Doctors' knowledge, practices, challenges, and limitations regarding disclosure of bad news: A multicentre study from Pakistan.

IF 1.1 Q4 PRIMARY HEALTH CARE Journal of Family Medicine and Primary Care Pub Date : 2024-12-01 Epub Date: 2024-12-09 DOI:10.4103/jfmpc.jfmpc_374_24
Asma Usman, Sameena Shah, Samar Zaki, Kashmira Nanji, Sobiya Sawani, Saher Naseeb Uneeb, Naseem Bari, Obaid Ullah, Sumera Abid
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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.

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医生关于披露坏消息的知识、实践、挑战和限制:来自巴基斯坦的一项多中心研究。
背景:对于执业医生来说,发布坏消息是最困难的任务之一,特别是对于那些在医疗保健专业工作的人来说,在这些专业中,危及生命的疾病是常规诊断和管理的。我们的目的是引出医生的知识和实践,并确定他们在巴基斯坦各省披露坏消息时面临的障碍。方法:在巴基斯坦15家政府和私立医院的外部资助下进行横断面、多中心研究。共有1185名医生接受了调查。对各省的反应进行了比较。结果:在所有专业中,80%的医生认为癌症和中风等危及生命的诊断是坏消息,而不到50%的医生认为疟疾和伤寒等疾病是坏消息。关于在0到6分的范围内说出坏消息的困难程度,超过57%的医生认为它在4分以上。确定的原因是缺乏保密,缺乏隐私,缺乏时间,缺乏培训,害怕病人和家人的反应,不想伤害病人或造成更多的痛苦,担心让病人失望,以及他们自己的反应。结论:技术熟练,培训,良好的以患者为中心的沟通,并结合社会文化方面是有效披露坏消息的必要条件。
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