HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE COVER ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a letter to the editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content

NEWS & VIEWS

PATIENTS REPORT DOCTORS DO A GOOD JOB AT A DIFFICULT TIME

Study shows doctors are sensitive to patient needs when relaying bad news.

In a survey answered by 120 recently diagnosed patients regarding the 50 physicians who informed them of their diagnosis, researchers found that patients felt most of the doctors were doing all they could to make it as easy as possible for them.

Issues the survey addressed included the doctors' behavior, the environment in which the news was discussed, and the language used to give the bad news. J. T. Ptacek, PhD, and John J. Ptacek, MD, of the Department of Psychology, Bucknell University, and the Department of Radiation Oncology, Mary Greeley Medical Center, respectively, reported their results in the Journal of Clinical Oncology (2001;19:4160-4164).

	Most Doctors Did All the Right Things

TOP Most Doctors Did All... Determinants of Patient...

 
Almost all of the patients who responded, reported that their doctors paid close attention to the do's and don'ts generally recommended for this situation. For example, more than 90 percent of the doctors:

• Chose a quiet, comfortable, and private setting.
  
• Delivered the news in person.
  
• Used direct and simple language.
  
• Broke the news in a way that the patient understood its implications.
  
• Delivered the news in a warm and caring manner.
  
• Conveyed some measure of hope.
  
• Gave the patient a chance to ask questions.
  
• Were sensitive to how the patient was feeling.
  

More than 80 percent of the patients answered yes to questions about whether their doctors:

• Made sure there were no inter-ruptions during the session.
  
• Chose his or her words carefully.
  
• Gave the patient an opportunity to express his or her feelings.
  
• Seemed to think about the patient's needs during the interaction.
  

	Determinants of Patient Satisfaction Studied

TOP Most Doctors Did All... Determinants of Patient...

 
In addition to a description of how frequently physicians followed recommendations such as these, researchers asked patients to rate their overall satisfaction with the bad news interactions, and performed statistical tests to identify factors patients associated with a high satisfaction rating.

Affirmative responses to the following were significantly and positively associated with patient satisfaction:

• "The place where I received the news was comfortable."
  
• "The doctor made sure there were no interruptions while s/he broke the news."
  
• "The doctor sat close to me."
  
• "The doctor let me know in words that bad news was forthcoming."
  
• "The doctor tried to empathize with what I was feeling."
  

Answering no to the following was a significant predictor of feelings of low patient satisfaction:

• "As the doctor delivered the news, s/he seemed to struggle to find the right words."
  
• "The doctor rushed through the news."
  

While most of the patients reported that their doctors followed these tips, researchers found that there was still some room for improvement. Patients whose doctors sat nearby as they relayed the diagnosis were 2.88 times more likely to be satisfied than were patients whose physicians did not, but only 60.7 percent of physicians did so. Telling the patient in advance that bad news was forthcoming increased satisfaction 6.57-fold, but this was done in only 58.4 percent of encounters. Thus, comparing data on what patients appreciate in this situation with what doctors actually do provides useful information on ways to improve this process.

According to the authors, "...care should be taken not to generalize too far beyond this specific sample [from a single Midwestern clinic]." Nonetheless, the significance of this issue should be clear—"... good communication and high satisfaction with one's health care providers are associated with increased compliance, better emotional adjustment, and a reduced likelihood of litigation."

This Article Full Text (PDF) Submit a letter to the editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content