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ABSTRACT: Background: Breaking bad news is one of the most difficult tasks for practicing doctors, especially for those working in health care specialties where life-threatening diseases are diagnosed and managed routinely. Our aim was to elicit the knowledge and practices of doctors and identify barriers faced by them in disclosure of bad news across the provinces of Pakistan. Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A total of 1185 doctors were surveyed. Responses were compared across provinces. Results: 80% of doctors across all specialties considered life-threatening diagnoses like cancer and stroke as equivalent to bad news, whereas less than 50% perceived conditions like malaria and typhoid as bad news. Regarding the level of difficulty encountered in giving bad news on a scale of 0 to 6, over 57% doctors rated it 4 and above. The reasons identified were lack of confidentiality, lack of privacy, lack of time, lack of training, fear of patients' and family reactions, not wanting to hurt the patient or causing more distress, concern of having failed the patient, and their own reactions among others. Conclusions: Technical proficiency, training, good patient-centered communication, and incorporating socio-cultural aspects are essential for effective disclosure of bad news. [ABSTRACT FROM AUTHOR]

Communication is a crucial tool in all forms of interaction. The medical world without communication is inconceivable. Guided by Austin's speech act theory, this work explores how doctors relay bad news in the form of infertility diagnoses in a reproductive health clinic in Kenya and the responses of male patients to this news. It is a qualitative study in a public health facility in Nakuru town in Nakuru County, Kenya. The two male patients recruited for this study were willing to participate without payment or coercion. The conversation on reproductive health problems between the doctor and male patients was collected using participant observation. The diagnosis of male infertility can be a significant source of distress for male patients as it challenges traditional perceptions of masculinity. Similar locutionary and illocutionary acts can elicit very different perlocutionary acts. An utterance, once made, cannot be altered, nor can its effect. A man's emotional response to an infertility diagnosis is profound and irreversible. Bad news in a reproductive health clinic includes male infertility diagnoses, a condition that impacts the masculine identity of a man and threatens his entire existence. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Effective communication is a critical and fundamental element of a successful medical practice and exerts a substantial influence on patient contentment, adherence, and disease outcome. This study was planned to identify domains for improvement in doctor–patient communication to enhance good practices in the future. Methods: A cross-sectional study was carried out involving 500 randomly selected samples of clinicians from government or private medical colleges across India. Data collection about current communication practices was carried out using google questionnaire forms and analysed. Results: Among the practitioners, there were 315 males and 185 females. The average time spent on patients' consultation is 9.8 minutes. Nearly 80% of doctors do not introduce themselves to the patients, while half of the doctors consistently employ the patient's name throughout discussion. The majority (82.8%) of the doctors listen to the patients attentively and showed empathy and positive attitude towards them. The maximum number of the doctors (55%) check that they comprehend what the patient explains about the disease, explain the need of prescribed tests (78%), and inform the result of the examination to the patient (68.8%). Approximately half of the study participants did not discuss the advantages and disadvantages of given treatments, but 78% of them agreed to do so in the future. More than half of clinicians schedule patient interviews to break unpleasant news. The majority of the doctors (60.8%) communicate the future treatment strategy and prognosis to patients. Conclusion: Overall, a positive attitude was observed; however, a few domains that needed improvements were discussing awareness of the disease, advantages and disadvantages of treatment, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Background Bad news refers to any information that create negative changes in a person’s understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. Methods This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. Results The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). Conclusion According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.

Objective: In this study, it was aimed to make a validity and reliability study by adapting the questionnaire on communicating bad news to be used to evaluate the knowledge and skills of nurses and midwives in breaking bad news.Methods: The questionnaire adaptation study was carried out in a gynecology and obstetrics hospital between 15/05/2022 and 15/012/2022. The questionnaire was translated into Turkish and then expert opinion was obtained. Cronbach's alpha coefficient was used for the reliability of the questionnaire. The stability of the questionnaire over time was evaluated by test-retest. For the purpose of construct validity of the questionnaire, exploratory factor analysis was used. SPSS 17.00 and AMOS programs were used for the validity and reliability analyzes of the questionnaire. Results: The Cronbach Alpha value of the 21-items final version of the questionnaire (n=262) was 0.87. Intraclass Correlation Coefficient value was 0.95 (n=21) and Cronbach's alpha coefficient was 0.97 (P

Background: Bad news refers to any information that create negative changes in a person's understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. Methods: This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. Results: The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). Conclusion: According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN. [ABSTRACT FROM AUTHOR]

Objectives: Receiving bad news about one's health can be devastating, yet little is known about how the therapeutic nature of the environment where bad news is delivered affects the experience. The current study aimed to explore how patients and their families were affected by the language and the built, natural, social, and symbolic environments when receiving bad news, through the Therapeutic Landscapes theoretical framework. Methods: Patients diagnosed with a life-limiting illness living in regional Victoria who had a hospital admission within 24 months and a diagnostic/prognostic conversation were invited to participate, as well as a family member who witnessed the conversation. Participants were recruited through social media and snowballing, resulting in 14 online semi-structured interviews being conducted between November 2021 and March 2022, audio-recorded, and transcribed verbatim. Reflexive thematic analysis was used to develop the themes. Results: Fourteen semi-structured interviews were conducted with women aged between 30 and 77 years. Interviews lasted between 45 and 120 minutes, with an average of 69 minutes, and were conducted online or via mobile phone. Four central themes were developed: "Hearing bad news for the first time," "Preferences for having hard conversations," "Creating a sense of safety for ongoing care," and "The therapeutic nature of the ward." Significance of results: This body of work will help inform practice and future policy regarding bad news delivery and the design and aesthetics of environments where bad news is delivered. It is essential that bad news is delivered within a quiet, calm, and emotionally safe environment within a supportive therapeutic relationship. [ABSTRACT FROM AUTHOR]

We investigate how executive pay disparity affects insider profits around earnings news. Our findings reveal that high pay disparity is linked to higher abnormal returns from insider purchases before positive news, suggesting insiders exploit good news for greater gains. Conversely, it is associated with lower abnormal returns from insider sales before negative news, indicating less benefit from such sales. These insights highlight the influence of pay disparity on insider trading and underscore the importance of understanding this dynamic to improve decision-making and reduce misuse of insider information. [ABSTRACT FROM AUTHOR]

Purpose: Determine if the SPIKES method was associated with less distress and more compassion than current modes of delivering negative pregnancy test results to patients undergoing in vitro fertilization. Methods: Twenty-seven nurses from two centers were randomized to use the modified SPIKES script or continue their standard of care; 136 patients with a negative hCG following embryo transfer were included. SPIKES nurses received 1 h of training by a study psychologist; nurses in the control group were instructed to deliver the news as done previously. Patients who underwent embryo transfer and received a call by a participating nurse with a negative test result received an email invitation on the following day. Results: Control patients reported significantly less distress than SPIKES patients; 33% of SPIKES patients reported that they had felt "extremely sad," compared to 15.2% of the control patients (p = 0.01). Perceived compassion did not differ between the groups (all p ≥ 0.22). Conclusion: Patients who received a negative pregnancy test result from the nurses who received a brief training and a script on how to deliver bad news via the modified SPIKES protocol reported significantly more distress than patients receiving negative results from nurses utilizing their standard of care. It is unclear whether a modified SPIKES method to deliver negative pregnancy test results will benefit patients undergoing in vitro fertilization. Trial registration: Clinical trials.gov NCT04917445. [ABSTRACT FROM AUTHOR]

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Introduction: The COVID-19 pandemic has exposed health professionals to conditions of increased stress, traumatic stress and depression, thereby reducing their resilience in treating patients with serious health problems, as well as in communication. In this environment, it is important to investigate the factors that influence nurses' attitudes towards informing patients who have serious or life-threatening illnesses. Aim: The aim of this study is to investigate the factors that influence nurses' attitudes towards informing patients who have serious or life-threatening illnesses. Material and Methods: One hundred thirty four nurses and assistant nurses of KAT hospital participated in the present synchronous research. A questionnaire was used for the data collection that included demographic / social characteristics, and 4 tools (scale of psychological empowerment-PEI, scale of physicians 'attitude towards informing patients, scale of physicians' attitude towards informing cancer patients, CD-RISC-10) . Data analysis was performed using SPSS 21. Results: Relatively high level of resilience (average 27.9, mean 6.38) and psychological empowerment (average 46,029, mean 7.41) was found. Regarding the three sub-scales of the WHO model: the sub-scale of truth disclosure, had a relatively high level (average 5.94, S.D.1.25), the sub-scale of concealment of truth had medium level (average 5.02, S.D.1,36), and the sub-scale personalized information with high level (average 6.86, S.D.1,009). Regarding the correlations, statistical significance was found (p:, 025) between the sub-scale Hidden Truth and Communication (<0.05), between the sub-scale Personalized Information and Communication (<0.01). In addition, statistical significance was found between Durability and Strengthening (<0.01). Conclusions: According to the objectives of the present study, the results showed the following: (a) nurses have a relatively high level of resilience, psychological empowerment and attitude in communication (for serious, chronic diseases), which highlights the special requirements of the nursing profession (b) personalized information is influenced by the attitude of nurses in communication (for serious & chronic diseases), and also, the work department of the nurse affects the disclosure and concealment of the truth in communication with the patient, and the position The nurse's responsibility affects the concealment of the truth when communicating with the patient about serious illnesses. However, new research on the subject of the present study needs to be conducted. Thus, it is proposed in the future to conduct a similar primary research with a larger sample and change the WHO measurement tool (or its extension), since it cannot work reliably due to its small size. [ABSTRACT FROM AUTHOR]

In today's globalizing economy, the importance of timely and accurate financial reporting has become more crucial than ever. These reports provide a detailed insight into a company's financial health and performance, offering critical information to investors, creditors, and other relevant parties to make informed decisions. While determining the publication timing of financial reports, strategies are set based on the weight of good and bad news. Companies tend to announce positive news quickly, especially during open market periods, to support their corporate reputation and boost the confidence of shareholders and potential investors. On the other hand, companies might be inclined to withhold or announce bad news during closed market periods to minimize or delay negative market reactions. Through these strategies, firms aim to create either a positive or negative impact on shareholders and investors and control the effect of news most efficiently. The purpose of this study is to examine whether the timing of financial reporting varies depending on firm characteristics. Logistic regression analysis was conducted using data from 2345 observation obtained from companies traded on Borsa Istanbul between 2009 and 2019. The results of the study indicate that firm characteristics such as firm size and financial leverage have a significant effect on whether financial reports are announced on weekdays or weekends. These findings reveal that the timing strategies in financial reporting can vary depending on certain characteristics of the firm. Notably, they highlight that when deciding how and when to announce positive or negative news, companies consider both their own characteristics and market conditions. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionsAfter stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients’ experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback.This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback.The analysis revealed the clinician’s interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician’s misjudged response to the patient’s aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit.Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation.IMPLICATIONS FOR REHABILITATIONAfter stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients’ psychological wellbeing and engagement in rehabilitation.After stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients’ psychological wellbeing and engagement in rehabilitation. [ABSTRACT FROM AUTHOR]

Effective communication is an important aspect of providing quality healthcare. Radiology staff may be called upon to communicate results, even when it is difficult. Simple, efficient communication models can be learned to reduce clinician distress and support patients and families through stressful times. These practical tips ensure essential communication elements are met, including assessing patient and family perspectives, clearly delivering medical information, responding with empathy, and collaborating around next steps. Models such as "Ask-Tell-Ask," "SPIKES," and "NURSE" can be used to disclose results, communicate serious news, and respond to emotion. Lastly, clinicians can also utilize "I wish... I worry... I wonder" statements to align with a patient's hopes and acknowledge a family's concerns, ultimately allowing healthcare professionals to support and guide families through challenging situations. [ABSTRACT FROM AUTHOR]

Conveying bad news in the medical field, can present a challenging scenario as it tends to evoke emotional responses such as sadness, anxiety, and anger in the recipients. Essentially, this communication scenario holds the potential to impact the recipient, aligning with the concept of perlocutionary speech acts. Research into perlocutionary speech acts in the context of delivering adverse news within medical communication has not been extensively explored. This study aims to provide an overview of perlocutionary speech acts observed in delivering bad news within a medical context, as depicted in The Resident series. Employing a qualitative research design, this study applied a pragmatic approach for data analysis. The dataset for this study comprises the dialogues of doctors in 11 distinct contexts involving the communication of bad news in The Resident series. The results of the study showed that perlocutionary speech acts appeared in the context of delivering bad news, including the act of asking for confirmation, calming, explaining, informing, suggesting, and convincing. Additionally, these speech acts incite various emotional responses in the recipients, including sadness, anger, self-blame, panic, surprise, and calm. The outcomes of this research serve as a valuable reference for enhancing communication skills and pragmatic competence among healthcare professionals when confronted with the task of conveying bad news.

Medical communication skills are learned during undergraduate studies and residency programmes by future doctors through case presentations, medical interviews, and healthcare staff interactions. Approaches like peer tutoring, simulation-based education, and blended learning enhance these skills. Our study aims to draw attention to the significance of doctor-patient and doctor-doctor scenarios by presenting a course that facilitates sociopragmatic, pragmalinguistic, and code-switching skills that medical students need to successfully employ in future healthcare settings. We consider patient information, case presenting, and interviewing skills, as well as profound knowledge of medical language equally important elements. While highlighting the essential components of the doctor-patient discourse and revealing the students’ development of code-switching abilities, this article shares the results of a feedback survey completed by participants in a course entitled ‘History taking with actors; simulation practices in the mediskillslab’. We can see the gradual improvement in using medical terms, and the growing confidence of students presenting cases. The programme’s assessment approach, which provides constructive feedback from three perspectives—clinician, simulated patient, and communication instructor—helps the students pinpoint their areas for enhancement. Most students report no major difficulties in taking medical history by employing a simplified ‘patient-friendly’ language understandable to laypeople. However, when they intentionally choose a different code for reporting on their patients by using medical terms, younger students face challenges in creating a brief medical text. The most demanding task for senior participants proved to be delivering bad news; both emotionally and code-switch wise. Our study identifies these difficulties from history-taking simulations to case reports to raise awareness of levels of medical communication. As a conclusion, we believe that an early onset and gradual introduction of activities including history taking, case presentation, and breaking bad news should be incorporated into medical curricula to assist in the acquisition of highly professional, assertive, and empathetic communication skills by graduation.

Background: While surgery is generally necessary for most solid-organ cancers, curative-intent resection is occasionally aborted due to unanticipated unresectability or occult metastases. Following aborted cancer surgery (ACS), patients have unique and complex care needs and yet little is known about the optimal approach to their management. Objective: The aim of this study was to define the practice patterns and perspectives of an international cohort of cancer surgeons on the management of ACS. Methods: A validated survey assessing surgeon perspectives on patient care needs and management following ACS was developed. The survey was distributed electronically to members of the Society of Surgical Oncology (SSO). Results: Among 190 participating surgeons, mean age was 49 ± 11 years, 69% were male, 61% worked at an academic institution, and most had a clinical practice focused on liver/pancreas (30%), breast (23%), or melanoma/sarcoma cancers (20%). Participants estimated that ACS occurred in 7 ± 6% of their cancer operations, most often due to occult metastases (67%) or local unresectability (30%). Most surgeons felt (very) comfortable addressing their patients' surgical needs (92%) and cancer treatment-related questions (90%), but fewer expressed comfort addressing psychosocial needs (83%) or symptom-control needs (69%). While they perceived discussing next available therapies as the patients' most important priority after ACS, surgeons reported avoiding postoperative complications as their most important priority (p < 0.001). While 61% and 27% reported utilizing palliative care and psychosocial oncology, respectively, in these situations, 46% noted care coordination as a barrier to addressing patient care needs. Conclusions: Results from this SSO member survey suggest that ACS is relatively common and associated with unique patient care needs. Surgeons may feel less comfortable assessing psychosocial and symptom-control needs, highlighting the need for novel patient-centered approaches. [ABSTRACT FROM AUTHOR]

Medical communication skills are learned during undergraduate studies and residency programmes by future doctors through case presentations, medical interviews, and healthcare staff interactions. Approaches like peer tutoring, simulation-based education, and blended learning enhance these skills. Our study aims to draw attention to the significance of doctor-patient and doctor-doctor scenarios by presenting a course that facilitates sociopragmatic, pragmalinguistic, and code-switching skills that medical students need to successfully employ in future healthcare settings. We consider patient information, case presenting, and interviewing skills, as well as profound knowledge of medical language equally important elements. While highlighting the essential components of the doctorpatient discourse and revealing the students' development of code-switching abilities, this article shares the results of a feedback survey completed by participants in a course entitled ‘History taking with actors; simulation practices in the mediskillslab’. We can see the gradual improvement in using medical terms, and the growing confidence of students presenting cases. The programme's assessment approach, which provides constructive feedback from three perspectives—clinician, simulated patient, and communication instructor—helps the students pinpoint their areas for enhancement. Most students report no major difficulties in taking medical history by employing a simplified ‘patient-friendly’ language understandable to laypeople. However, when they intentionally choose a different code for reporting on their patients by using medical terms, younger students face challenges in creating a brief medical text. The most demanding task for senior participants proved to be delivering bad news; both emotionally and code-switch wise. Our study identifies these difficulties from history-taking simulations to case reports to raise awareness of levels of medical communication. As a conclusion, we believe that an early onset and gradual introduction of activities including history taking, case presentation, and breaking bad news should be incorporated into medical curricula to assist in the acquisition of highly professional, assertive, and empathetic communication skills by graduation. [ABSTRACT FROM AUTHOR]

This study investigates the relation between the disclosure of corporate social responsibility (CSR) bad news and reputation. In particular, our analysis focuses on the moderating effect that such disclosure may have on corporate reputation. A large and growing number of studies in the CSR accounting literature provides empirical evidence supporting the argument that CSR disclosure – which has been criticized for its self-laudatory style – may serve as a reputation management tool used to camouflage a company's image among stakeholders, hence protect its reputation. These studies suggest that an optimistically biased reporting may enhance reputation. However, recent research in the financial accounting area shows that a non-or less-optimistically biased reporting may actually have positive effects on the credibility of the information disclosed. Therefore, the paper argues that the disclosure of CSR-related bad news could be beneficial and turn into better reputation. Based on data from a sample of the most visible companies in the US, this study shows that the disclosure of bad CSR news may have positive reputational outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Due to the high prevalence of adverse events during pregnancy and childbirth, the present study was conducted as a narrative review study investigating the challenges of disclosing bad news in the midwifery field and various intervention approaches for teaching bad news. Method: This study is in the form of a narrative review and by searching Persian and English databases including Medline, PubMed, Embase, Web of Science, Scopus, CINAHL, IRANDOC, Google Scholar, Iranmedex, medlib, Sid, and Mag-Iran with key Words including bad news, midwifery, childbirth, pregnancy, spikes (S-P-I-K-E-S), midwifery education were conducted in the time range of 1990-2022. Finally, 20 quantitative and qualitative articles were included in the research. Results: These articles were examined in two areas: the challenges of health personnel in conveying bad news and different strategies for teaching how to convey bad news. In studies, various techniques have been used to teach the delivery of bad news, such as Spikes protocol, ABCDE method, simulated patient or Mini-CEX, in the teaching of delivery of bad news in various fields of obstetrics, such as IVF failure, intrauterine death, etc. have been. The use of clinical encounter cards or CECs, Asci tests and Mini-CEX are techniques that were used to evaluate students. Conclusion: Proper transmission of bad news is one of the challenges of healthcare personnel. Using appropriate educational techniques for students and medical personnel can reduce the negative consequences of inappropriate transmission of bad news.

Alebel Guangul Gessesse,1 Jemal Mohammed Haile,2 Amanuel Gebru Woldearegay3 1Department of Journalism and Communication, Dilla University, Dilla, Ethiopia; 2Departments of Journalism and Communication, Bahir Dar University, Bahir Dar, Ethiopia; 3School of Journalism and Communication, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Alebel Guangul Gessesse, Tel +251-910922903, Email alebelg@du.edu.etIntroduction: Delivering Bad News (DBN) presents a highly challenging situation in physician-patient communication. This study aims to gain insight into the various communication strategies employed by physicians when DBN.Methods: This qualitative study conducted thematic analysis of in-depth interviews. Physicians from two comprehensive hospitals with large patient populations were selected purposively based on their engagement in delivering bad news to patients. Thematic analysis was made.Results: Thematic analysis of the data revealed several communication strategies physicians use when delivering bad news. These communication strategies include. Jointly Initiated Physician-Patient Communication Strategies: ((i) Discussing with patient family/caregivers, (ii) Collaborating with other physicians and specialists), Patient-Engaged/Led Communication Strategies: ((iii) Investigating with adolescents alone or without the family, (iv) Helping patients predict what the news is, (v) Identifying patients’ emotions related to bad news, (vi) Assessing patients’ level of understanding, (vii) Minimizing patient anxiety), Physician-Related Communication Strategies: ((viii) Making sure diagnostic results are accurate, (xi) Identifying causes for rejection, (x) deliveringbad news using clear and simple communication).Conclusion: Delivering bad news to patients can be challenging for physicians. It is important to be clear and accurate, and to prepare patients for the news. Patients may feel more comfortable and open when they are unaccompanied and with their healthcare provider. The study concluded that physicians need to be prepared to deliver bad news in a sensitive and effective manner.Keywords: bad news, communication strategies, communication, patient, physicians

Nine studies investigate when and why people may paradoxically prefer bad news—for example, hoping for an objectively worse injury or a higher-risk diagnosis over explicitly better alternatives. Using a combination of field surveys and randomized experiments, the research demonstrates that people may hope for relatively worse (vs. better) news in an effort to preemptively avoid subjectively difficult decisions (studies 1 and 2). This is because when worse news avoids a choice (study 3A)—for example, by "forcing one's hand" or creating one dominant option that circumvents a fraught decision (study 3B)—it can relieve the decision-maker's experience of personal responsibility (study 3C). However, because not all decisions warrant avoidance, not all decisions will elicit a preference for worse news; fewer people hope for worse news when facing subjectively easier (vs. harder) choices (studies 4A and B). Finally, this preference for worse news is not without consequence and may create perverse incentives for decision-makers, such as the tendency to forgo opportunities for improvement (studies 5A and B). The work contributes to the literature on decision avoidance and elucidates another strategy people use to circumvent difficult decisions: a propensity to hope for the worst. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What do fertility staff and patients think is bad news in fertility care? SUMMARY ANSWER Staff and patients agree bad news is any news that makes patients less likely to achieve parenthood spontaneously or access and do successful treatment, but their appraisals of how bad the news is are differently influenced by specific news features and the context of its delivery. WHAT IS KNOWN ALREADY Bad news is common in fertility care, but staff feel unprepared to share it and four in 10 patients react to it with unanticipated emotional or physical reactions. Research has paid much attention to how bad news should be shared, but considerably less to what news is perceived as bad, despite the fact this may dictate elements of its delivery. STUDY DESIGN, SIZE, DURATION Two cross-sectional, online, mixed-method surveys (active 7 January–16 July 2022) were distributed to fertility staff and patients across the UK and Europe. PARTICIPANTS/MATERIALS, SETTING, METHODS Staff inclusion criteria were being a healthcare professional working in fertility care and having experience of sharing bad news at least once a month. Patients' inclusion criteria were being adults and having had a conversation in which staff shared or explained bad news concerning their fertility care within the last 2 months. Surveys were created in English using Qualtrics, reviewed by patients and healthcare professionals, and distributed via social media, Prolific, fertility organizations, and scientific societies. Patients were asked, regarding the last time bad news were shared with them, 'What was the bad news?' and 'What other news would you consider bad news in fertility care?'. Staff were asked to 'List the three most challenging topics of bad news you share with your patients'. Staff and patient data were separately thematically analysed to produce basic codes, organized into sub-themes and themes. Themes emerging from patients' and staff data were compared and synthesized into meta themes. MAIN RESULTS AND THE ROLE OF CHANCE Three hundred thirty-four staff accessed the survey, 286 consented, and 217 completed (65% completion rate). Three hundred forty-four patients accessed the survey, 304 consented, and 222 completed (64% completion rate). Eighty-five percent of participants were women, 62% resided in Europe, and 59% were in private care. Average staff age was 45.2 (SD = 12.0), 44% were embryologists or lab technicians, 40% were clinicians (doctors, consultants, or physicians), and 8% nurses or midwifes. Average patient age was 32.2 (SD = 6.4) and 54% had children. Staff answers originated 100 codes, 19 sub-themes and six themes. Patients' answers produced 196 codes, 34 sub-themes, and 7 themes. Staff and patient themes were integrated into three meta-themes reflecting main topics of bad news. These were Diagnosis and negative treatment events and outcomes, Inability to do (more) treatment, and Care and patient factors disrupting communication. Staff and patients agreed that some news features (uncertain, disruptive, definitive) made news more challenging but disagreed in relation to other features (e.g. unexpected/expected). Patient factors made bad news more challenging to staff (e.g. difficult emotions) and care factors made bad news more challenging to patients (e.g. disorganized care). LIMITATIONS, REASONS FOR CAUTION Participants were self-selected, and most were women from private European clinics. Questions differed for staff and patients, focused on subjective perceptions of news, and did not measure news impact. WIDER IMPLICATIONS OF THE FINDINGS The badness of fertility news is not only a product of the extent to which the news compromises parenthood goals but also of its features (timing, nature, number) and the context in which the news is delivered. Guidance on sharing bad news in fertility care needs to go beyond easing the process for patients to also consider staff experiences. Guidance may need to be tailored to news features and context. STUDY FUNDING/COMPETING INTEREST(S) Cardiff University funded the research. S.G. J.B. O'.H. and A.D. report funding from the Higher Education Funding Council for Wales and the European Society for Human Reproduction and Embryology (ESHRE) to develop fertiShare: a sharing bad news eLearning course for fertility care. fertiShare will be distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). No other conflicts are reported in relation to this work. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objectives: Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a “bad news” consultation using the consultation and relational empathy (CARE) measure. Methods: A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the “bad news” group, or the “neutral/good news” group along with information about the patient and the consultation. The patient was given the CARE measure after the visit. Results: The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11min longer. Conclusions: Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient. [ABSTRACT FROM AUTHOR]

This article investigates the dissipation speed of positive and negative news in a geopolitical context. We perform a sentiment analysis of geopolitical news and measure the gamma of the corresponding sentiment scores per time unit in order to compare the travel speed of news with positive sentiment scores with news having negative sentiment scores. While prospect theory suggests that bad news is perceived as more impactful than good news, we show that this does not necessarily hold for the travel speed of news. On the contrary, we find that good news linked to keywords, which have usually a negative association, travel faster than bad news, and vice versa; a seeming repudiation of folk wisdom. Since our use cases were geopolitical crises, we associate phrases connected with conflict or the potential for conflict to have a broadly negative association. The implications of our insights suggest that the dissipation speed of news can be improved by framing and releasing positive news about events or entities with a negative association. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the quality of receiving bad news (BN) for women diagnosed with cervical neoplasia. We evaluated adherence to the SPIKES protocol in three cohorts of women with different stages of the disease and treatment modalities. Patients and methods: We included women with cervical cancer who underwent radical vaginal trachelectomy (RVT group, n = 110), radical hysterectomy or chemo-radiation (HE/RCT group, n = 101), and women with CIN 3 treated by loop excision (CIN group, n = 108). We asked the participants about how they received the bad news delivery in reality and how they would envision an ideal communication process based on the main items of the SPIKES protocol. The participants filled out a questionnaire with 38 items of the Marburg Breaking Bad News (MABBAN) Scale representing the six SPIKES subscales. Results: Only 72% of all patients reported being satisfied with their BBN experience. The following factors were considered important by 90% of the patients: an undisturbed atmosphere, taking enough time, coherent explanation of the disease, and the possibility to ask questions. However, the reality of their experiences fell significantly short of their expectations. Asking about the patient's knowledge of the disease, addressing their concerns, allowing them to show emotions, providing clarity about the change in quality of life, informing them about alternative therapies, and involving them in further planning were also significantly lacking in the actual BBN encounters compared to the patients' preferences. The experience of RVT patients was more negative compared to the HE/RCT patients (p = 0.036). The CIN patients had an overall satisfactory impression (p < 0.0001). Conclusion: The process of breaking bad news in German women diagnosed with cervical neoplasia requires substantial improvement. The SPIKES protocol can be used as a guideline for enhancement but should be supplemented by incorporating a second consultation as the norm rather than the exception. Continuous monitoring and improvement of the quality of BBN is recommended for all oncologic institutions, utilizing the MABBAN questionnaire as a valuable tool. [ABSTRACT FROM AUTHOR]

Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity. [ABSTRACT FROM AUTHOR]

This article demonstrates four principal results. First, returns from an investing strategy based on prior news are driven by future news that reinforces the prior news. This result provides additional nuance to the literature showing that momentum returns occur due to underreaction to news. Second, returns are higher, on average, for firms with bad news in the prior period than for firms with no news in the prior period. While markets initially under-adjust to bad news, there is an increased expectation that there will be bad news in the next period (albeit not high enough), so that negative news in the next period is less costly, positive news in the next period is more profitable, and no news in the next period is akin to good news. Third, returns for firms with two prior periods of bad news or with more thorough bad news are higher than for other firms with bad news. The rationale is that repeated bad news or more thorough bad news convinces investors that the bad news is "real" and results in the market more fully pricing the bad news. Fourth, the market's response to a given period's news is a function of prior periods' news. [ABSTRACT FROM AUTHOR]

This study aims to reveal the organization of negative business messages preferred by higher education students while receiving messages from university parties. The participants are the vice-chancellors for finance and academic affairs or the representatives (heads of divisions) at three private universities within the Association of Catholic Higher Learning Institutions as the senders and 170 active students in several universities as the receivers. This study uses quantitative and qualitative descriptive approaches. I collected data through online questionnaires, semistructured interviews, and observation of written documents in email and WhatsApp. I proposed four essential dimensions of negative message, namely, organization/approach, language, medium, and response, with the Likert scale questionnaire. I also inserted two cases of negative messages at the end of the questionnaire to find students’ tendency to select one they liked. The questionnaire results are used to discover the participants’ preference for the approach of relaying negative messages, corroborated by the interviews. The study found that students preferred direct approach to negative business messages. Buffers, prevalent in negative business with indirect order, are found in the email. A positive tone was not found at the end of the message. The study concluded that negative messages should be conveyed in writing with direct organizations and positive language and addressed to students before being forwarded to their parents [ABSTRACT FROM AUTHOR]

BACKGROUND: Nurses have the most contact with COVID-19 patients and their families, while it is unclear how nurses react when they give bad news during pandemic disaster, particularly in the cultural and social context of Iran. So, our main purpose was to explore the experiences of clinical nurses about breaking bad news (BBN) in the context of the COVID-19 epidemic era. MATERIALS AND METHOD: The study was a qualitative content analysis approach. Data were collected by the purposive sampling method through in-depth interviews with 13 nurses in Isfahan University of Medical Sciences. The method of data analysis was conventional qualitative content analysis. RESULTS: The participants of this study were 13 nurses. The work experience range was from 2 to 18 years, and in terms of education, one of them was Ph.D., eight had a bachelor’s degree education, and four had a master’s degree in nursing. Qualitative data of content analysis were obtained in four main categories such as nurses’ avoidance of BBN, considering the patient’s and family’s beliefs in BBN, nurses’ unpreparedness to deliver bad news during the pandemic crisis, and surrender of the patient and family members in the face of the COVID-19 bad news. CONCLUSION: The results of the research showed that due to probability of occurrence of pandemic in the futureand also the nature of the nursing profession, so nurses should be familiar with the correct ways of BBN and existing protocols on crisis conditions and cultural and religious context of the society to provide a high quality of care for patients and their families.

Copyright of Contemporary Accounting Research is the property of Canadian Academic Accounting Association 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.)

Using hand-collected data for 2007-2008, we show that using the notice-only option to deliver proxy materials is an effective way to influence proxy voting outcomes in favor of the management. Firms performing poorly, firms with high CEO pay, and firms restating earnings are more likely to choose the notice-only option. In the subsequent year, notice-only firms experience lower stock returns and a drop in analysts' earnings forecasts, consistent with that real economic factors drive the choice of the notice-only option. Overall, our findings suggest that the managers strategically use proxy delivery methods to control the negative impact of bad news. [ABSTRACT FROM AUTHOR]

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.

Objectives: Disclosure of bad news is distressing for patients and family members. Our aim was to assess patients' perceptions and preferences regarding bad news in the health setting. Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A sample size of 1673 patients and family members was used. Ethics permission/consent was taken from each participating hospital and participant. Responses were compared across provinces, gender, age, education and income. Results: >80% patients preferred their relatives to know the diagnosis first and they wanted the news to be disclosed to them by doctors. Significant association between education level, income and preference for wanting to know the diagnosis was found. Reasons for wanting to know the diagnosis included treatment, prognosis and prevention options whereas reasons for not wanting to know included fear of emotions and God's will. Conclusion: The majority of Pakistani patients want to be informed and want the family to know first. Preferences for disclosure vary across, age, education and income level. Innovation: First countrywide study on this topic. Identifies need for culturally sensitive guidelines that include the family's role in disclosure of bad news.

This paper studies how the human capital embedded in rank-and-file employees affects firms' stock price crash risk. Employing a unique setting in China where we measure human capital using employee information at the firm level, we show that human capital quality improves firms' internal information environments, curbs bad-news hoarding and overinvestment, leading to lower stock price crash risk. The findings are robust to instrumental variable regressions. Our study highlights the internal informational role of human capital and sheds light on its implications for capital markets and outside investors. Therefore, we contribute to the literature on the interaction between non-shareholding stakeholders and shareholders. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. Background: In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Method: Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Results: Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." Conclusions: A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards. [ABSTRACT FROM AUTHOR]

Introduction: Due to the high prevalence of adverse events during pregnancy and childbirth, the present study was conducted as a narrative review study investigating the challenges of disclosing bad news in the midwifery field and various intervention approaches for teaching bad news. Method: This study is in the form of a narrative review and by searching Persian and English databases including Medline, PubMed, Embase, Web of Science, Scopus, CINAHL, IRANDOC, Google Scholar, Iranmedex, medlib, Sid, and Mag -Iran with key Words including bad news, midwifery, childbirth, pregnancy, spikes (S-P-I-K-E-S), midwifery education were conducted in the time range of 1990 -2022. Finally, 20 quantitative and qualitative articles were included in the research. Results: These articles were examined in two areas: the challenges of health personnel in conveying bad news and different strategies for teaching how to convey bad news. In studies, various techniques have been used to teach the delivery of bad news, such as Spikes protocol, ABCDE method, simulated patient or Mini -CEX, in the teaching of delivery of bad news in various fields of obstetrics, such as IVF failure, intrauterine death, etc. have been. The use of clinical encounter cards or CECs, Asci tests and Mini -CEX are techniques that were used to evaluate students. Conclusion: Proper transmission of bad news is one of the challenges of healthcare personnel. Using appropriate educational techniques for students and medical personnel can reduce the negative consequences of inappropriate transmission of bad news. [ABSTRACT FROM AUTHOR]

The larger association between earnings and contemporaneous returns for negative returns than for positive returns is often attributed to conditional conservatism. We reason that this asymmetry may also be driven by the lack of timeliness with which stock price incorporates bad news relative to good news. Consistent with our reasoning, we show that when stock price incorporates bad news with delay, the asymmetry can exist in the absence of conditional conservatism. This suggests the testable hypothesis that the asymmetry decreases (increases) with factors that facilitate (impede) the incorporation of bad news into stock price. Using stock liquidity to test this hypothesis, we find that the earnings-return asymmetry decreases as stock liquidity increases. Our findings support the view that variation in the earnings-return asymmetry also reflects variation in the quality of the return generation process. Data Availability: Data are available from public sources cited in the text. JEL Classifications: G14; G40; M4; M40; M41. [ABSTRACT FROM AUTHOR]

Background: Stroke is a prevalent neurological disease that can have a profound impact on women's physical, psychosocial, and spiritual well-being. In many cases, women living with stroke may have marginalized palliative care needs that are often not adequately addressed by healthcare providers. Unfortunately, the experience of women with stroke and their specific palliative care needs have been largely overlooked in research conducted in Jordan. Aim: The purpose of this study is to examine the specific palliative care needs of women who have experienced a stroke and are currently living in Jordan. By conducting this research, we aim to identify the various physical, emotional, social, and spiritual needs of women with stroke and gain a better understanding of how these needs can be addressed through palliative care interventions. Methods: This research utilized a phenomenological descriptive study approach to explore the experiences of twelve women recruited from the outpatient clinic of rehabilitation centers. The data was collected through semi-structured interviews. The analysis was conducted using the method of Colaizzi (1978), which involves identifying significant statements, extracting meanings, and formulating an exhaustive description of the phenomenon under study. Results: The study findings uncovered three primary themes that reflect the palliative care needs of women who are currently living with stroke in Jordan, including (1) Spiritual practices, beliefs, and needs; (2) Coping with distressing symptoms; and (3) Managing the delivery of unfavorable news. Discussion: This study provides valuable insights into the experiences of Jordanian women living with stroke, highlighting the far-reaching consequences of this condition on various aspects of their lives. The findings reveal that stroke has a significant impact on women's physical, emotional, social, and spiritual well-being, with many facing unmet palliative care needs. By illuminating these challenges, our study underscores the importance of taking a holistic approach to stroke care that addresses the multifaceted needs of women living with stroke. Healthcare providers must consider these findings and integrate palliative care interventions into treatment plans to improve the quality of life of women living with stroke in Jordan. Conclusion: This study provides valuable insights into the palliative care needs of women who have experienced a stroke. Our findings highlight the importance of addressing women's physical, psychosocial, and spiritual needs as part of a comprehensive approach to stroke care. We recommend integrating palliative care interventions into rehabilitation programs to improve the quality of life of women living with stroke in Jordan. By doing so, we can address the pain and complications that can arise from stroke, while also providing holistic support to address the emotional and spiritual impact of the illness. This approach has the potential to improve outcomes for women living with stroke and enhance their overall well-being. [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]

Copyright of Journal of Accounting Knowledge is the property of Shahid Bahonar University of Kerman, Faculty of Management & Economics 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.)

Copyright of Al-Qadisiah Medical Journal is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) 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.)