Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Reproductive Health
Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Research

Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study

Authors: José Atienza-Carrasco, Manuel Linares-Abad, María Padilla-Ruiz, Isabel María Morales-Gil

Published in: Reproductive Health | Issue 1/2018

Login to get access

Abstract

Background

To consider the thoughts and actions of healthcare personnel in situations when an adverse prenatal diagnosis must be communicated, including appropriate strategies and skills to respond to information needs and to manage the emotional responses of patients.

Methods

Descriptive qualitative study using non-participant observation and semi-structured interviews to analyse the discourses of physicians, midwives, nurses and nursing assistants who provide healthcare to obstetric patients.

Results

There may be barriers to effective communication between healthcare personnel and patients, depending on the characteristics of the persons involved, the organisation of healthcare, biotechnological progress and cultural factors.

Conclusions

The human quality of healthcare has deteriorated due to excessive workloads and to the growing role played by technology. In order to improve communication, more attention should be paid to human and spiritual dimensions, prioritising empathy, authenticity and non-judgmental listening. An appropriate model of clinical relationship should be based on shared decision making, clarifying the functions of the multidisciplinary team to alleviate a mother’s suffering when a pregnancy is interrupted. To do so, protocols should be implemented to ensure the provision of comprehensive care, not only addressing biological issues but also providing psychosocial attention. Finally, training should be provided to healthcare staff to enhance their social skills and cultural competence.
This study identifies potential improvements in the interventions made by healthcare personnel and in the organisation of the institution, concerning the attention provided to pregnant women when an adverse prenatal diagnosis must be communicated.
Footnotes
1
The superscripts correspond to the authors who have made this part of the methodology.
 
Literature
1.
M. Rodriguez de Alba, A. Bustamante-Aragones, S. Perlado, M. J. Trujillo-Tiebas, J. Diaz-Recasens, J. Plaza-Arranz, y C. Ramos, Noninvasive prenatal diagnosis of monogenic disorders. Expert Opin Biol Ther, vol. 12 Suppl 1, pp. S171-S179, jun. 2012.
2.
L. Butalid, J. M. Bensing, y P. F. M. Verhaak, «Talking about psychosocial problems: an observational study on changes in doctor-patient communication in general practice between 1977 and 2008.», Patient Educ Couns, vol. 94, n.o 3, pp. 314-321, mar. 2014.
3.
F. A. Derksen, T. C. Olde Hartman, J. M. Bensing, y A. L. Lagro-Janssen, «Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.», The British journal of general practice : the journal of the Royal College of General Practitioners, vol. 66, n.o 653, pp. e887-e895, dic. 2016.
4.
R. M. Epstein y R. L. J. Street, «Shared mind: communication, decision making, and autonomy in serious illness.», Ann Fam Med, vol. 9, n.o 5, pp. 454-461, 2011.
5.
R. L. J. Street, G. Makoul, N. K. Arora, y R. M. Epstein, «How does communication heal? Pathways linking clinician-patient communication to health outcomes.», Patient Educ Couns, vol. 74, n.o 3, pp. 295-301, mar. 2009.
6.
J. K. Rao, L. A. Anderson, T. S. Inui, y R. M. Frankel, «Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence.», Med Care, vol. 45, n.o 4, pp. 340-349, abr. 2007.
7.
O. Barr, H. Skirton, «Informed decision making regarding antenatal screening for fetal abnormality in the United Kingdom: a qualitative study of parents and professionals.», Nursing & health sciences, vol. 15, n.o 3, pp. 318-325, sep. 2013.
8.
A. L. Greiner, J. Conklin, «Breaking bad news to a pregnant woman with a fetal abnormality on ultrasound.», Obstetrical & gynecological survey, vol. 70, n.o 1, pp. 39-44, ene. 2015.
9.
J. Hodgson, P. Pitt, S. Metcalfe, J. Halliday, M. Menezes, J. Fisher, C. Hickerton, K. Petersen, y B. McClaren, «Experiences of prenatal diagnosis and decision-making about termination of pregnancy: a qualitative study.», Aust N Z J Obstet Gynaecol, vol. 56, n.o 6, pp. 605-613, dic. 2016.
10.
R. Simpson y R. Bor, «‘I’m not picking up a heart-beat’: experiences of sonographers giving bad news to women during ultrasound scans.», The British journal of medical psychology, vol. 74 Part 2, pp. 255-272, jun. 2001.
11.
R.-L. Van Keer, R. Deschepper, A. L. Francke, L. Huyghens, y J. Bilsen, «Conflicts between healthcare professionals and families of a multi-ethnic patient population during critical care: an ethnographic study.», Critical care (London, England), vol. 19, p. 441, dic. 2015.
12.
K. Sweeny, J. A. Shepperd, y P. K. J. Han, «The goals of communicating bad news in health care: do physicians and patients agree?», Health expectations : an international journal of public participation in health care and health policy, vol. 16, n.o 3, pp. 230-238, sep. 2013.
13.
L. Fallowfield y V. Jenkins, «Communicating sad, bad, and difficult news in medicine.», Lancet (London, England), vol. 363, n.o 9405, pp. 312-319, ene. 2004.
14.
R. R. Wallace, S. Goodman, L. R. Freedman, V. K. Dalton, y L. H. Harris, «Counseling women with early pregnancy failure: utilizing evidence, preserving preference.», Patient Educ Couns, vol. 81, n.o 3, pp. 454-461, dic. 2010.
15.
J. Halpern, «Empathy and patient-physician conflicts.», J Gen Intern Med, vol. 22, n.o 5, pp. 696-700, may 2007.
16.
L. Martin, J. T. Gitsels-van der Wal, M. T. R. Pereboom, E. R. Spelten, E. K. Hutton, y S. van Dulmen, «Clients’ psychosocial communication and midwives’ verbal and nonverbal communication during prenatal counseling for anomaly screening.», Patient Educ Couns, vol. 99, n.o 1, pp. 85-91, ene. 2016.
17.
M. Driessnack, V. D. Sousa, y I. A. C. Mendes, «An overview of research designs relevant to nursing: part 2: qualitative research designs.», Rev Lat Am Enfermagem, vol. 15, n.o 4, pp. 684-688, 2007.
18.
Guba EG, Lincoln YS. Competing paradigms in qualitative research. Thousand Oaks: The handbook of qualitative research. CA: Sage; 1994.
19.
M. Pla, "Rigor in qualitative research", Aten Primaria, vol. 24, n.o 5, pp. 295-300, 1999.
20.
Taylor R, Bogdan S.J. Introduction to qualitative research methods. The search for meanings. Barcelona: Ed. Paidós; 1987.
21.
N. Carter, D. Bryant-Lukosius, A. DiCenso, J. Blythe, y A. J. Neville, «The use of triangulation in qualitative research.», Oncol Nurs Forum, vol. 41, n.o 5, pp. 545-547, sep. 2014.
22.
D. Meitar, O. Karnieli-Miller, y S. Eidelman, «The impact of senior medical students’ personal difficulties on their communication patterns in breaking bad news.», Academic medicine : journal of the Association of American Medical Colleges, vol. 84, n.o 11, pp. 1582-1594, nov. 2009.
23.
F. Delevallez, A. Lienard, A.-S. Gibon, y D. Razavi, «[Breaking bad news in oncology: the Belgian experience].», Revue des maladies respiratoires, vol. 31, n.o 8, pp. 721-728, oct. 2014.
24.
C. Burgers, C. J. Beukeboom, y L. Sparks, «How the doc should (not) talk: when breaking bad news with negations influences patients’ immediate responses and medical adherence intentions.», Patient Educ Couns, vol. 89, n.o 2, pp. 267-273, nov. 2012.
25.
A. Gesser-Edelsburg y N. A. E. Shahbari, «Decision-making on terminating pregnancy for Muslim Arab women pregnant with fetuses with congenital anomalies: maternal affect and doctor-patient communication.», Reprod Health, vol. 14, n.o 1, p. 49, abr. 2017.
26.
A. Herrera, M. Rios, J. M. Manriquez, y G. Rojas, «[Breaking bad news in clinical practice].», Rev Med Chil, vol. 142, n.o 10, pp. 1306-1315, oct. 2014.
27.
N. H. M. Labrie y P. J. Schulz, «Exploring the relationships between participatory decision-making, visit duration, and general practitioners’ provision of argumentation to support their medical advice: results from a content analysis.», Patient Educ Couns, vol. 98, n.o 5, pp. 572-577, may 2015.
28.
J. G. Lalor, D. Devane, y C. M. Begley, «Unexpected diagnosis of fetal abnormality: women’s encounters with caregivers.», Birth (Berkeley, Calif), vol. 34, n.o 1, pp. 80-88, mar. 2007.
29.
M. Brann y J. J. Bute, «Communicating to promote informed decisions in the context of early pregnancy loss.», Patient Educ Couns, vol. 100, n.o 12, pp. 2269-2274, dic. 2017.
30.
J. Shaw, R. Brown y S. Dunn, «The impact of delivery style on doctors’ experience of stress during simulated bad news consultations.», Patient Educ Couns, vol. 98, n° 10, pp. 1255-1259, oct. 2015.
31.
P. M. Moore, S. Rivera Mercado, M. Grez Artigues, y T. A. Lawrie, «Communication skills training for healthcare professionals working with people who have cancer.», The Cochrane database of systematic reviews, no. 3, p. CD003751, mar. 2013.
32.
A. P. Jacques, E. J. Adkins, S. Knepel, C. Boulger, J. Miller, y D. P. Bahner, «Educating the delivery of bad news in medicine: Preceptorship versus simulation.», International journal of critical illness and injury science, vol. 1, n.o 2, pp. 121-124, jul. 2011.
33.
M. L. Bascunan, «[Truth disclosure in medicine: psychological perspective].», Rev Med Chil, vol. 133, n.o 6, pp. 693-698, jun. 2005.
34.
W. F. Baile, R. Buckman, R. Lenzi, G. Glober, E. A. Beale, y A. P. Kudelka, «SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer.», Oncologist, vol. 5, n.o 4, pp. 302-311, 2000.
35.
K. R. Monden, L. Gentry, y T. R. Cox, «Delivering bad news to patients.», Proc (Baylor Univ Med Cent), vol. 29, n.o 1, pp. 101-102, ene. 2016.
36.
D. Armentrout y L. A. Cates, «Informing parents about the actual or impending death of their infant in a newborn intensive care unit.», The Journal of perinatal & neonatal nursing, vol. 25, n.o 3, pp. 261-267, 2011.
37.
C. Strong, «Fetal anomalies: ethical and legal considerations in screening, detection, and management.», Clin Perinatol, vol. 30, n.o 1, pp. 113-126, mar. 2003.
38.
A. Arber y A. Gallagher, «Breaking bad news revisited: the push for negotiated disclosure and changing practice implications.», Int J Palliat Nurs, vol. 9, n.o 4, pp. 166-172, abr. 2003.
39.
S. Nunez, T. Marco, G. Burillo-Putze, y J. Ojeda, «[Procedures and skills for the communication of bad news in emergency units].», Med Clin, vol. 127, n.o 15, pp. 580-583, oct. 2006.
40.
R. Norouzinia, M. Aghabarari, M. Shiri, M. Karimi, y E. Samami, «Communication barriers perceived by nurses and patients.», Global journal of health science, vol. 8, n.o 6, pp. 65-74, sep. 2015.
41.
H. Gluyas, «Effective communication and teamwork promotes patient safety.», Nursing standard (Royal College of Nursing (Great Britain) : 1987), vol. 29, n.o 49, pp. 50-57, ago. 2015.
42.
M. Omura, J. Maguire, T. Levett-Jones, T. E. Stone, «Effectiveness of assertive communication training programs for health professionals and students: a systematic review protocol.», JBI database of systematic reviews and implementation reports, vol. 14, n.o 10, pp. 64-71, oct. 2016.
43.
A. Lyndon, M. G. Zlatnik, y R. M. Wachter, «Effective physician-nurse communication: a patient safety essential for labor and delivery.», Am J Obstet Gynecol, vol. 205, n.o 2, pp. 91-96, ago. 2011.
44.
M. Schmid Mast, A. Kindlimann, y W. Langewitz, «Recipients’ perspective on breaking bad news: how you put it really makes a difference.», Patient Educ Couns, vol. 58, n.o 3, pp. 244-251, sep. 2005.
45.
F. Oflaz y H. Vural, «The evaluation of nurses and nursing activities through the perceptions of inpatients.», Int Nurs Rev, vol. 57, n.o 2, pp. 232-239, jun. 2010.
46.
G. Novick, «Women’s experience of prenatal care: an integrative review.», Journal of midwifery & women’s health, vol. 54, n.o 3, pp. 226-237, 2009.
47.
E. C. Heberlein, A. H. Picklesimer, D. L. Billings, S. Covington-Kolb, N. Farber, y E. A. Frongillo, «Qualitative comparison of Women’s perspectives on the functions and benefits of group and individual prenatal care.», Journal of midwifery & women’s health, vol. 61, n.o 2, pp. 224-234, 2016.
48.
J. C. M. Cole, J. S. Moldenhauer, K. Berger, M. S. Cary, H. Smith, V. Martino, N. Rendon, y L. J. Howell, «Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality.», Archives of women’s mental health, vol. 19, n.o 3, pp. 443-453, jun. 2016.
49.
L. T. de Beer, J. Pienaar, y S. J. Rothmann, «Work overload, burnout, and psychological ill-health symptoms: a three-wave mediation model of the employee health impairment process.», Anxiety Stress Coping, vol. 29, n.o 4, pp. 387-399, jul. 2016.
50.
S. Newell y Z. Jordan, «The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.», JBI database of systematic reviews and implementation reports, vol. 13, n.o 1, pp. 76-87, ene. 2015.
51.
G. Ferreira Padilla, T. Ferrandez Anton, y J. Baleriola Julvez, «[Informed consent versus “communicated consent” in the need to ensure a two-way doctor-patient relationship and to improve patient and doctor satisfaction].», Aten Primaria, vol. 45, n.o 4. Spain, pp. 225-226, abr-2013.
52.
F. Baena-Antequera, y E. Jurado-Garcia, «[The woman at the termination of pregnancy for fetal anomalies: clinical case].», Enferm Clin, vol. 25, n.o 5, pp. 276-281, 2015.
53.
E. Paternotte, F. Scheele, C. M. Seeleman, L. Bank, A. J. J. A. Scherpbier, y S. van Dulmen, «Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.», Perspectives on medical education, vol. 5, n.o 5, pp. 268-275, oct. 2016.
54.
H. Harmsen, L. Meeuwesen, J. van Wieringen, R. Bernsen, y M. Bruijnzeels, «When cultures meet in general practice: intercultural differences between GPs and parents of child patients.», Patient Educ Couns, vol. 51, n.o 2, pp. 99-106, oct. 2003.
55.
R. L. Sudore, C. S. Landefeld, E. J. Perez-Stable, K. Bibbins-Domingo, B. A. Williams, y D. Schillinger, «Unraveling the relationship between literacy, language proficiency, and patient-physician communication.», Patient Educ Couns, vol. 75, n.o 3, pp. 398-402, jun. 2009.
Metadata
Title
Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study
Authors
José Atienza-Carrasco
Manuel Linares-Abad
María Padilla-Ruiz
Isabel María Morales-Gil
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0454-2

Other articles of this Issue 1/2018

Reproductive Health 1/2018 Go to the issue

Research

Sexual and reproductive health behavior and unmet needs among a sample of adolescents living with HIV in Zambia: a cross-sectional study

Research

HIV status disclosure to male partners among rural Nigerian women along the prevention of mother-to-child transmission of HIV cascade: a mixed methods study

Study protocol

Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol

Research

Associations of gestational weight gain with offspring thinness and obesity: by prepregnancy body mass index

Review

Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions

Research

How can collective action between government sectors to prevent child marriage be operationalized? Evidence from a post-hoc evaluation of an intervention in Jamui, Bihar and Sawai Madhopur, Rajasthan in India