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Doctors' strategies when breaking bad news to terminally ill cancer patients
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of LAH/Linnéa.ORCID iD: 0000-0002-9606-3238
Karolinska Institutet, Stockholm.
2003 (English)In: Journal of Palliative Medicine, ISSN 1096-6218, Vol. 6, no 4, 565-574 p.Article in journal (Refereed) Published
Abstract [en]

Breaking bad news to patients with a terminal disease is a difficult task for physicians. The aim of this study was to study how doctors perceive their strategies when giving information to cancer patients about discontinuing active tumour treatment. Thirty doctors with different demographic characteristics working with patients with cancer in Sweden participated. Semistructured interviews were conducted and analyzed using a qualitative phenomenographic method. The goal when giving this information was described as making the patient understands while being as considerate as possible. However, the strategies for reaching this goal were different: (1) explaining and convincing information, (i.e., giving a long explanation about why treatment has to be discontinued); (2) softening the impact of the information, with the doctor recommending discontinuation of treatment; (3) and preparing either the patient or the physician himself/herself for the information; (4) adapting or tailoring the information to the patient, with the doctor actively seeking knowledge about the patient in order to be able to adapt the information to the patient's level, or with the doctor briefly describing the situation and then remaining silent, allowing room for the patient's reactions and questions (i.e., letting the patient take an active part). When giving information, the doctors' goal was to make patients understand, but the strategies differed depending on the context.

Place, publisher, year, edition, pages
2003. Vol. 6, no 4, 565-574 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13727DOI: 10.1089/109662103768253678OAI: oai:DiVA.org:liu-13727DiVA: diva2:21213
Available from: 2002-05-24 Created: 2002-05-24 Last updated: 2015-06-10
In thesis
1. Crossing the border: Different ways cancer patients, family members and physicians experience information in the transition to the late palliative phase
Open this publication in new window or tab >>Crossing the border: Different ways cancer patients, family members and physicians experience information in the transition to the late palliative phase
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Information in the transition to the late palliative phase is not a well-studied area, especially not from the perspective of patients and family members. The aim of this thesis was to describe how cancer patients, family members and physicians experience information during the transition from a curative or early palliative phase to a late palliative phase, i.e. when tumour-specific treatment could not be offered. Cancer patients (n=30) admitted to palliative hospital based home care, family members (n=20) of cancer patients, and physicians (n=30) working with cancer patients in different settings were included in order to create a maximum variation sampling.

Tape-recorded, semi-structured interviews and qualitative, phenomenographic analyses were done in all the studies.

Patients described the physician as an expert (study I), an important person during this event, despite characterising him/her in different ways ranging from the empathetic professional to the rough and ready expert. Their relationship with the physician was also stressed. Their own resources, i.e. a sense of well being, a sense of security and individual strength, and their previous knowledge, were important components regarding their ability to take part in the communication (study II). Patients interpret words and phrases carefully and can perceive them as forewarnings, as being emotionally trying, and as fortifying and strengthening (study III). The overall message could be interpreted as either focused on quality if life, on treatment or on death and threat.

Family members wanted to protect the patient during this period and could be very active and prominent in their protective role (study IV). However, other family members described themselves as being in the background more or less involuntarily. Family members also felt that there were expectations regarding their behaviour, either that they should take over in terms of communication, or that they should restrict their participation. When giving information, the physicians had a clear goal - to make the patient understand while being as considerate toward the patient as possible. However, the strategies for reaching this goal differed and included: explaining and convincing, softening the impact and vaguely suggesting, preparing and adapting. Some physicians had a main strategy while others mixed different strategies depending on the context.

The experience of receiving and providing information about discontinuing tumour specific treatment is like crossing a border, where patients experience the behaviour of the physician and the words they express of great significance. Family members assume the role of protectors. Physicians use different strategies in order to help patients cross the border.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 68 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 727
Keyword
communication, information, patient-physician relationship, family, prognosis, palliative care, cancer
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5231 (URN)91-7373-166-8 (ISBN)
Public defence
2002-04-26, Fornborgen, Vrinnevisjukhuset, Norrköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of the article II was: In press and the title was: Patient interpretation of verbal expressions when given information about ending cancer treatment.; the status of article V was: Submitted.Available from: 2002-05-24 Created: 2002-05-24 Last updated: 2015-06-10Bibliographically approved

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Friedrichsen, MariaStrang, Peter

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