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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.

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.

[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...

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.

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.

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

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.

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.

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.

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.

Physicians often are uncomfortable when communicating an unfavorable outcome: they feel inadequate in the face of uncontrollable disease and unprepared to manage the emotional reactions of patients. For lack of proper training, they often adopt inappropriate ways to disclose unfavorable information. We will outline some key points about the issue of disclosing bad news and aim to provide useful tools to physicians who have to cope frequently with breaking bad news to patients, providing examples and clinical sceneries specific to gastroenterology and hepatology practice.

El paciente oncológico terminal puede encontrarse en la situación en la que sus familiares y profesionales sanitarios le oculten su diagnóstico y/o pronóstico. A esta forma de proceder se conoce como “conspiración del silencio”. Un fenómeno cuya elevada prevalencia está demostrada en el medio sanitario y que surge como un déficit en el proceso comunicativo al final de la vida. El objetivo principal de este Trabajo de Fin de Grado es analizar la complejidad de este fenómeno en un escenario de toma de decisiones. Y para ello se realiza una búsqueda bibliográfica sistematizada en bases de datos y páginas web de sociedades de oncología, así como libros relacionados con los cuidados paliativos. Este trabajo incluye una propuesta específica. Consistirá en un taller dirigido al profesional de enfermería del servicio de cuidados paliativos para lograr concienciar sobre este fenómeno y ofrecer unas pautas para el manejo de esta situación. Terminal cancer patients can be found in a situation where their family and healthcare professionals avoid to communicate them the clinical information. This situation is known as “conspiracy of silence”. Many studies have confirmed that this event happens frecuently in the situation where the patient have to take decisions. This study aims to analyze the causes and consequences of the conspiracy of silence. To achieve the main objective, a literatura review was done in specialized databases, websites of oncology and some books of paliative care. This proyect incorporates a practical proposal. It is a education workshop for nurses who are in palliative service. The objective of the practical porposal is to raise awaraness about this problem and also to provide guidelines to face the conspiracy of silence. Graduado o Graduada en Enfermería por la Universidad Pública de Navarra Erizaintzan Graduatua Nafarroako Unibertsitate Publikoan

Background The issue of breaking bad news in assisted reproductive technology (ART) has been only partially explored by literature, and although some recommendations are available, specific guidelines are lacking. The present study aimed to explore the applicability of the oncologic SPIKES Protocol to the ART context. Methods Thirteen ART clinicians (7 gynecologists; 4 psychologists; 1 biologist; 1 obstetrician) completed the Critical Incidents Report (CIR) to describe the experience of delivering bad news in ART. The CIRs were first discussed with clinicians, then a focus group was created composed of 13 clinicians, one health communication expert and a patient to discuss the applicability of the six-step (SPIKES) Buckman Protocol to ART. The discussion was audiotaped, transcribed and analyzed with content analysis. Results The SPIKES Protocol seems to fit ART consultations and participants found it practical and easy to understand. Some specificities were found for the ART context: the reiteration of bad news, the “patient” as a couple and the fact that ability to conceive is closely related to self-esteem, as well as to social and family identity. During the discussion of the SPIKES Protocol, participants highlighted the importance of: 1) providing a caring setting, by adding a reflection on the value of communication by phone; 2) exploring patients’ perceptions but also misinformation; 3) exploring patients’ desires and expectations, while balancing the need to be honest and clear; 4) applying Buckman’s suggestions for delivering information, and integrating clinical aspects with psychosocial ones; 5) managing and legitimizing patients’ emotions, in particular anger; 6) having a strategy for follow-up and supporting couples to make meaning of the ART experience. Conclusion The proposal of a shared protocol for giving bad news in ART could be the starting point for training and experimental studies.

In the natural environment, when an animal encounters a stimulus that signals the absence of food-a 'bad-news' stimulus-it will most likely redirect its search to another patch or prey. Because the animal does not pay the opportunity cost of waiting in the presence of a bad-news stimulus, the properties of the stimulus (e.g., its duration and probability) may have little impact in the evolution of the decision processes deployed in these circumstances. Hence, in the laboratory, when animals are forced to experience a bad-news stimulus they seem to ignore its duration, even though they pay the cost of waiting. Under certain circumstances, this insensitivity to the opportunity cost can lead to suboptimal preferences, such as a preference for an option yielding a low rather than a high rate of reinforcement. In 2 experiments, we tested Vasconcelos, Monteiro, and Kacelnik's (2015) assumption that, if given the opportunity, animals will escape the bad-news stimulus. To predict when an escape response should occur, we incorporated ideas from the prey choice model into Vasconcelos et al. (2015) model and made 2 novel predictions. Namely, both longer intertrial intervals and longer durations of signals predicting food or no food should lead to higher proportions of escape responses. The results of 2 experiments with pigeons supported these predictions., This study was conducted at the Psychology Research Centre, University of Minho, Portugal, and was supported by the Portuguese Foundation for Science and Technology (FCT) and the Portuguese Ministry of Education and Science through national funds cofinanced by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013). This work was also supported by FCT Grant PTDC/MHC-PCN/3540/2012 to Armando Machado. Ines Fortes was supported by FCT Doctoral Grant (SFRH/BD/77061/2011). We thank the members of the Animal Learning and Behavior Laboratory of University of Minho for their comments on a prior version of this paper., info:eu-repo/semantics/publishedVersion

Do the quality and the quantity of arguments have an impact on the evaluation of bad news messages? To answer this question, two experiments were carried out using bad news letters in which the quality and the quantity of the arguments were manipulated in a contextually realistic way. The results of both experiments show that adding argumentation has a positive impact on the perceived politeness and the persuasive force of the letters. Furthermore, the studies show that the impact of strong arguments is greater than that of weak arguments. The effect of adding successive arguments is positive as well. However, the results indicate that one or two arguments are sufficient. Adding a third argument only minimally contributes to better evaluations.

Marko teorikoa eta justifikazioa: Berri txarren komunikazioa osasun profesional guztiek noizbait biziko duten esperientzia bat da. Halako informazioak pazientearengan inpaktu emozional handia sortzen du. Ondorioz gaixoarengan sortzen diren jarrera eta emozioak oso kontuan izan behar ditugu. Askotan, transmisioan, informazioaren integrazioa pobrea izaten da, sortzen diren emozio negatibo hauek atentzioan eragiten baitute. Horregatik, beharrezkoa da komunikazio eraginkor bat aurrera eramatea. Hala ere, prozesu hau zaila da, faktore asko kontuan izan behar ditugulako. Profesionalen informatzeko moduak pazientearen emozioetan eta jasaten duen inpaktuan eragin dezake. Ondorioz, garrantzitsua da erizainek osasun taldearen barnean nola jokatu behar duten jakitea. Helburua: Literaturaren errebisio honek, erizaintzak pazientearen maneiu emozionalean berri txar bat jaso ondoren daukan papera aztertzeko asmoa dauka, zein esku hartze edo komunikazio estilo aurrera eraman behar diren ikusiz. Metodologia: 2006. urtetik aurrerako artikuluak aukeratu dira. Ingelesez eta gazteleraz idatzitako lanak barneratu dira. Bilaketa bibliografikoa MEDLINE, PSYCHINFO, COCHRANE PLUS, CINHAL, CUIDEN, NICE eta LILACS datu baseetan egin da. Gainera, artikuluen bibliografiak eta praktika klinikoaren gidak ere aztertu dira. Lan honen emaitzak burutzeko hamasei artikulu aurkitu dira. Emaitzak eta eztabaida: Informazio transmisiorako, pazientearen prestaketa aurrera eraman behar da, momentu horretan bere beharrak zeintzuk diren berrikusiz. Honek aldi berean profesionalei prestatzen lagunduko die, gaixoak informazioa nola ematea nahi duen jakingo dutelako. Aurretik, profesionalak pazientearen datu guztiak errepasatu eta haien sentimenduak aztertuko dituzte. Berri txarrak ematerakoan ingurunea kontrolatuko da eta informazioa transmititzeko protokoloak erabiliko dira, hauek emozioak kudeatzeko gidekin konbinatuz. Erizainek atal honetan garrantzia handia daukate, izan ere, sostengu rola betetzen dute. Gainera hauek, medikuaren informazioa argitu eta paziente eta familiaren abokatu bezala jarduten dute. Garrantzitsua da ere profesionalek berria eman ondoren haien emozioak aztertzea. Ondorioak: Horren ondorioz, profesional guztiek era bateratu eta koordinatu batean lan egin behar dute, pazientean eragin onak lortzeko. Horrela, gaixoaren egoera emozionalean hainbat emaitza positibo lortu daitezke, sentitu ditzakeen emozio negatiboak txikituz. Erizainak osasun talde honetan rol oso garrantzitsua daukala ikusi egin da, hala ere, oraindik bere funtzioa ez dago oso definitua. Langile hauek informazio transmisioan sentitzen duten urduritasuna heziketa faltagatik eta egoera hauetan nola jokatzen den ez dakitelako izan daiteke. Izan ere, berri txarren transmisioari eta honetan parte hartzen duten profesional guztien funtzioei buruz gehiago ikertzeko premia dago.

Introducción: La demanda de información por parte de los pacientes y familiares, ha aumentado en las últimas décadas y enfermería requiere adaptar la gestión de sus cuidados en base a esta necesidad social. Objetivos: Explicar la responsabilidad adscrita al ejercicio profesional de enfermería en relación con la comunicación con el paciente y su familia. Identificar algunas limitaciones que dificulten la comunicación. Conocer la situación percibida por los usuarios en el área de oncopediatría. Metodología: Revisión bibliográfica sobre el estado del tema y aportación de un estudio cualitativo en oncopediatría con entrevistas a padres y madres de niños con cáncer y a miembros del equipo asistencial de la Unidad de Pediatría del Complejo Hospitalario de Navarra. Resultados y conclusiones: Existe consenso en la literatura revisada, en reconocer la responsabilidad de enfermería en la comunicación con el paciente y la familia. En oncopediatría la comunicación de un cáncer en un niño supone una situación de mucho impacto para los padres donde todo el equipo sanitario se ve involucrado y deberá hacer frente a la situación valorando siempre el contexto cultural y la propia voluntad de los padres de informar o no al menor Introduction: Population is demanding to be informed by patients and families have increased in recent decades and nursing requires adapting management of their care based on this social demand. Aims: Explain the responsibility attached to nursing practice in relation to the provision of information on the patient and his family. Identify some limitations that hinder communication. Meet the perceived situation in the area Oncopediatrics. Methodology: Literature review on the status of the topic and contribution of a qualitative study in Oncopediatrics with interviews in parents of children with cancer and health team workers in Navarra's Hospital. Results and conclusions: There is consensus in the literature reviewed in assuming responsibility for nursing in communication with the patient and the family as a more competitive within their managed care. In Oncopediatrics communication of cancer in a child is a situation much impact for parents. All healthcare team is involved and will face the situation always valuing one's willingness to inform parents or the child about his illness

This study attests the belief-adjustment model to examine whether there are differences in investment decision making between the participants who obtain good news fol-lowed by bad news and those who obtain bad news followed by good news on the in-formation pattern which is processed based on end-of-sequence and long series infor-mation. The experiment design in this study is the pattern of presentation 1x1x2 end-of-Sequence, a long series information and directions of evidence (good news followed by bad news and bad news followed by good news). The research hypotheses were tested using Mann Whitney test. The variables used in this research are investment decision, pattern of presentation in end-of-sequence, length of the series of information, and order of evidence. The participants involved in this research are 47 students (ba-chelor program) of STIE Perbanas Surabaya majoring in Accounting and Manage-ment who are taking or have taken courses of Financial Statement Analysis and/or Investment Management and Capital Markets. The results show that there is no sig-nificant difference in the judgment between the participants who obtain good news followed by bad news and those who obtain bad news followed by good news. In addi-tion, there is no order-effect occurring in investment decision making.

The stress-coping paradigm of Folkman and Lazarus (1984) was applied to investigate if the communicative reactions of the physician in a bad news transaction are related to the stressfulness of the situation. A standardized video bad news consultation was presented to 88 medical students. To examine their communicative reactions we selected 10 patient cues with different levels of expressed emotion to which the participants responded from the physician’s point of view. A strongly positive relationship between expressed emotion and perceived difficulty of the cues and a gender effect occurred, confirming that handling emotions is stressful for physicians. The reluctance of physicians to address the emotionally laden issues of the consultation can be understood as a lack of a frame of reference. The problem-solving strategies, which they apply in the instrumental domain of the consultation, are ineffective when dealing with psychosocial suffering.

Purpose: Delivering bad news (DBN) to a patient or patient’s family is one of the most difficult tasks for physicians. As a complicated task, DBN requires better than average communication skills. This study investigated trainee’s attitude and awareness of DBN based on a self-assessment of their experiences and performance in practice. Survey subjects were also asked to assess their perception and the need for education in conducting DBN. Methods: A survey was carried out on their experiences with DBN, how they currently deal such situations, how they perceive such situations and the need for education and training programs. A SPIKES protocol was used to assess how they currently deal with DBN. Results: One hundred one residents and fellows being trained in a teaching hospital participated in the survey. Around 30% had bad experiences due to improperly delivered bad news to a patient. In terms of self-assessment of how to do DBN, over 80% of trainees assessed that they were doing DBN properly to patients, using a SPIKE protocol. As for how they perceived DBN, 90% of trainees felt more than the average level of stress when they do DBN. About 80% of trainees believed that education and training is much needed during their residency program for adequate skill development regarding DBN. Conclusion: We suggest that education and training on DBN may be needed for trainees during the residency program, so that they could avoid unnecessary conflict with patients and reduce stress from DBN.

This paper investigates the relationship between negative news in financial newspapers and stock markets in times of global crisis, such as the 2008/2009 period. We analyzed one year of front page banner headlines of three financial newspapers, such as the Wall Street Journal, Financial Times, and Il Sole24ore and created an index of bad news at a daily base. We examined the influence of bad news both on market volatility and dynamic correlation of American, Britain and Italian stock markets to look at the impact of bad news on global investment strategies. Our results show that press and markets co-influenced each other in generating market volatility. The three newspapers showed significant differences in their stance on the crisis, with Financial Times more pessimistic. Our results also show that Wall Street Journal bad news had higher predictability value for the correlation between US and the foreign markets. This confirms the international influence of Wall Street Journal.

La comunicació, privilegi de la condició humana, està present i influeix de manera decisiva sobre totes les àrees de la vida. La medicina actual ha perdut molta sensibilitat a causa del fet que no es reforça la comunicació, que passa a segon lloc. En canvi, agafa preeminència el coneixement. La sanitat actual -abans la medicina- tracta usuaris -abans malalts-, i valorant-los així actua com un problema tècnic que s’ha de solucionar. Els patiments com el dolor o l'angoixa vital s’enfoquen com a problemes tècnics que s’han de reparar. Però des del moment en què s’han codificat els drets del malalt, la salut és un dret fonamental, recollit en la nova legislació. Els malalts passen a tenir un paper central en la presa de decisions sobre la seva salut. És un canvi radical sobre el concepte anterior de la praxis mèdica. Ara les habilitats de comunicació estan especialment indicades i destinades a millorar la relació metge-malalt, en general, i de manera especial en les malalties greus. D’aquí la importància que el metge tingui formació en habilitats de comunicació per poder comprendre el seu significat. Les directrius de Bolonya i els nous programes formatius de medicina van en aquesta direcció., Communication is a privilege of the human condition, one that is present and decisively influential in all areas of life. The practice of medicine has often placed emphasis on knowledge and technical advances, relegating communication to second place to the detriment of sensitivity. Users who access the healthcare system and their symptoms are treated as technical problems to be solved. Nevertheless, healthcare is a fundamental right, and patients should play a central role in making decisions about their health. A strong doctor-patient relationship and a focus on communication skills represents a radical change in previous medical practice, and one that is increasingly being adopted, particularly in the treatment of serious diseases. Therefore, doctors should receive training in communication skills, a priority that is reflected in the Bologna guidelines and other recent medical training programs., La comunicación, privilegio de la condición humana, está presente e influye de manera decisiva en todas las áreas de la vida. La medicina actual ha perdido mucha sensibilidad, debido a que no se refuerza la comunicación y pasa a un segundo lugar. En cambio toma preeminencia, el conocimiento. La sanidad actual, antes la medicina, trata usuarios, antes enfermos, y valorándolos así actúa como un problema técnico que tiene que solucionar. Los sufrimientos con dolor o angustia vital, se enfocan como problemas técnicos que deben ser reparados. Pero desde el momento en el que se han codificado los derechos de los enfermos, la salud es un derecho fundamental, recogido en la nueva legislación. Los enfermos, pasan a tener un papel central en la toma de decisiones sobre su salud. Es un cambio radical sobre el concepto anterior de la praxis médica. Ahora les habilidades de comunicación están especialmente indicadas y destinadas a mejorar la relación entre médico y enfermo, en general, y de manera especial en las enfermedades graves. De aquí la importancia que el médico tinga formación en habilidades de comunicación para poder comprender su significado. Las directrices de Boloña y los nuevos programas formativos de Medicina van en esta dirección.

Using a Verrecchia [1983]-type model, we study the optimal voluntary disclosure strategy of a manager with private information that helps the market interpret financial information the firm is required to report. In equilibrium, the manager's disclosure strategy enhances upward or mitigates downward revisions in the market's estimate of firm value conditional on the firm's financial reports. Hence, what the manager discloses (large or small values of her private information) and the probability of disclosure depend on the information in the firm's financial reports. This leads to testable implications regarding the probability of voluntary disclosure (e.g., firms whose financial reports are more surprising provide more voluntary disclosures), and how earnings and revenue response coefficients depend on the manager's voluntary disclosure strategy. Finally, we show that changes in mandatory disclosure regulations can reduce the probability of voluntary disclosure even though the manager's private information is used to interpret the firm's mandatory disclosures.

We reexamine the descriptive ability of the conventional wisdom that earnings announcements made after trading and on Friday are dominated by bad news in light of the 24/7 media coverage and other technological changes of the 1990’s. We find that the change in media coverage has facilitated a significant change in earnings announcement times: only 27% of earnings announcements are now made during trading as opposed to 67% in prior research. However, our finding of continued dominance of bad news in Friday announcements in particular strongly suggests that the conventional wisdom is not solely the result of managers’ desire to take advantage of limited media coverage. Instead, managers appear to be taking advantage of other aspects of investors’ behavior, such as their anticipating negative Friday announcements earlier in the week, and the relatively quiet (in terms of trading) weekend period to manage stock price responses to their companies’ financial news.

Introduction: Discussion of bad news and resuscitation in terminal cancer is an important but difficult and often neglected issue in day-to-day oncology practice. Materials and Methods: We interviewed 35 radiation oncologists using an indigenous 15-item questionnaire on their beliefs about breaking bad news and resuscitation to terminal cancer patients. Results: Most responders had an oncology experience of three to seven years (20/35).Thirty-two were comfortable discussing cancer diagnosis, prognosis and life expectancy-related issues. A similar number believed all cancer-related information should be disclosed, while only four believed in imparting all information in one visit. All agreed that disclosing sensitive information did not affect survival. When requested by relatives to withhold truth from patients, 11 said they would not comply, 22 agreed to tell the truth only if asked and two agreed to avoid difficult questions. Twenty responders denied having been adequately trained in breaking bad news and were keen on dedicated classes or sessions in this area of practice. Most (33/35) believed that Indian patients were keen on knowing their diagnosis and prognosis. Although all agreed to the importance of discussing resuscitation, only 17 believed patients should be involved. Majority (20/35) agreed that the issue needs to be discussed while the patient was conscious. Patients with unsalvageable disease were deemed unsuitable for aggressive resuscitation by 30 responders while the rest believed it should be offered to all. Most (21/35) admitted to feeling depressed after breaking bad news though only seven felt disclosure was more stressful than untruthful statements. Only four knew of a law regarding resuscitation in cancer. Conclusion: Observing the widely varied beliefs and practices for disclosing bad news, it is recommended that such training be a regular part of medicine curriculum, especially in the Oncology setting.

Background: Brain metastases are a common manifestation of systemic cancer and exceed primary brain tumors in number and are a significant cause of neurologic problems. They affect 20-40% of all cancer patients. Aggressive management of brain metastases is effective in both symptom palliation and prolonging the life. Radiotherapy has a major role to play in the management of brain metastases. AIM: The aim of the study was to know the outcome of palliative radiotherapy in symptomatic brain metastases in terms of improvement in their performance status. Materials and Methods: This is a retrospective study of 63 patients diagnosed to have brain metastases and treated with palliative whole brain radiotherapy to a dose of 30 Gy in 10 fractions over two weeks between June 1998 and June 2007. Diagnosis was done in most of the cases with computed tomography scan and in a few with magnetic resonance imaging. Improvement in presenting symptoms has been assessed in terms of improvement in their performance status by using the ECOG scale. Results: Fifty-four patients completed the planned treatment. Eight patients received concurrent Temozolamide; 88% of patients had symptom relief at one month follow-up; 39/54 patients had a follow-up of just one to three months. Hence survival could not be assessed in this study. Conclusion: External beam radiotherapy in the dose of 30 Gy over two weeks achieved good palliation in terms improvement in their performance status in 88% of patients. Addition of concurrent and adjuvant Timozolamide may improve the results.

Introdução: À semelhança do que ocorre na Medicina Humana, também em Medicina Veterinária, a prevalência da doença oncológica em animais de companhia tem vindo a aumentar significativamente. Desenvolvimento: A evolução da Medicina Veterinária, nas últimas décadas, veio trazer mudança nos paradigmas clínicos, nomeadamente no respeitante à relação com o animal mas também com o proprietário. Sendo a oncologia a especialidade em que há maior probabilidade de ter que comunicar uma má notícia, neste trabalho propõe-se a adaptação do modelo ABCDE da Medicina Humana para a Medicina Veterinária. Conclusões: A adaptação do modelo ABCDE para a Medicina Veterinária permite melhorar a comunicação com o proprietário cuidador e dotar os profissionais da equipe Médica Veterinária de melhores competências., Millenium - Journal of Education, Technologies, and Health, Serie 2, n.º1, EN: september 2016

El hecho de tener que comunicar malas noticias es ya de por sí una situación incómoda para la gran mayoría de personas que se dedican al ámbito sanitario. Es por este motivo por el que existe el protocolo SPIKES, en el que se detalla, mediante seis pasos, el procedimiento a seguir para comunicar de la mejor manera posible las malas noticias e intentar que el impacto sea menor. Objetivo Averiguar si existen, a la luz de la literatura, maneras de actuar concretas a la hora de comunicar las malas noticias a la etnia gitana. Metodología Se ha realizado una revisión sistemática en las bases de datos Pubmed, Web of Science, Cinahl, Cochrane, Cuiden Plus, Psycinfo, y en diferentes artículos y guías clínicas, para encontrar información al respecto. Resultados Después de haber revisado 1.557 artículos, no se ha encontrado información específica de cómo dar malas noticias a la etnia gitana. Los protocolos van destinados a la población en general, sin tener en cuenta los diversos grupos minoritarios de personas, como puedan ser la etnia gitana, que debido a su diversidad cultural y costumbres particulares, necesitan una atención especial. por este motivo se sugiere una adaptación de dicho protocolo a la etnia gitana. Conclusiones Debido a las diferencias culturales, la etnia gitana necesita una atención especial a la hora de comunicar malas noticias. Por este motivo se insta a la comunidad enfermera a realizar estudios de formación y estudios de campo, para conocer mejor las costumbres y tradiciones de la etnia gitana, a fin de obtener un mayor conocimiento de sus necesidades, proporcionar los cuidados vinculados a ellas y lograr así un mayor y mejor entendimiento entre la comunidad gitana y los profesionales sanitarios. PALABRAS CLAVE: malas noticias, comunicar, comunicación, comunicar malas noticias, noticias difíciles, grupos étnicos, pena, gitanos, gitano, métodos, metodología, luto, procedimientos, duelo, romaní, técnicas, transmitir, manera. Having to impart bad news is an uncomfortable situation for the majority of people within the health care community. For this reason the six step SPIKES protocol was developed not only to effectively communicate bad news but also to lessen the impact of such information. Objective To verify if there is any published literature that describes concrete ways to impart bad news to the ethnic Roma (Gypsy) community. Methodology A systematic review of various databases, Pubmed, Web of Science, Cinahl, Cochrane, Cuiden Plus, Psycinfo, open-source articles and clinical guidelines was conducted to try and find any relevant information. Results After having reviewed 1.557 articles, no specific information about how to deliver bad news to the ethnic Roma community was found. The protocols that were found for delivering bad news are intended for the general population and don’t take into account ethnic minorities such as the Roma, which due to their cultural diversity and particular customs require special attention. Conclusions Due to their cultural diversity and customs, which are unfamiliar to many, there is a need for special attention to the ethnic Roma community when communicating bad news. For this reason we urge the nursing community to initiate training and field studies to better understand the customs and traditions of the Roma, in order to obtain knowledge of their needs and thereby provide both better care and a greater understanding between the Roma and the health care professional community. KEYWORDS: Bad news, break, communicate, communication, deliver bad news, difficult news, Ethnic groups, grief, Gypsies, Gypsy, methods, methodology, mourning, procedures, report, Roma gypsy, Romany, techniques, transmit, truth disclosure, way

Dissertação de Mestrado em Enfermagem Médico-Cirúrgica apresentada na Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo A comunicação de más notícias é, provavelmente, uma das tarefas mais difíceis e complexa que os profissionais de saúde têm que enfrentar no contexto das relações interpessoais, e deve ser moldada a cada pessoa e a cada contexto. O reconhecimento desta realidade aponta que é necessário ter em consideração que o serviço de urgência tem características particulares e distintas de outros contextos. O objetivo deste estudo visa compreender o processo de comunicação de más notícias ao utente/família em contexto de serviço de urgência, de modo a contribuir para uma melhor intervenção neste processo e suscitar nos profissionais de saúde a necessidade de desenvolvimento de competências nesta área. O estudo assenta numa abordagem qualitativa, exploratória e descritiva, com recurso ao método de estudo de caso. O procedimento de recolha de dados foi um questionário dirigido a profissionais de saúde. A análise dos dados obtidos foi realizada através da técnica de análise de conteúdo nas questões abertas e da análise estatística descritiva nas questões fechadas, com recurso ao programa Statistical Package for the Social Science (SPSS) versão 22. De entre os resultados, destaca-se que para os profissionais de saúde o significado e o tipo de má notícia mais frequentemente comunicada, está quase sempre associada a doença, designadamente a doença súbita ou oncológica. A má notícia tem impacto negativo na vida pessoal e familiar e é um acontecimento gerador de sentimentos. A maioria dos profissionais de saúde considera que o utente/família tem o direito de ser informado sobre o conteúdo da má notícia, mas na sua prática diária nem sempre o fazem. Na perspetiva dos mesmos a comunicação de más notícias deve ser uma responsabilidade da equipa multidisciplinar, no entanto na prática diária o responsável é o Médico. Foram evidenciadas as dificuldades sentidas pelos profissionais na sua prática diária no que se refere à temática em estudo, que se centram sobretudo, no facto de ser um diagnóstico súbito e imprevisto, ser uma tarefa difícil e complexa, e pela incerteza quanto às reações do utente/família. De um modo geral, os profissionais de saúde mencionaram que quando comunicam uma má notícia fornecem apenas a informação que consideram adequada, no sentido de proteger o bem-estar do utente/família.Foram identificados alguns fatores dificultadores que interferem no processo de comunicação de más notícias, e que se relacionam nomeadamente, com a inexistência de condições físicas para o efeito, falta de disponibilidade de tempo e ausência de coordenação na equipa, assim como fatores facilitadores centrados no utente/família e nos profissionais de saúde. A principal estratégia identificada como sendo fundamental para desenvolver competências neste âmbito, foi a formação contínua. Delivering bad news is probably one of the most demanding and complex tasks that healthcare professionals must face within the context of interpersonal relationships, which must also be adapted to each individual and context. Recognising such reality underlines the need to consider that the emergency department has specific characteristics, different from other contexts. This study aims to understand the process of delivering bad news to the patient/family members in the context of an emergency department, in order to contribute towards a better intervention in this process and to foster the need to develop health professionals’ skills in this area. The study was based on a qualitative, exploratory and descriptive approach, using the case study method. The data collection procedure was a questionnaire addressed to health professionals. The analysis of the data obtained was carry out using the content analysis technique for open questions and descriptive statistical analysis for closed questions, using the Statistical Package for the Social Science (SPSS) software, version 22. From such results, one underlines that, for healthcare professionals, the significance and the type of bad news most frequently delivered is almost always associated with disease, particularly sudden illness or oncologic conditions. Such bad news negatively affects personal and family life and it is an event that originates feelings. Most health professionals consider that patients/family members have the right to be informed of the content of the bad news, but they don’t do exactly that during their daily practice. In their perspective, delivering bad news should be the responsibility of the multidisciplinary team, but physicians are often the ones responsible for such action during their everyday practice. The difficulty experienced by health professional during their daily practice regarding the matter at hand have been highlighted, mostly including it being a sudden or unexpected diagnosis, being a complex and challenging task and due to the uncertainty of the reactions of the patient/family members. Broadly speaking, healthcare professionals mentioned that, when delivering bad news, they only deliver information they deem fit, as to protect the wellbeing of the patient/relatives.Some hindering factors have been identified that infer with the process of delivering bad news, particularly the non-existence of facilities for such purpose, lack of availability and absence of coordination between the team, as well as facilitating factors centred on the patient/family and healthcare professionals. The main strategy identified as essential to develop competences in this particular area was continuous training.