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Table 2 Category.- How to give bad news

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

Subcategory: issuers and receivers of bad news
Verbatim
OBST S4 : “A woman who is pregnant always expects everything to go well, that the delivery will go well and that a healthy baby will be born; anything that goes wrong is bad news”.
MID S2 : “Unexpected information that causes sadness and pain and provokes a change in your life”.
MID S1 : “Something that doesn’t fit what you had expected, that spoils plans and means you have to adapt to a new situation”.
OBST S17 : “The doctor is the person who can and should communicate bad news”.
NASST S8 : “The news has to be given by the doctor and we are there to provide support”.
MID S4 : “Ideally, there should be a multidisciplinary team, including nurses and, if possible, a psychotherapist”.
NUR S3 : “Although the doctor gives the news, nurses are also involved, because the patients ask us to clarify what they don’t understand”.
OBST S9 : “Obviously, you have to tell the patient and her partner, if there is one, and then assess the advisability of informing the family”.
OBST S2 : “According to the rules on patient autonomy, the patient must always be told, and we assume that whoever is with her can also receive the news”.
NUR S2 : “The patient must be informed because she is the one who is pregnant”.
MID S2 : “It is very important that the information should also be received by someone the patient trusts (…)”
Subcategory: what bad news is communicated and how
Verbatim
NASST S6 : “(...) miscarriages, foetal malformations, syndromes, foetal heart disease, proposal to interrupt the pregnancy”.
NUR S3 : “In the ward, we have patients who decide to abort because of a diagnosis of severe malformation or chromosomal alteration”.
MID S12 : “Very often, non-viable pregnancies, anomalies detected by ultrasound scan, antepartum deaths, intrauterine growth problems”.
OBST S8 : “There is no magic formula. Usually the news is given little by little so that the information can be assimilated, but this does not always work, and for some patients it is very painful. Although for others, telling it all at once can be devastating (...)”
OBST S13 : “(...) using the same means seen to be successful when done by more experienced colleagues”.
MID S3 : “You create your own style, by doing it over and over again”.
OBST S13 : “(...) I prefer to be totally frank. Sometimes, only when you say that the foetus is dead or that its situation is incompatible with life does the patient realise the gravity of the news”.
NUR S3 : “We try to take into account the patient’s socio-cultural level, but we often forget and use too much medical jargon”.
NASST S4 : “(...) we aren’t very close to the patients, we don’t take their hands, we don’t give them a hug, we avoid looking directly into their eyes, we focus on filling in the report, on the computer and on the ultrasound scan”.
Subcategory: optimum environmental conditions when bad news must begiven
Verbatim
NUR S1 : “Somewhere private, without interruptions, separated from the maternity area, comfortable and with sufficient natural light”.
OBST S13 : “(...) knocking at the door, people coming in and out, telephones ringing continually”.
MID S2 : “The intentions are good, but there is no area specially equipped for this purpose. We try to assign a single room for a pregnancy termination, but it is not always possible”.
Subcategory: the evolution of carer-patient communication
Verbatim
OBST S8 : “We always have to bear in mind the question of the medical professional’s legal defence. The social situation makes this inevitable, but it makes it very difficult to provide personalised, direct treatment”.
NUR S2 : “Consent forms, signatures in duplicate, the next appointment with another healthcare professional ... all of this greatly interferes with the doctor-patient relationship”.
OBST S6 : “We pay more attention to the diagnostics, we’ve gained in technological capabilities and lost in human quality”.
Subcategory: the role of nursing staff, according to the physician
Verbatim
OBST S11 : “The nurses provide very important support; they help us convey the message we want the patient to receive”.
OBST S1 : “They can provide support, but diagnosis is the doctor’s job and we have to communicate the message, even if we don’t like it”.
OBST S12 : “(...) nurses spend many hours at the patient’s bedside, so they are well aware of the patient’s fears and expectations”.
Subcategory: strategy and summary
Verbatim
OBST S16 : “The extra time you give to one patient is time you’re taking away from another. Ideally, an appointment should be made for another day”.
NASST S7 : “Patients are seen again at the end of the consultation, to answer their questions”.
OBST S14 : “At the end of the interview I do not have enough time for the patient to repeat everything I have explained to her and check if she has understood me”.
Subcategory: setting of the intervention
Verbatim
OBST S10 : “With experience, you usually know what to do, but patients can ask unpredictable questions that you have to address on the spot”.
OBST 16 : “Prior awareness or otherwise of the diagnosis and of the time available determines whether the talk to the patient can be prepared or must be improvised”.
OBST S13 : “Inadequate training in communication is a handicap, making it hard to adapt the discourse to meet all the patient’s needs”.
  1. OBST Obstetrician, MID Midwife, NUR Nurse, NASST Nursing assistant