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Table 3 Category.- Communication skills

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

Subcategory: training in the communication of bad news
OBST S14 : “In the 2nd year at university, we did workshops on doctor-patient communication, but little else in the 6 years spent in the faculty.”
OBST S12 : “During the first year of residency, we had a course on the doctor-patient relationship, in which we discussed the quality of care and the communication of bad news. But nothing since then.”
NUR S3 : “(...) I’ve had training in helping and in the humanisation of care, but that was a few years ago.”
MID S3 : “Every year we offer a course on how to respond to perinatal grieving, but hardly any of the medical staff take it.”
OBST S13 : “We would need to learn communicative techniques and skills through role playing and recordings of our own interventions, and then analyse them.”
MOBST S1 : “(...) we need advice from a psychotherapist, and medical team sessions to make our criteria consistent.”
➣Desirable qualities in the person who must transmit bad news:
OBST S11 : “Sensitivity and humanity, I think.”
OBST S12 : “Empathy with the patient and showing self-assuredness in what you have to convey.”
OBST S6 : “Having sufficient knowledge of pathology, of what can and can’t be done, and time in which to carry out possible solutions.”
NASST S1 : “Closeness, putting yourself in the patient’s place and speaking in terms that she can understand.”
Subcategory: the ability to explore psycho-social issues
ASST S7 : “This isn’t examined. Some patients will say they’ve had a stressful experience, but the doctor doesn’t go into this question, there isn’t time.”
OBST S2 : “(...) that isn’t examined. I honestly don’t know what kind of inquiry might be made. If the patient has problems of this type, she usually tells you herself.”
MID S2 : “The psychological and social aspects aren’t considered due to our feelings of insecurity. We make the excuse that we don’t have time, but it depends to a great extent on each individual’s attitude and personal interest in the matter.”
MID S4 : “Unless the patient tells you spontaneously (although you might intuitively sense it), you don’t usually go into these areas, you only address the physical side.”
Subcategory: responding to the patient’s emotions
NASST S1 : “You don’t have the knowledge or skills to deal with certain problems and the easiest thing to do is to avoid them. Without specific and continuous training in the necessary areas, we can’t offer patients comprehensive quality care.”
OBST S3 : “We don’t have time. To respond properly we’d need a specialised consultation, with the presence of a psychologist.”
➣Counselling strategies and Models of resilience:
OBST S4 : “... yes, I’d recommend it, but to help in all these areas, right now I don’t have the tools, nor do we schedule appointments to assess the patient’s evolution, how she’s coping with the bad news or accepting it.”
OBST S1 : “I don’t know what these strategies consist of.”
MAT S4 : “What we do is listening, and little else. The patients go home, basically, with nothing.”
Language barriers:
OBST S2 : “There are language barriers, especially with the Chinese and Arab populations, and this makes you anxious.”
  1. OBST Obstetrician, MID Midwife, NUR Nurse, NASST Nursing assistant