Different Preference Of Cancer Patients,Family Members,Medical Staffs And Interns Regarding Delivery Of Bad News

BACKGROUNDThe methods of delivering a bad news to a cancer patient may affect the patient's understanding of the disease,as well as their long-term psychological adaptation.A better way of breaking a bad news can reduce the patient's mental distress and increase his/her compliance with the treatment and treatment satisfaction.In line with the development of bio-Psycho-Social medical model,the healthcare outcome is not sorely defined as the cure of a disease and disease recovery,but is also referred to the patient's experience during a treatment.A rational,lawful and appropriate method of delivering the bad news to the patient is a significant care intervention to improve healthcare outcomes.In western and many other Asian countries,people have commonly recognized the importance of patients' preference of ways of cancer disclosure.In China,research on approaches of delivering a bed news to cancer patients is behind those other countries.In the past ten years,relevant research has been increasingly conducted,mainly focusing on understanding of cancer patients,their family members and healthcare professionals with regards to whether there is a need to disclose the cancer diagnosis to the patients and its influential factors.There is lack of research on the preferences of cancer patients,their family members and health professional in relation to the methods of cancer disclosure to the patients.Research instruments used in those studies were simply self-designed with poor validity and reliability.OBJECTIVE1.To understand the attitudes of cancer patients,their families,medical students and health professionals toward cancer disclose;2.To investigate the preferences of medical students in cancer disclosure and to compare their preference with the health professionals actual clinical practice;3.To study the preferences of cancer patients and their families in cancer disclosure andto compare their preferences with the health professionals' actual clinical practices4.To explore the underlying factors of the health professionals' actual practice about cancer disclosure.METHODSThis was a cross-sectional study which was carried out in four oncology units of a teriteray hospital.A survey was conducted with 216 cancer patients,242 families,124 students and 175 clinical staff members recruited using a convenience sampling method.Four questionair forms were used,including self-designed forms collecting participants' general information and their attitudes toward cancer disclosure and the Japanest Truth-telling Scale in a brief Chinese version.Statistical methods applied in data analysis included descriptive statistics for participants' general information,Chi-square for differences of preferences among different sample groups and multi-regression for underlying factors of the health professionals' clinical practice.RESULTS1.Statistically significant difference of attitude scares were found among patient families,medical students and health professionas;2.The total preference score of medical students and their scores for for the dimensions of Way of Communication,Emotional Support and Additional Information of the preference survey form were statistically significantly higher than the relevant scores for medical staff's clinical practices w(t=3.619,p<0.001,t=3.937,p<0.001;t=3.680,p<0.001;t=5.027,p<0.001;t=2.649,p<0.05).3.The health professionals were scored lower than the cancer patients and their families did in terms of the total score,way of communication,emotional support,and additional information in relation to their cancer disclosure preference(F =16.134,p<.001;F = 28.604,p<.001;F = 13.839,p<.001;F = 16.745,p<.001).Factors underlying thehealth professionals' clinical practices included,gender(p =.03)and willingness to improve the way of communication about the cancer(p=.006).CONCLUSION1.There is a marked difference in the attitude of people to their own and other people's illness,and as the cancer progresses,the patients' the family members'communication dependence on the nurse increases.2.Communication skills training is lacking in medical education in our country.Faced with the yawning gap in medical-patient preferences in truth telling,medical colleges should offer related courses.3.Multilateral effort is needed to alleviate the medical-patient tension and improve the clinical outcomes.4.A gap existed between the health professionals' clinical practice and the preferences of the cancer patients and their families.The health professionals should receive adequate training to develop their communication skills in truth telling for cancer patients their families.When designing training materials for skill development in delivering bad news to cancer patients,the well-being of cancer patients and their families must be thoroughly considered,and patient demands for information should be satisfied.5.There is a need to raise Chinese people's awareness in relation to truth telling.Attention needs to be paid on two asepcts.Firstly,patients need to be aware of their autonomy;and secondly health professionals are required to be aware of patients'need in relation to truth telling and to develop communication skills required for delivering bad news to the patients.