Onkologische Aufklärungsgespräche: Zufriedenheit und Anforderungen - Eine Längsschnittbetrachtung -
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Philipps-Universität Marburg
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Abstract
Breaking Bad News (BBN) challenges clinicians both professionally and personally on a regular basis. Only a few German-language studies are available that assess satisfaction of BBN consultations and the patient's needs during such an encounter. Little is known about the change to which factors influence the assessment of satisfaction and whether communicative needs during such a conversation vary over time.
The present study aimed to measure satisfaction with bad news consultations, capture the impacts on emotional well-being and to portray communication preferences taking into account temporal and patient-related factors.
For this purpose, patients with a new-onset tumor disease and undergoing inpatient treatment at Marburg University Hospital were asked to participate in the study from October 2014 to September 2016. The study design chosen was a quantitative longitudinal study based on a questionnaire. Patients were interviewed shortly after the BBN disclosure (t0), again after six months (t1) and once more after twelve months (t2) within the observation period. The two follow up surveys were aimed at capturing possible changes over time in communication needs, in rating of satisfaction with the bad news delivery, and in factors influencing the rating behavior.
At the first survey point (t0) 139 oncological patients could be interviewed. At this time, the consultation had taken place no more than four weeks previously. It could be shown that the majority of patients (69.4%) rated their satisfaction with the bad news conversation in the upper range between 7-10 points with a mean value of 7.06 (Likert scale 0-10). Higher satisfaction was significantly related to the length of the BBN encounter. In this study, female participants indicated a notable higher satisfaction than male participants.
For the longitudinal analysis, survey data from 50 patients was available. Satisfaction with the BBN delivery was rated very similarly over the three surveys – there was no evidence that rating behavior was influenced by the time passed since the BBN delivery.
In a further step, we investigated whether the patient's current state of health at the time of the survey had an influence on the assessment of the BBN disclosure. It was found that the assessment of satisfaction measured at the survey point t2 was not significantly influenced by the physical or mental condition at that time. Rather, the assessment of satisfaction at survey point t2 was most strongly predicted by the earlier assessment of satisfaction at survey point t0.
Merely the current relation to clinicians was an additional, but weaker predictor of reassessment.
There was no significant relation between the overall satisfaction with the BBN delivery and the emotional state in the days after the disclosure. Again, the time span since the BBN encounter had no effect on the investigated correlation.
In addition to looking at patient satisfaction, this study evaluated communication preferences for the BBN conversation at different survey points after the disclosure. At all survey points, patients expressed strong interest in clear and understandable communication to explain the diagnosis, the expected course of the disease and possible treatment options. Furthermore, the physician providing the information should be emotionally supportive and allow the patient to express his or her feelings and have a say in the therapeutic steps.
The longitudinal study was able to show that patient preferences and the ranking in terms of the importance of categories remained the same throughout the entire survey period. It became clear that the creation of an appropriate framework (setting) is of the highest relevance for BBN conversations. In essence, this involves the news-bearer taking sufficient time for the conversation, providing for an undisturbed atmosphere, explaining details of the disease in an understandable way, and ensuring the consent of the patient.
This study identifies the resource "time" as playing an important role for BBN disclosures: First, the need for "sufficient time for the conversation" is part of the highest rated category “Setting”. Second, it could be shown that satisfaction with the conversation significantly correlated with the length of the conversation. In practice, this means that creating adequate (time) framework conditions alone could lead to a significantly higher satisfaction with BBN disclosures.
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Created: 2023Issued: 2023-05-02Updated: 2023-05-02
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Onkologische AufklärungsgesprächeBBN Oncology patient needs satisfaction
DFG-subjects
Aufklärungsgespräche Patientenbedürfnisse Zufriedenheit Krebserkrankung
DDC-Numbers
610
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Möller, Daniel: Onkologische Aufklärungsgespräche: Zufriedenheit und Anforderungen - Eine Längsschnittbetrachtung -. : Philipps-Universität Marburg 2023-05-02. DOI: https://doi.org/10.17192/z2023.0310.