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Purpose: The patient-centered communication principles in Western countries are widely esteemed. In Eastern countries, a family-centered approach to medical decision-making is preferred. However, the predicaments faced by attending physicians and their coping strategies in the process of truth-telling about cancer are unknown. Therefore, this study aimed to understand attending physicians’ predicaments and coping strategies in implementing truth-telling for cancer in Taiwan. Methods: This study used a qualitative description approach to conduct in-depth interviews with attending physicians. Data were collected from two medical centers in Taiwan. Purposive sampling was also conducted. A total of 17 attending physicians participated in individual semi-structured interviews. All interviews were audio recorded and transcribed verbatim. Inductive content analysis was used to analyze and develop the subcategories, generic categories, and main categories. Results: Four main categories emerged: (1) Causing harm to the patient: Family members’ cooperation is needed. (2) Family members’ request to conceal the truth: Physicians should judge based on the patient’s disease condition. (3) Delayed treatment: Physicians should prioritize establishing confidence. (4) Delivering bad news about relapse: Physicians have different coping strategies. Conclusion: Physicians in Taiwan face challenges but prioritize family-centered care despite having coping strategies to protect patients. When faced with a scenario in which family members request concealment of truth, most physicians cooperate with them to determine the level and method of disclosing unfavorable news to patients. Physicians should prioritize patients’ psychological needs when they experience relapse or metastasis or face strong negative emotions. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments. Results: A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information ('bad news'), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients' family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6-85.4%, 12.4-34.8% and 1.1-11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels. [ABSTRACT FROM AUTHOR]

Abstract Background Medical error is a leading cause of disability and death in healthcare settings and reporting colleagues’ medical errors is one of the main strategies for medical error management and an ethical responsibility of all healthcare providers, including nurses. Most studies into reporting colleagues’ medical errors used quantitative designs while it seems that using qualitative designs can provide better insight in this area. Purpose This study explored nurses’ experiences of reporting the medical errors of their colleagues. Methods This qualitative study was conducted using the conventional content analysis approach. Participants were 22 hospital nurses purposively selected in 2021–2022 from different cities in Iran. Twenty-two in-depth semi-structured interviews were held for data collection. The data were analyzed via Graneheim and Lundman’s conventional content analysis and trustworthiness was maintained using the criteria proposed by Guba and Lincoln. Findings The main categories of the study were burnout and intention to leave the profession and growth and development. The two subcategories of the first category were the experience of injury and the experience of violence and the two subcategories of the second category were sense of worthiness and sense of motivation. Moral distress was the most important experience of almost all participants. Conclusion Nurses mostly have negative experiences in terms of reporting their colleagues’ medical errors. Negative experiences can act as the barriers to report colleagues’ errors while positive experiences can act as its facilitators. Improvement of the patient safety culture in healthcare settings and interpersonal relationships among healthcare providers can reduce the negative experiences and promote the positive experiences of reporting colleagues’ medical errors.

Background: Hope is an important source of human coping when facing problems. Cancer is a common disease which can cause great physical and mental stress for patients, but if the diagnosis is delivered correctly, it can reduce anxiety and confusion for the patient and improve outcomes for both the patient and healthcare staff.Aim: The present study was performed with aim to determine the impact of implementing a truth-telling protocol on life expectancy of patients with gastrointestinal cancer.Method: This randomized clinical trial study with a controlled pre-test post-test design was conducted at Mashhad Ghaem Hospital and Pazh Clinic in 2020-2021. Sixty patients with gastrointestinal cancer were divided into two groups: intervention group who received information about their diagnosis using the "truth-telling" protocol, and control group who received standard hospital disclosure of diagnosis. Miller's life expectancy questionnaire was used to collect data before and one month after the intervention.Results: One month after the intervention, the mean of life expectancy score in the intervention group was 191.56±25.56 and in the control group was 176.93±32.98. The difference between before and after the intervention in the intervention group was -4.41+12.60 and in the control group was -23.02+18.60. There was a significant difference in the mean difference life expectancy score of patients in the control group (p

Background: Medical error is a leading cause of disability and death in healthcare settings and reporting colleagues' medical errors is one of the main strategies for medical error management and an ethical responsibility of all healthcare providers, including nurses. Most studies into reporting colleagues' medical errors used quantitative designs while it seems that using qualitative designs can provide better insight in this area. Purpose: This study explored nurses' experiences of reporting the medical errors of their colleagues. Methods: This qualitative study was conducted using the conventional content analysis approach. Participants were 22 hospital nurses purposively selected in 2021–2022 from different cities in Iran. Twenty-two in-depth semi-structured interviews were held for data collection. The data were analyzed via Graneheim and Lundman's conventional content analysis and trustworthiness was maintained using the criteria proposed by Guba and Lincoln. Findings: The main categories of the study were burnout and intention to leave the profession and growth and development. The two subcategories of the first category were the experience of injury and the experience of violence and the two subcategories of the second category were sense of worthiness and sense of motivation. Moral distress was the most important experience of almost all participants. Conclusion: Nurses mostly have negative experiences in terms of reporting their colleagues' medical errors. Negative experiences can act as the barriers to report colleagues' errors while positive experiences can act as its facilitators. Improvement of the patient safety culture in healthcare settings and interpersonal relationships among healthcare providers can reduce the negative experiences and promote the positive experiences of reporting colleagues' medical errors. [ABSTRACT FROM AUTHOR]

Background: The accurate disclosure of patient safety incidents is necessary to minimize patient safety incidents and medical disputes. As prospective healthcare providers, nursing students need to possess the ability to disclose patient safety incidents. Purpose: This study was designed to investigate the effect of a patient safety incident disclosure education program for undergraduate nursing students on participants' knowledge and perception of disclosure of these incidents, attitudes toward patient safety, and self-efficacy regarding disclosure of these incidents. Methods: A quasi-experimental study with a nonequivalent pretest--posttest design was conducted on fourth-year undergraduate nursing students recruited between September 6 and October 22, 2021, through convenience sampling from two universities in South Korea. The experimental group (n = 25) received the education program. The control group (n = 25) received educational materials on the disclosure of patient safety incidents only. Knowledge and perceptions of patient safety incident disclosure, attitudes toward patient safety, and self-efficacy regarding incident disclosure were measured. Data were analyzed using descriptive analysis, t test, χ² test, Fisher's exact test, Mann--Whitney U test, Wilcoxon signedrank test, and ranked analysis of covariance. Results: Posttest results revealed knowledge (p < .001), perceptions (p = .031), and self-efficacy (p < .001) with regard to the disclosure of patient safety incidents were all significantly higher in the experimental group than in the control group. Posttest attitudes toward patient safety were not significantly different between the two groups (p = .908). Conclusions/Implications for Practice: The patient safety incident disclosure education program effectively enhances the knowledge, perception, and self-efficacy of nursing students with regard to safety incidents. The findingsmay be used to improve training and educational programs in nursing colleges and hospitals to improve the knowledge, perception, and selfefficacy of nursing students with rega [ABSTRACT FROM AUTHOR]

IntroductionBreaking bad news is a critical yet challenging aspect of healthcare that requires effective communication skills, empathy, and cultural sensitivity. Health professionals in the World Health Organization’s (WHO) Eastern Mediterranean Region face unique cultural and social factors distinct from other parts of the world. This scoping review aims to comprehensively explore the peer-reviewed literature on the health professionals’ experiences in delivering bad news within the WHO’s Eastern Mediterranean Region.MethodsThis scoping review was conducted according to the Joanna Brigg Institute’s scoping review methodology and reported utilizing the Preferred Reporting Items for Systematic Reviews extension for scoping review (PRISMA-ScR) guidelines. A search using a combination of keywords and MeSH terms related to “breaking bad news” and “health professionals” was performed in PubMed, Scopus, CINAHL, EBSCO, ERIC via Embase, and Dar Almandumah (Arabic) databases. Common themes were synthesized from studies conducted in the WHO’s Eastern Mediterranean Region.ResultsOut of 4,883 studies initially identified in the databases, 24 studies met the inclusion criteria, involving a total of 4,710 participants, including physicians, nurses, and residents. The studies were published between 2006 and 2022, predominantly from Iran (n = 12). The majority employed a cross-sectional design (n = 21) or mixed methods (n = 3), with a notable absence of qualitative studies. No studies used theoretical frameworks. More than half of the studies (n = 14) reported that participants had positive attitudes toward breaking bad news. This positivity was evident in their willingness to share bad news, perceived possession of adequate knowledge, positive attitudes, having received training, awareness of accepted approaches, and adherence to protocols. The lack of training and limited awareness of established protocols like SPIKES, ABCDE, and BREAKS for breaking bad news were major concerns among participants.ConclusionThe scoping review reveals both positive and negative experiences of breaking bad news by health professionals in the WHO’s Eastern Mediterranean Region. Most studies highlight the need for culturally sensitive targeted education and training programs on breaking bad news. Further research, particularly using qualitative methodologies and theoretical frameworks is warranted.

There is limited data on the effectiveness of training interventions to improve the delivery of bad news. This preliminary research included pre–post assessments and an open-ended survey to evaluate the effectiveness and perceived value of training on delivering bad news for 26 first- and second-year fellows from five adult and pediatric fellowship programs. There was a significant increase in faculty assessment scores (34.5 vs. 41.0, respectively, Z = −3.661, p < 0.001) and Standardized Patient (SP) assessment scores (37.5 vs.44.5, respectively, Z = −2.244, p = 0.025). Fellows valued having a standard framework to aid in the delivery of bad news; receiving targeted feedback and having the opportunity to apply their skills in a subsequent case. A one-hour, four-phase lesson plan that includes an individualized training approach and simulation do-overs can be effective and valuable for preparing fellows to deliver bad news. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to explore intensive care unit (ICU) nurses' perceptions regarding the disclosure of patient safety incidents (DPSI) and identify the relationship between the perception of DPSI and communication barriers. Methods: This study used a descriptive research design. A total of 110 ICU nurses from a tertiary hospital were surveyed online between September 14 and October 5, 2022. The mean DPSI score ranged between 1.0 and 4.0, with a higher score indicating a higher perception of DPSI. Results: The mean score for ICU nurses' perceptions of DPSI was 2.92 (SD=0.37). Among the characteristics of ICU nurses, differences were observed in perceptions of DPSI according to gender, age, total work experience, and ICU work experience. Communication barriers among ICU nurses were negatively correlated with negative results as a sub-factor of perceptions of DPSI. Ambiguity in the nurse's position, lack of confidence, differences in perspectives with patients, and inadequate nurse-patient relationships as sub-factors of communication barriers exhibited a negative correlation with negative results as a sub-factor of perceptions of DPSI. Conclusions: ICU nurses' perceptions of DPSI and the sub-factors related to communication barriers are negatively related to DPSI. To improve ICU nurses' perceptions, open and non-punitive circumstances, staff education, practical guidelines, and support systems are required. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Communication is one of the central axes around which end-of-life care revolves in the context of palliative care. Communication of bad news is reported as one of the most difficult and stressful tasks by palliative care professionals. Therefore, the aim of this study is to identify aspects related to the communication of bad news in palliative care in Spain. Methods: Descriptive cross-sectional study. An ad hoc questionnaire was designed and sent by e-mail to all palliative care teams in Spain. Results: Overall, 206 professionals (102 nurses, 88 physicians and 16 psychologists) completed the questionnaire. A total of 60.2% considered their communication of bad news skills to be good or very good. This was related to older age, experience in both the profession and palliative care, and to having received specific postgraduate training (P <.001). Around 42.2% perform communication of bad news with the patient first, which is associated with lower skill (P =.013). About 78.15% of the professionals do not use any specific protocol. Conclusion: This study suggests that patients access palliative care with little information about their diagnosis and prognosis. The barriers identified in the communication of bad news are the lack of specific education and training in protocol management, the difficult balance between hope and honesty, the young age of the patient, and the family. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that the informed consent process, in which patients are warned about potential side effects of a treatment, can trigger a nocebo effect where expectations about side effects increase side effect occurrence. This has sparked an ethical debate about how much information patients ought to receive before a treatment while trying to balance the moral principles of patient autonomy and nonmaleficence. In keeping with the principle of patient autonomy, the opinion of patients themselves in relation to how much information they want about side effects is of utmost relevance in this debate. The literature was searched to identify surveys assessing patient attitudes towards side effect information. Across a broad variety of patient populations, treatment types, and countries, the majority of patients wished to be fully informed of potential side effects, particularly in relation to frequent and severe side effects, while only a small minority wanted minimal or no information at all. Results from this review suggest that nocebo research should focus on methods of avoiding nocebo effects of informed consent while ensuring that patients are well-informed about potential side effects. [ABSTRACT FROM AUTHOR]

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Krzysztof Sobczak,1 Marcin Trzci&nacute;ski,2 Agata Kot&lstrok;owska,2 Julia Lenkiewicz,2 Oliwia Lenkiewicz,2 Julia Przenios&lstrok;o,2 Jan Plenikowski2 1Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Gdansk, Poland; 2Student Scientific Circle of Medical Communication, Medical University of Gdansk, Gda&nacute;sk, PolandCorrespondence: Krzysztof Sobczak, Department of Sociology of Medicine & Social Pathology, Medical University of Gdansk, Tuwima, 15 Street, 80-210, Gdansk, Poland, Tel +48 58 349 15 53, Email krzysztof.sobczak@gumed.edu.plPurpose: The aim of our study was to analyze students’ emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN).Patients and Methods: 291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience – whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ2 tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA).Results: Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy.Conclusion: The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.Keywords: truth disclosure, communication, emotions, medical educations, anxiety

BackgroundSerious illness communication skills are important tools for surgeons, but training in residency is limited.MethodsThirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes.ResultsResidents had frequent conversations and employed known communication strategies. Three themes highlighted challenges they face. Illness severity included factors attributed to the illness that made serious illness communication more challenging: symptoms, poor prognosis, and urgency. Knowledge and feelings included the factual understanding and emotional experience of residents, patients, and families. Academic structure included hierarchy and the residents' dual role as learners and teachers. On reflection, residents identified needing greater experiential practice, analogous to learning procedural skills.ConclusionsSurgical residents regularly face serious illness conversations with little training beyond observation of role models. Dedicated training may help meet this need.

BACKGROUND: Bad news may be defined as “any information which adversely and seriously affects an individual’s view of his or her future.” It seems necessary for physicians to use a specific method to break the bad news to patients properly. Due to the importance of this skill and its effects on patient’s hope and motivation to continue his treatment process, in this study, we evaluate the interns of Guilan University of Medical Sciences’ attitude to breaking bad news (BBN) to the patients based on strategy for BBN, perception of condition or seriousness, invitation from the patient to give information, knowledge: giving medical facts, explore emotions, and sympathize (SPIKES) model in 2020–2022. MATERIALS AND METHODS: In this cross-sectional study in Iran, 153 Guilan University of Medical Sciences interns were selected as a census sample in 2020–2022. A self-administered questionnaire collected the information with standard tests confirming its reliability and validity. The collected data were described and analyzed using Statistical Package for the Social Sciences (SPSS) 16. The Chi-square test was used to measure the statistical relationship between the demographic variables and the entire questionnaire. Also, a one-way analysis of variance (ANOVA) test was used to measure the relationship between the average age and the scores obtained from the four main areas and the entire questionnaire. A statistical level of less than 0.05 was considered significant. RESULTS: 43.1% of the interns were men, and 56.9% were women. The mean attendance age was 26.12 ± 1.32, the minimum age was 23, and the maximum was 33. Only 8.5% of the interns in this study had been taught about BBN, and most participants announced that they feel pressure and anxiety when BBN to patients. The attitude of interns in this study was not satisfying in all four parts of the study: individual preference (54.2% of participants showed poor attitude), preparing environmental conditions for BBN (60.8% of participants showed poor attitude), how to break bad news (52.3% of participants showed poor attitude), and the things that are done after BBN (52.9% of participants showed poor attitude). CONCLUSION: Based on the results, the attitude of the interns who had participated in this study was not satisfactory. Due to the importance of this communication skill to reduce physician anxiety and best control patients’ reactions, managing courses in the undergraduate curriculum seems necessary.

Although parental HIV disclosure has benefits for parents and children, the disclosure rate among parents remains low. This study aims to qualitatively examine parental concerns regarding disclosure of their HIV status to their children. Eighty parents were enrolled in a randomized controlled trial of a three-session disclosure-support intervention, with forty receiving the intervention and forty receiving treatment as usual. Intervention sessions were audio recorded, and transcriptions were qualitatively coded for content related to concerns of disclosure. Four themes emerged: Intention to disclose, disclosure approach, indicators for disclosure, and fears about disclosure. These themes reveal struggles that parents experience when considering HIV disclosure suggesting that an effective disclosure intervention must help parents assess pros and cons, discuss the emotions of the children after the disclosure, and monitor the impact on children's lives after disclosure over time. Future research is needed to implement interventions supporting HIV-positive parents' disclosure decision-making and actions.

Background Discordance between physicians' and patients' prognostic perceptions in advanced cancer care threatens informed medical decision-making and end-of-life preparation, yet this phenomenon is poorly understood. We sought to: (1) describe the extent and direction of prognostic discordance, patients' prognostic information preferences in cases of prognostic discordance, and physicians' awareness of prognostic discordance; and (2) examine which patient, physician, and caregiver factors predict prognostic discordance. Materials and Methods Oncologists and advanced cancer patients (median survival ≤12 months; n = 515) from 7 Dutch hospitals completed structured surveys in a cross-sectional study. Prognostic discordance was operationalized by comparing physicians' and patients' perceptions of the likelihood of cure, 2-year mortality risk, and 1-year mortality risk. Results Prognostic discordance occurred in 20% (likelihood of cure), 24%, and 35% (2-year and 1-year mortality risk) of physician-patient dyads, most often involving patients with more optimistic perceptions than their physician. Among patients demonstrating prognostic discordance, the proportion who preferred not knowing prognosis varied from 7% (likelihood of cure) to 37% (1-year mortality risk), and 45% (2-year mortality risk). Agreement between physician-perceived and observed prognostic discordance or concordance was poor (kappa = 0.186). Prognostic discordance was associated with several patient factors (stronger fighting spirit, self-reported absence of prognostic discussions, an information source other than the healthcare provider), and greater physician-reported uncertainty about prognosis. Conclusion Up to one-third of the patients perceive prognosis discordantly from their physician, among whom a substantial proportion prefers not knowing prognosis. Most physicians lack awareness of prognostic discordance, raising the need to explore patients' prognostic information preferences and perceptions, and to tailor prognostic communication. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of our research was to find out patients' preferences concerning their doctors' attitudes and behaviour as they deliver bad news to them. Material and methods: In national research conducted from February to October 2017 using the computer-assisted web interview (CAWI) technique, we studied the statements of 314 adult patients who had received bad medical news from their doctors. Seventy-nine per cent of them were women and 21% were men. Fifty-nine per cent had higher education and 33% had secondary education. A specially designed closed question survey was used as a tool to collect the data. Results: Most of the patients (59.6%) expected a doctor-patient relationship based on partnership and collective decisions concerning further treatment. Patients wanted their doctors to be honest with them, to provide them with solid information and an opportunity to ask questions and discuss the suggested solutions. Less than 2 out of 10 patients expected "an empathy specialist". The patients who evaluated their doctors' behaviour and the way bad news was delivered to them negatively were more likely to change doctors or terminate their treatment. Conclusions: The doctor-patient relationship when an unfavourable diagnosis is being communicated is an important aspect, which defines the way people who participate in this difficult situation behave and communicate. Doctors' behaviour during DBN should meet the patients' expectations. Such an attitude guarantees trust towards doctors and results in more positive evaluations on them. Most importantly, it translates directly into the patients' therapeutic behaviours and treatment effects. [ABSTRACT FROM AUTHOR]

Background: Communication skills significantly contribute to good clinical practice. A systematic approach to delivering bad news could avoid unfavorable workplace circumstances. SPIKES protocol has been incorporated into clinical practice in many countries to deliver bad news systematically to build a better doctor–patient relationship. Objectives: To assess post-graduate residents' awareness and practice of SPIKES protocol and to determine the need for training/education for delivering bad news. Methods: A cross-sectional study among 96 post-graduates from various medical and dental clinical departments was done using a self-directed questionnaire consisting of four sections (i.e. socio-demographic data, awareness and adherence, practice, and need for training/education). The questionnaire was circulated through online platforms, and responses were tabulated. Results: About 55% of the participants were aware of the SPIKES protocol. About 90% felt that the protocol was simple, easy, and practical. 92% felt that adequate training is required for delivering bad news. Also, 90% of the participants expressed a willingness to attend training sessions to improve their communication skills. Conclusion: Only half of the study population was aware of the SPIKES protocol; among them, a fair adherence to the protocol was noted.

HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10 years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided.

The role of HIV disclosure and its influence on engagement in HIV care after initial linkage to care is not well understood. We conducted 28 in-depth interviews with patients newly entering HIV care. Gaining access to social support was a key reason that many patients disclosed their HIV status. For some, HIV disclosure improved support networks related to engagement in care at the time of care entry, in the form of appointment reminders, emotional support, and confidence to disclose more widely. However, some participants cited anticipated stigma as a barrier to disclosure, as they feared rejection or further disclosure without their permission. Early access to social support and skill building related to stigma reduction and coping can be useful resources to help patients manage HIV, as they initiate care. In addition, incorporating support for smart disclosure decisions into interventions may improve access to social support, ultimately improving engagement in care.

Ethical discourse on prognosis disclosure is not yet well established. The core of the problem continues to be the dilemma between the right of self-determination and non-maleficence of patients. The prognosis disclosure policy based on Kantian autonomy provides a good solution for the problem. The policy includes demand for strict truth telling and its compatibility with patients’ best interest. However, there remains a discrepancy between theory and practice, especially when prognosis is disclosed just prior to their death. Kantian theory of prognosis is supplemented by a moralistic perspective. The moralistic perspective places high importance on temporality and relationships with others, which all human beings inherently possess. From the moralistic viewpoint, decisions about prognosis disclosure at the final stages of life must be individualized in order to be authentically autonomous. The decision to disclose a prognosis or not can only be determined by the relationships fostered over time with patients.

Background and objectivesThe availability of whole genome sequencing (WGS) is increasing in clinical care, and WGS is a promising tool in diagnostic odyssey cases. Physicians' ability to effectively communicate genomic information with patients, however, is unclear. In this multiperspective study, we assessed physicians' communication of patient genome sequencing information in a diagnostic odyssey case series.MethodsWe evaluated physician communication of genome sequencing results in the context of an ongoing study of the utility of WGS for the diagnosis of rare and idiopathic diseases. A modified version of the Medical Communication Competence Scale was used to compare patients' ratings of their physicians' communication of general medical information to communication of genome sequencing information. Physician self-ratings were also compared with patient ratings.ResultsA total of 47 patients, parents, and physicians across 11 diagnostic odyssey cases participated. In 6 of 11 cases (54%), the patient respondent rated the physician's communication of genome sequencing information as worse than that of general medical information. In 9 of 11 cases (82%), physician self-ratings of communication of genome sequencing information were worse than the patient respondent's rating. Identification of a diagnosis via WGS was positively associated with physician self-ratings (P = .021) but was not associated with patient respondent ratings (P = .959).ConclusionsThese findings reveal that even in diagnostic odyssey cases, in which genome sequencing may be clinically beneficial, physicians may not be well-equipped to communicate genomic information to patients. Future studies may benefit from multiperspective approaches to assessing and understanding physician-patient communication of genome-sequencing information.

Unintended pregnancy in adolescence and early adulthood is stigmatized in the United States because it deviates from social norms that consider young people's sexuality as a social problem. While limited, prior research has found that this stigma prevents young people from telling people in their lives about their pregnancies, for fear of judgment or negative reactions. We hypothesized that this selective disclosure of unintended pregnancy due to stigma would reduce the social support available to young pregnant people at a particularly vulnerable time-social support that we know is important for optimal physical and mental health of the young person, and the pregnancy (should they choose to carry to term). To explore this hypothesis, we conducted a qualitative study among young people to understand if and how they experienced stigma in relation to an unintended pregnancy, how this stigma shaped patterns of pregnancy disclosure, the implications for received social support, and participant thoughts on how to alleviate the influence of this stigma on their lives. In in-depth interviews with 25 young people in the San Francisco Bay area who had experienced at least one unintended pregnancy, using a thematic analysis approach, we found that the stigma of unintended pregnancy led participants to selectively disclose the pregnancy to limited people, which in turn cut them off from needed sources of social support. Black and Hispanic women disproportionately described this experience. Participants expressed a desire for programs that would connect young people who had experienced unplanned pregnancy to each other-either via the internet, organized groups through clinical care sites, college or high school campuses, or other forums-as a way to alleviate stigma, share perspectives and lessons learned, and otherwise build emotional and informational support networks for themselves where their usual support had fallen away.

Communication of diagnosis in chronic disease has been little studied in pediatric oncology. Clinical practices for disclosure are mainly carried out at the end of life, not at the onset of the disease, and there does not seem to be clarity on how to communicate to families. Objective: to understand the current communication practices of diagnosis in children and young people with oncologic disease. Method: systematic review according to PRISMA guidelines. Results: A total of 17 studies were obtained that met the inclusion criteria. Two protocols for communicating the diagnosis were identified and several recommendations were found for disclosure according to the patient’s age, the right to be informed, and the importance of involving the family. Discussion: validated communication practices are required that respond to the mental health needs in pediatric oncology, considering the culture and environment of patients and their families, and other barriers to effective communication.

Abstract Background Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP. Methods For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations. Results IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen’s d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%). Conclusions ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.

IntroductionOlder Chinese Americans often defer end-of-life care discussions. Researchers sought to explore how to engage older Chinese Americans and their families in end-of-life care discussions and to understand the optimal timing to initiate such discussions.MethodsIndividual, semistructured interviews were conducted with 14 community-dwelling older Chinese Americans, 9 adult children, and 7 clinicians. The data were collected and analyzed using focused ethnographic methodology.ResultsOlder Chinese Americans and their families would discuss end-of-life care when introduced at "optimal times," which included after-triggering events (e.g., death of loved ones, fall accidents), changes in health status, or advanced age.DiscussionAdult children are not expected to initiate end-of-life care discussions with their parents. Thus, culturally congruent health care that could better engage Chinese Americans in such discussions would be optimized by having clinicians proactively assess their patients' readiness and initiate such discussion at optimal times.

Background: Communicating bad news is of great interest in the geriatric field, but few works have considered the physician's point of view in this regard. Objectives: The aim of this study was to explore possible differences related to physicians' gender and work experience in how a terminal diagnosis is disclosed to older patients. Methods: Study participants were 420 Italian physicians (277 M, 143 F) working in clinical medicine (58.2%), surgery (33.3%), or other medical departments (8.5%). They completed an anonymous multiple-choice questionnaire that investigated various issues associated with communicating bad news to terminally ill older patients. Results: Men had more work experience than women (55.6% vs. 44.8% had worked for ≥23 years) and were more likely to work in surgery departments, while more women worked in clinical medicine. Most physicians declared that terminally ill older patients, if mentally competent, should always (14.4%) or generally (64.3%) be directly and openly informed of their condition. With no difference in gender, length of work experience, or specialty area, 36.9% of physicians thought that this was a human right and 18% that it would improve the patient's quality of life. Where older patients were alone, male physicians were more likely than female (30.2% vs. 8.9%) to always communicate bad news directly to them. More than 70% of physicians, especially those with longer work experience, declared that they always or often took enough time to inform the patient. Female physicians and those working in clinical medicine were more likely to need psychological help when deciding to break bad news, but only a smaller proportion declared to have received it. Conclusions: Gender and work experience may influence how physicians communicate with patients and how often they seek psychological support. [ABSTRACT FROM AUTHOR]

Ethical discourse on prognosis disclosure is not yet well established. The core of the problem continues to be the dilemma between the right of self-determination and non-maleficence of patients. The prognosis disclosure policy based on Kantian autonomy provides a good solution for the problem. The policy includes demand for strict truth telling and its compatibility with patients' best interest. However, there remains a discrepancy between theory and practice, especially when prognosis is disclosed just prior to their death. Kantian theory of prognosis is supplemented by a moralistic perspective. The moralistic perspective places high importance on temporality and relationships with others, which all human beings inherently possess. From the moralistic viewpoint, decisions about prognosis disclosure at the final stages of life must be individualized in order to be authentically autonomous. The decision to disclose a prognosis or not can only be determined by the relationships fostered over time with patients. [ABSTRACT FROM AUTHOR]

Background: Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure. Objective: To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE). Methods: Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care. Results: Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines. Conclusion: Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress. [ABSTRACT FROM AUTHOR]

Krzysztof Sobczak Department of Sociology Medicine and Social Pathology, Medical University of Gdansk, Gdansk, PolandCorrespondence: Krzysztof Sobczak, Department of Sociology Medicine and Social Pathology, Medical University of Gdansk, Tuwima 15 Str., 80-210 Gdansk, Poland, Tel +48 58 349 15 51, Email krzysztof.sobczak@gumed.edu.plAbstract: The COVID-19 pandemic has changed the principles of communication within the health-care setting. Communication skills as developed for use in the context of a direct and personal encounter have become insufficient. As a result, numerous health professionals came to believe they were not sufficiently prepared to deliver bad news in relation to medical care. The CONNECT protocol is a tool designed to help health-care professionals in the delivery of such messages. The name of the protocol is an acronym derived from C – context, O – organization, NN – near and niceties, E - emotions, C – counseling, T – taking care. The objective of the protocol is to improve the effectiveness of the delivery of bad news in relation to medical care by ensuring proper organization of the key elements of the encounter with the patient and/or their family.Keywords: truth disclosure, physician–patient relations, communication, COVID-19, pandemic

To develop and implement specific training based on the knowledge and management of conspiracy of silence among nursing students. Conspiracy of silence refers to the concealment of information from a patient on the family's request, under the influence of a paternalistic culture that seeks to protect the patient. Participatory action research. Was conducted in the following stages: reconnaissance (focus groups); planning, action and observation (theoretical sessions); and reflection (analysis of care plans). The focus group consisted of six fourth year and eight second-year students. The intervention was conducted with 42 s-year students and a total of 93 s-year students participated in the resolution of the clinical case. The study was conducted between October 2022 and June 2023 at the Faculty of Nursing, University of Valencia. For data analysis, the process described by Carrillo et al. (2011) was followed, involving coding and the creation of categories and subcategories. The focus group deficiencies were detected in the students' learning of palliative care competence, breaking bad news and the conspiracy of silence (reconnaissance stage). Therefore, an intervention was conducted to reinforce these knowledge areas, specifically addressing the conspiracy of silence (planning, action and observation stages). The resolution of the case showed how students with training approached the situation more comprehensively, including the family and proposed activities that were consistent with managing the situation (reflection stage). An active feedback process was successfully established, where the students' feedback helped create specific training on oncological palliative care and provided the students with tools to manage the conspiracy of silence. The results underscore the importance of providing students with training in palliative care and managing conspiracy of silence, through therapeutic communication training, active training or enhancing emotional intelligence. This training is essential for cultivating the attitudes and skills required to deliver high-quality palliative care. [ABSTRACT FROM AUTHOR]

This study was designed to examine the rates of HIV serostatus disclosure in a sample of HIV-infected children in the state of Karnataka in South India, their reactions to learning their HIV-positive status and the reasons for and barriers to disclosure from the point of view of their caregivers. We enrolled 233 HIV-infected children, aged 5-18 years and their caregivers between July 2011 and February 2013 at HIV clinics in three tertiary care centers. Caregiver interviews included information about demographic characteristics, medical history, type of disclosure to the child and other related factors, including disclosure barriers. Three quarters (n = 185) of the caregivers reported that there had been no disclosure to the child, 15.4% (n = 38) reported partial disclosure (e.g. telling the child he or she had a 'chronic illness') and only 9.7% (n = 24) reported full disclosure, at a mean age of 10.9 (SD: 2.5) years. Caregivers, who planned to disclose in the future, stated on average that 16 years would be the right age. Those who favored a later disclosure reported that they feared strong negative emotional reactions from the child (p = 0.03) and social isolation (p

Many politicians manipulate information to prevent voters from holding them accountable; however, mobile text messages may make it easier for nongovernmental organizations to credibly share information on official corruption that is difficult for politicians to counter directly. We test the potential for texts on budget management to improve democratic accountability by conducting a large (n = 16,083) randomized controlled trial during the 2016 Ugandan district elections. In cooperation with a local partner, we compiled, simplified, and text-messaged official information on irregularities in local government budgets. Verified recipients of messages that described more irregularities than expected reported voting for incumbent councillors 6% less often; verified recipients of messages conveying fewer irregularities than expected reported voting for incumbent councillors 5% more often. The messages had no observable effect on votes for incumbent council chairs, potentially due to voters' greater reliance on other sources of information for higher profile elections. These mixed results suggest that text messages on budget corruption help voters hold some politicians accountable in settings where elections are not free and fair.

HIV status disclosure is a key support strategy to start and maintain HIV care and treatment and to reduce HIV transmission. We explored the patterns and correlates of disclosure and described the effectiveness of nurse-facilitated disclosure among HIV-infected mothers of infants in coastal Tanzania. We enrolled 400 HIV positive women in an observational longitudinal study in 2011, interviewed them about maternal sociodemographic and economic characteristics, maternal and child health and history of HIV disclosure experiences and offered nurse-facilitated HIV disclosure at enrolment or at follow-up 1 month later. Mothers frequently disclosed their status to husbands and/or female relatives and experienced predominantly positive reactions. Economically vulnerable women disclosed more often to elderly female relatives, indicating that Infant and Young Child Feeding counseling given to HIV positive women should garner the support of elderly female relatives for implementing appropriate feeding practices. Nurse-facilitated disclosure was feasible in this low resource setting and was used by patients to help them with both first-time disclosure and disclosure to new persons.

ObjectiveResearchers traditionally rely on participant self-report for contraceptive use. We hypothesized that self-reported contraceptive use by clinical research participants may disagree with objectively measured hormonal status.Study designWe enrolled women in Harare, Zimbabwe, aged 18-34, who by self-report had not used hormonal or intrauterine contraception for >30 days, or depot medroxyprogesterone acetate for >10 months, into a study designed to assess biologic changes with contraceptive initiation and use. Blood samples obtained at enrollment and each follow-up visit (N=1630 from 447 participants) were evaluated by mass spectrometry for exogenous hormones. We individually interviewed a subset of participants (n=20) with discrepant self-reported and measured serum hormones to better understand nondisclosure of contraceptive use.ResultsDiscrepant with self-reported nonuse of hormonal contraception, synthetic progestogens were detectable in 120/447 (27%, 95% confidence interval 23%-31%) enrolled women. Measured exogenous hormones consistent with use of contraceptive pills (n=102), injectables (n=20) and implants (n=3) were detected at enrollment, with 7 women likely using >1 contraceptive. In-depth interviews revealed that participants understood the requirement to be hormone free at enrollment (100%). Most (85%) cited partner noncooperation with condoms/withdrawal and/or pregnancy concerns as major reasons for nondisclosed contraceptive use. All interviewed women (100%) cited access to health care as a primary motivation for study participation. Of participants who accurately reported nonuse of hormonal contraception at enrollment, 41/327 (12.5%) had objective evidence of nonstudy progestin use at follow-up that disagreed with self-reported nonuse.ConclusionsWomen joining contraceptive research studies may misrepresent their use of nonstudy contraceptive hormones at baseline and follow-up. Objective measures of hormone use are needed to ensure that study population exposures are accurately categorized.Implications statementAmong Zimbabwean women participating in a contraceptive research study, 27% had objective evidence of use of nonstudy contraceptives at enrollment that disagreed with self-report. Studies that rely on self-report to identify contraceptive hormone exposure could suffer from significant misclassification.

ObjectivesThe objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families.MethodsIn all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems.ResultsInterviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy.ConclusionsAdolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.

This study examined the utility of two interview instructions designed to overcome children's reluctance to disclose transgressions: eliciting a promise from children to tell the truth and the putative confession (telling children that a suspect "told me everything that happened and wants you to tell the truth"). The key questions were whether the instructions increased disclosure in response to recall questions and in response to recognition questions that were less or more explicit about transgressions and whether instructions were differentially effective with age. A total sample of 217 4- to 9-year-old maltreated and comparable non-maltreated children and a stranger played with a set of toys. For half of the children within each group, two of the toys appeared to break while they were playing. The stranger admonished secrecy. Shortly thereafter, children were questioned about what happened in one of three interview conditions. Some children were asked to promise to tell the truth. Others were given the putative confession, and still others received no interview instructions. When coupled with recall questions, the promise was effective at increasing disclosures only among older children, whereas the putative confession was effective regardless of age. Across interview instruction conditions, recognition questions that did not suggest wrongdoing elicited few additional transgression disclosures, whereas recognition questions that explicitly mentioned wrongdoing elicited some true reports but also some false alarms. No differences in disclosure emerged between maltreated and non-maltreated children. Results highlight the potential benefits and limitations of different interviewing approaches when questioning reluctant children.

Background and Objectives: Undoubtedly, breaking bad news is one of the most difficult duties of a doctor. Not having this skill and not paying attention to its details can result in poor patient satisfaction, psychological morbidity, and weak clinical decisions. The present study was conducted to investigate the medical students’ perspectives about delivering bad news to patients. Methods: A cross-sectional study was conducted using a questionnaire for all medical students of Qom University of Medical Sciences, Iran. A total of 269 out of 310 students responded to this survey (86.8% response rate). The questionnaire was designed and validated by ten medical ethics experts. Results: In this study, 54.4% of students believed that delivering bad news to patients depends on the patient’s compliance and condition and 55.8% of the participants believed that patients’ families should be the first recipient of the bad news. In addition, 54.3% believed that physicians should deliver the bad news. A total of 78.8% of the participants believed that breaking bad news should be accompanied by empathy and hope Also, 47.6% of students said that they did not receive training about breaking bad news. Conclusion: Breaking bad news is a balancing act that requires doctors to constantly adapt to different factors. Although most medical students were keen to help their patients, they lacked the essential knowledge and skills for breaking bad news. Development of strategies and guidelines is needed to improve societal views, and train physicians about breaking bad news.

The great enemy of communication, we find, is the illusion of it. • William Hollingsworth Whyte, 19501 On September 6, 2022, a combined investigation by research integrity experts, data and analytics experts, publishing and operational teams, and legal counsels from Hindawi and its parent company Wiley, led to the initial recommendation to retract 511 articles that were compromised based on reviewer activity alone.2 That same month, the physics publisher Institute of Physics (IOP) announced the retraction of 494 papers after investigation indicated they “may have been created, manipulated, and/or sold by a commercial entity” (or paper mill).3 This October, the Elsevier journal Thinking Skills and Creativity retracted 47 papers that appear to have been generated by a paper mill because they were each accepted on the “positive advice of one illegitimate reviewer report.”4 Paper mills and phony peer reviews5 undermine the soundness of science, because it is based on illusion rather than truth. Truth (veritas) is only verifiable if it is transparent. The Committee on Publication Ethics (COPE), the Directory of Open Access Journals (DOAJ), the Open Access Scholarly Publishing Association (OASPA), and the World Association of Medical Editors (WAME) have been collaborating to identify principles of transparency and best practice for scholarly publications.6 The fourth version of this work in progress was published on September 15, 2022 and is available from: https://publicationethics.org/files/principles-transparency-best-practice-scholarly-publishing.pdf The Philippine Journal of Otolaryngology Head and Neck Surgery upholds these principles of transparency and continues to strive to implement these best practices. In a related development, the International Association of Scientific, Technical and Medical Publishers (STM) has proposed a standard taxonomy for peer review,7 recognizing a need to identify and standardize definitions and terminology in peer review practices to help align nomenclature as more publishers use open peer review models. This peer review taxonomy will help make the peer review process for articles and journals more transparent and will enable the community to better assess and compare peer review practices between different journals. According to STM, peer review should be described using four components:7 • identity transparency: • all identities visible: reviewers, authors, decision-making editor [editor] all visible to each other • single anonymized: reviewer identity is not visible to the author, author and editor identities are visible to everyone (also known as single masked, formerly single blinded, review) • double anonymized: reviewer identity is not visible to the author, author identity is not visible to the reviewer, editor identity is known to both (also known as double masked, formerly double blinded, review) • triple anonymized: reviewer identity is not visible to the author or editor, author identity is not visible to the reviewer or editor, editor identity is not visible to reviewer or author (also known as triple masked, formerly triple blinded, review) • who the reviewer interacts with: the editor only (traditional review), direct interaction with the other reviewers (with or without their identities visible), and/or directly with the authors (with or without identities visible) • what information about the review process is published: options include no information, review summaries, review reports, review reports if the reviewer opts to have review published, review reports if the author opts to have review published, the submitted manuscript (can be posted as a preprint), the submitted manuscript if the author opts in, the editor’s correspondence with the author, the authors’ response (rebuttal) letter, reviewer identities, reviewer identities if the review opts in, editor identities 4. whether post-publication commenting takes place: online comments may be either open (commenters may be anonymous or required to sign comments; could also include whether comments are moderated) or invited only; this item does not include letters to the editor. This item is not mentioned if no commenting is allowed. Using STM terminology, the Philippine Journal of Otolaryngology Head and Neck Surgery may be described as follows: • Identity transparency: Double anonymized • Reviewer interacts with: Editor • Review information published: None We are updating our Instructions to Authors and About the Journal to reflect these developments. On another front, the Philippine Journal of Otolaryngology Head and Neck Surgery has agreed to co-publish an editorial calling on wealthy countries to do more to support Africa and other vulnerable nations in mitigating the impact of climate change on health.8 The guest editorial in this issue is authored by the editors of 16 African health journals, and is co-published by 259 international journals, including The Lancet, British Medical Journal, New England Journal of Medicine, National Medical Journal of India, and Medical Journal of Australia and the Philippine Journal of Otolaryngology Head and Neck Surgery (see http://press.psprings.co.uk/bmj/october/Journals.pdf). Never have so many journals come together to make the same call, reflecting the severity of the climate change emergency now facing the world. The authors say Africa has suffered disproportionately although it has done little to cause the crisis and urges wealthy nations to step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change.8 They explain that the climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects. In West and Central Africa, for example, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock, while extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1.7 million deaths annually in Africa.8 Changes in vector ecology brought about by floods and damage to environmental hygiene has also led to increases in malaria, dengue fever, Ebola virus, and other infectious diseases across sub-Saharan Africa.8 In all, it is estimated that the climate crisis has destroyed a fifth of the gross domestic product (GDP) of the countries most vulnerable to climate shocks.8 The damage to Africa should be of supreme concern to all nations, they write, because in an interconnected world, leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations.8 We call on participants of the 2022 United Nations Climate Change Conference (COP27) to take concrete steps towards achieving our collective climate goals by turning their commitments under the Paris Agreement into action, without falling short as they did in COP26 Glasgow.9 Without compromise; in truth, transparently.

How should clinicians respond when parents will not allow their child to know the truth about their medical condition and treatment? There is wide consensus amongst clinicians and ethicists that children should be given "honest" information delivered in a developmentally appropriate manner. However, the basis in ethical theory is not clear, especially for pre‐adolescents. These children are old enough to understand some information, but are not yet "mature minors" capable of making their own health care decisions. We take the position that thinking in terms of a child's "right to know" is not the most helpful in dealing with the ethical complexity of these situations. We propose that questions of truth‐telling are best addressed in terms of how a child's interests are promoted or set back by being told the truth. Our first step is to give an account of the concept of children's interests in general. Then we relate that account specifically to truth‐telling. In doing so, we use a relatively straightforward hypothetical but realistic case, in order to illustrate how ethical deliberation using interests would proceed. The case is not intended to be particularly contentious or difficult, so that the focus is on the nature of the ethical reasoning, rather than any complexities of the case. [ABSTRACT FROM AUTHOR]

Background: Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date. Aim: The purpose is to explore the reasons for dishonesty in transmitting information to patients. Design and Method: In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January 2020 till August 2020. Data were analyzed according to Graneheim and Lundman approach. Ethical consideration: The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485). Results: The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth. Discussion and conclusion: Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice. [ABSTRACT FROM AUTHOR]

Knowledge is capable of transforming realities, in such a way that society equips itself with its truths to share them with others, exercising parresia, that is, the courage to tell the truth. Professionals working on the issue of violence against women also need to be equipped with their knowledge so that, together with the individual, it can transform their reality. Thus, the present study seeks to identify and analyze the subjective and objective knowledge of nurses working in Primary Care about domestic violence against women, from the perspective of exercising parresia. This is a qualitative research developed with 20 nurses working in Primary Care in a municipality located in the south of Rio Grande do Sul. Data were collected between April and June 2018, through recorded semistructured interviews. The content of the interviews was inserted in the NVivo software and treated in the light of the Discursive Textual Analysis. It was found that nurses have subjective knowledge and objective knowledge about domestic violence against women to exercise parresia. Subjective knowledge refers to everything that is intrinsic to the subject, elaborated from his experiences, thoughts and convictions, while objective knowledge comprises scientific knowledge. This knowledge is complementary and contributes to the work with women. Diagnosing domestic violence in the lives of women who maintain this veiled wound and still acting as a parresiasta is an arduous task, but capable of transforming realities. [ABSTRACT FROM AUTHOR]

In 1965, the Sugar Research Foundation (SRF) secretly funded a review in the New England Journal of Medicine that discounted evidence linking sucrose consumption to blood lipid levels and hence coronary heart disease (CHD). SRF subsequently funded animal research to evaluate sucrose's CHD risks. The objective of this study was to examine the planning, funding, and internal evaluation of an SRF-funded research project titled "Project 259: Dietary Carbohydrate and Blood Lipids in Germ-Free Rats," led by Dr. W.F.R. Pover at the University of Birmingham, Birmingham, United Kingdom, between 1967 and 1971. A narrative case study method was used to assess SRF Project 259 from 1967 to 1971 based on sugar industry internal documents. Project 259 found a statistically significant decrease in serum triglycerides in germ-free rats fed a high sugar diet compared to conventional rats fed a basic PRM diet (a pelleted diet containing cereal meals, soybean meals, whitefish meal, and dried yeast, fortified with a balanced vitamin supplement and trace element mixture). The results suggested to SRF that gut microbiota have a causal role in carbohydrate-induced hypertriglyceridemia. A study comparing conventional rats fed a high-sugar diet to those fed a high-starch diet suggested that sucrose consumption might be associated with elevated levels of beta-glucuronidase, an enzyme previously associated with bladder cancer in humans. SRF terminated Project 259 without publishing the results. The sugar industry did not disclose evidence of harm from animal studies that would have (1) strengthened the case that the CHD risk of sucrose is greater than starch and (2) caused sucrose to be scrutinized as a potential carcinogen. The influence of the gut microbiota in the differential effects of sucrose and starch on blood lipids, as well as the influence of carbohydrate quality on beta-glucuronidase and cancer activity, deserve further scrutiny.

ImportanceLong-term prognosis informs clinical and personal decisions for older adults with late-life disability. However, many clinicians worry that telling patients their prognosis may cause harm.ObjectiveTo explore the safety of and reactions to prognosis communication in late-life disability.DesignParticipants estimated their own life expectancy and were then presented their calculated life expectancy using a validated prognostic index. We used a semi-structured interview guide to ask for their reactions. Qualitative data were analyzed using constant comparative analysis. Potential psychological and behavioral outcomes in response to receiving one's calculated prognosis were recorded and re-assessed 2-4 weeks later.SettingCommunity-dwelling older adults age 70+ residing in the San Francisco Bay Area.ParticipantsThirty five older adults with a median age of 80 requiring assistance with ≥1 Activity of Daily Living.ResultsSelf-estimates of life expectancy were similar to calculated results for 16 participants. 15 estimated their life expectancy to be longer than their calculated life expectancy by >2 years, while 4 shorter by >2 years. An overarching theme of, "fitting life expectancy into one's narrative" emerged from qualitative analysis. Discussing life expectancy led participants to express how they could alter their life expectancy (subtheme "locus of control"), how they saw their present health (subtheme "perceived health"), and their hopes and fears for the remaining years of their lives (subtheme "outlook on remaining years"). Feelings of anxiety and sadness in reaction to receiving calculated prognosis were rare.Conclusions and relevanceAbout half of the disabled older adults' self-estimates of prognosis were similar to calculated estimates. Evidence of sadness or anxiety was rare. These data suggest that in most cases, clinicians may offer to discuss prognosis.