d’opinió que s’ha configurat a Colòmbia després de la presa de possessió del president Iván Duque. Per últim, a la tercera secció, a partir d’una perspectiva fonamentada en els mètodes mixtos, s’analitzen les principals tendències informatives reproduïdes pels mitjans de comunicació sobre el procés de pau i la implementació dels acords durant els primers mesos del nou govern. L’article finalitza amb unes conclusions, on es presenten algunes de les possibles conseqüències de les males notícies en els processos de formació d’opinió pública a Colòmbia en l’actualitat.

Objective: This study illuminates the degree of psychological stress response experienced by spouses of cancer patients when given bad news at three different times (notification of the name of the disease, notification of recurrence, and notification of terminality) as well as the factors that influence the response and the health status of the spouse as measured by health-related quality of life (QOL). Methods: A total of 203 individuals (57 men and 146 women) who had received the three types of news were surveyed using a self-report questionnaire on psychological stress response, marital satisfaction, and health-related QOL scales. Results: The degree of the psychological stress response was the highest for notification of terminality, followed by notification of the name of the disease, and notification of recurrence. The influencing factors varied depending on the notification period. Although no significant difference was observed for health-related QOL among the three notification types, significant differences were observed for certain items when compared with national standard values. Conclusions: When a notification of terminality, which produced the highest psychological stress response, is given, providing care that considers health-related QOL is necessary not only for patients but also for their spouses.

Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to "realize" the bad news because it involves the deliverer and recipient in a particular social relation. The deliverer of bad news initiates the telling by giving an advance indication of the bad news to come; this allows the recipient to calculate the news in advance of its final presentation, when the deliverer confirms what the recipient has been led to anticipate. Thus, realization of bad news emerges from intimate collaboration, whereas stalling and being blunt require recipients to apprehend the news in a social vacuum. Exacerbating disruption to recipients' everyday world, stalling and being blunt increase the probability of misapprehension (denying, blaming, taking the situation as a joke, etc.) and thereby inhibit rather than facilitate realization. Particular attention is paid to the "perspective display sequence", a particular forecasting strategy that enables both confirming the recipient's perspective and using that perspective to affirm the clinical news. An example from acute or emergency medicine is examined at the close of the paper.

Background and Objectives: Most physicians believe that telling lies and withholding the truth is not permissible. However, it appears that holding the phenomenon telling the truth to be absolute or unconditional is not acceptable either. This study was conducted to examine Qom City physicians’ attitudes with regard to revealing the influential news to patients. Methods: This was a descriptive-analytical investigation whose statistical population encompassed 150 physicians working in Qom City, including physicians engaged in hospitals, clinics, and medical offices. A tailor-made questionnaire was utilized to examine physicians’ attitudes to telling the truth to patients. SPSS Ver.16 was used to analyze data obtained in the study, employing the statistical tests of Independent T-Test, ANOVA, and chi-square. Results: 41 (27.3%) male and 109 (72.7%) female physicians took part in this study. The mean work experience of the participants was 16.21±9.19. Overall, the attitudes of 36 physicians (24%) were low, 85 (56.7%) average, and 29 (19.3%) were weak. Pearson correlation coefficient indicated a positively significant relationship between work experience and attitude. Conclusion: The results demonstrated that most physicians believed that telling lies is not absolutely prohibited for health professionals, who, in some certain cases, are permitted to do it. Moreover, it is concluded that patients’ level of knowledge, awareness, age, and other items should be taken into vigilant account upon disclosure of bad news to them, who are entitled to know about their health status.

To describe the experience of the Italian Program to Enhance Relations and Communication Skills (PERCS-Italy) for difficult healthcare conversations. PERCS-Italy has been offered in two different hospitals in Milan since 2008. Each workshop lasts 5 h, enrolls 10&ndash, 15 interdisciplinary participants, and is organized around simulations and debriefing of two difficult conversations. Before and after the workshops, participants rate their preparation, communication, relational skills, confidence, and anxiety on 5-point Likert scales. Usefulness, quality, and recommendation of the program are also assessed. Descriptive statistics, t-tests, repeated-measures ANOVA, and Chi-square were performed. A total of 72 workshops have been offered, involving 830 interdisciplinary participants. Participants reported improvements in all the dimensions (p &lt, 0.001) without differences across the two hospitals. Nurses and other professionals reported a greater improvement in preparation, communication skills, and confidence, compared to physicians and psychosocial professionals. Usefulness, quality, and recommendation of PERCS programs were highly rated, without differences by discipline. PERCS-Italy proved to be adaptable to different hospital settings, public and private. After the workshops, clinicians reported improvements in self-reported competencies when facing difficult conversations. PERCS-Italy&rsquo, s sustainability is based on the flexible format combined with a solid learner-centered approach. Future directions include implementation of booster sessions to maintain learning and the assessment of behavioral changes.

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Lopes Dias do Instituto Politécnico de Castelo Branco para cumprir os requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizado sob orientação científica da Doutora Ângela Sofia Lopes Simões, do Instituto Politécnico de Castelo Branco. Submitted by Lurdes Grilo (lurdesgrilo@ipcb.pt) on 2019-01-24T15:27:43Z No. of bitstreams: 1 final paliativos_A.pdf: 3154812 bytes, checksum: 179941330e5f7beaf166521c53406293 (MD5) Approved for entry into archive by Lurdes Grilo (lurdesgrilo@ipcb.pt) on 2019-01-24T15:28:26Z (GMT) No. of bitstreams: 1 final paliativos_A.pdf: 3154812 bytes, checksum: 179941330e5f7beaf166521c53406293 (MD5) Made available in DSpace on 2019-01-24T15:28:46Z (GMT). No. of bitstreams: 1 final paliativos_A.pdf: 3154812 bytes, checksum: 179941330e5f7beaf166521c53406293 (MD5) Previous issue date: 2019-01-08