Family physicians' opinions on and difficulties with breaking bad news

José António Ferraz Gonçalves; Carla Almeida; Joana Amorim; Rita Baltasar; Joana Batista; Yusianmar Borrero; João Pedro Fallé; Igor Faria; Manuel Henriques; Helena Maia; Teresa Fernandes; Mariana Moreira; Susana Moreira; Camila Neves; Ana Ribeiro; Ana Santos; Filipa Silva; Susana Soares; Cristina Sousa; Joana Vicente; Rita Xavier

doi:10.1016/j.pbj.2017.04.004

Family physicians' opinions on and difficulties with breaking bad news

Porto Biomed J. 2017 Nov-Dec;2(6):277-281. doi: 10.1016/j.pbj.2017.04.004. Epub 2017 May 22.

Authors

José António Ferraz Gonçalves¹, Carla Almeida², Joana Amorim³, Rita Baltasar⁴, Joana Batista⁵, Yusianmar Borrero⁶, João Pedro Fallé⁷, Igor Faria⁸, Manuel Henriques⁹, Helena Maia¹⁰, Teresa Fernandes¹¹, Mariana Moreira¹², Susana Moreira¹³, Camila Neves¹⁴, Ana Ribeiro¹⁵, Ana Santos¹⁶, Filipa Silva¹⁷, Susana Soares¹⁸, Cristina Sousa¹⁹, Joana Vicente²⁰, Rita Xavier²¹

Affiliations

¹ Portuguese Institute of Oncology, Palliative Care, Porto, Portugal.
² Unidade de Saúde Familiar Famílias, Santa Maria da Feira, Portugal.
³ Unidade de Saúde Familiar Santa Clara, Póvoa de Varzim/Vila do Conde, Portugal.
⁴ Unidade de Saúde Familiar Santa Maria, Bragança, Portugal.
⁵ Unidade de Saúde Familiar Terras de Ferreira, Paços de Ferreira, Portugal.
⁶ Unidade de Saúde Familiar Lethes, Ponte de Lima, Portugal.
⁷ Unidade de Saúde Familiar Lagoa - Senhora da Hora, Matosinhos, Portugal.
⁸ Unidade de Saúde Familiar Gil Eanes, Viana do Castelo, Portugal.
⁹ Unidade de Saúde Familiar Ramalde, Aldoar, Porto, Portugal.
¹⁰ Unidade de Saúde Familiar Porta do Sol, Matosinhos, Portugal.
¹¹ Unidade de Saúde Familiar Infesta, Matosinhos, Portugal.
¹² Unidade de Saúde Familiar Mar, Póvoa de Varzim/Vila do Conde, Portugal.
¹³ Unidade de Saúde Familiar Arco do Prado, Gaia, Portugal.
¹⁴ Unidade de Saúde Familiar São Mamede Infesta, Matosinhos, Portugal.
¹⁵ Unidade de Saúde Familiar Oceanos, Matosinhos, Portugal.
¹⁶ Unidade de Saúde Familiar São João, Porto, Portugal.
¹⁷ Unidade de Saúde USF Nova Lousada, Lousada, Portugal.
¹⁸ Unidade de Saúde Familiar São Martinho, Penafiel, Portugal.
¹⁹ Unidade de Saúde Familiar Renascer, Gondomar, Portugal.
²⁰ Unidade de Saúde Familiar Macedo de Cavaleiros, Macedo de Cavaleiros, Portugal.
²¹ Unidade de Saúde Familiar Aldoar, Porto, Portugal.

Abstract

Highlights: Breaking bad news is still deemed a difficult task by family physicians.Family physicians feel they need training in breaking bad news.The family physicians' attitude to this issue is different from what they would wish if they themselves had a life-threatening disease.

Background: Family practice is the specialty with the highest number of doctors and covers all of Portugal. Therefore, the attitude of these doctors may have a high impact on patients.

Objective: To explore the opinion and difficulties of Portuguese family doctors on dealing with communication with patients with life threatening diseases.

Methods: A questionnaire was sent to about 10% of family doctors of Northern Portugal. The questionnaire included questions about the disclosure of information, if they feel they need training courses and what they would want if they had a life-threatening disease.

Results: A questionnaire was given to 196 doctors and 159 (81%) participated in this study. The median age was 43 years (26-64) and 108 (68%) were females. One hundred thirty-five (85%) consider that breaking bad news is a difficult task. One hundred twenty-four (78%) feel they need training in breaking bad news. For many doctors, the disclosure of diagnoses and prognoses has a detrimental psychological effect and affects patients' hope, but gives patients' control of the situation. Given a situation where the doctors themselves had a life-threatening disease, the vast majority would want to know the diagnosis and the prognosis and to participate in treatment decisions.

Conclusions: Breaking bad news is still a difficult task. Their attitude to this duty is different from what they would wish if they themselves had a life-threatening disease. One important conclusion is the need of specific training in communication for family physicians that should begin in the training phase of their specialty.

Keywords: Breaking bad news; Diagnosis disclosure; Family physicians; Prognosis disclosure.