The event of breaking bad news is a subject that no one present in the practical setting could choose to avoid. It is a subject that the practitioners comes in touch with during a daily basis. Traditionally the role as the breaker of bad news has been settled by the physician, but at the time being, disagreements occur in the clinical setting about who should break bad news to familys and patients. Aim: The aim of this study was to explore the nurses’ experiences of breaking bad news. What are the nurses’ role in the event of breaking bad news, and are there any barriers that can affect the way the bad news is given to the patients and family members? These were two questions of issue that were looked into. Method: The integrative review method based out of Whittemore and Knafl (2005) was used for this review. A systematic search resulted in twelve articles that were deemed fitting for the purpose of this study. Results: This integrative review resulted in five identified roles carried out by the nurse in the event of breaking bad news. Further on, nine factors were identified as being of significance in how the bad news were delivered by nurses and received by patients and the patient’s family members. Nurses expressed a desire and a wish for some kind of education or training in how to break bad news. Conclusion:  This article contributes with five roles experienced by nurses, along with nine different factors to have in mind when carrying out difficult news. The SPIKE model and Gibbs reflective model were discussed to have a great importance in the clinical setting.

Le projet ANR ACORFORMed, dans lequel s’inscrit cette thèse, a pour objectif la création (par des informaticiens) d’un agent conversationnel animé « patient » comme outil de formation à l’annonce, par la simulation et à l’aide d’un environnement virtuel. A l’aide de la méthodologie issue des études de la gestuelle et des apports de la littérature sur l’organisation des interactions, nous tentons de répondre à la question suivante : quelle est l’organisation structurelle globale de l’interaction patient-médecin, lorsque ce dernier se forme à l’annonce d’un dommage associé aux soins ? Les analyses menées dans cette thèse nous permettent de décrire l’interaction patient/médecin lors de formations à l’annonce en proposant différentes phases composants l’interaction, ainsi que des précisions quant à leur découpage et leurs articulations. Elles constituent une base indispensable et utilisable par les informaticiens pour concevoir et implémenter un agent conversationnel « patient » crédible qui pourra être utilisé dans la formation des médecins. Située au coeur d’un projet interdisciplinaire, cette thèse en linguistique permet donc de transposer les pratiques interactionnelles des médecins en vue de l’implémentation d’un agent virtuel par des informaticiens. / The ACORFORMed ANR project, in which this PhD project is integrated, aims at the creation (by computer scientists) of a "patient" animated conversational agent as a training tool for announcing, simulating and using a virtual environment. Using the methodology resulting from gestures studies and contributions of the literature on the organisation of interactions, we try to answer the following question: what is the overall structural organisation of the doctor/patient interaction, when this last is training to break the news of a damage associated with care? The analyses carried out in this thesis allow us to describe the doctor/patient interaction during training to break the news by proposing different phases that make up the interaction, as well as details about their division and their articulations. They are an indispensable and usable base for computer scientists to design and implement a credible "patient" conversational agent that can be used in physician training. Located at the heart of an interdisciplinary project, this thesis in linguistics makes it possible to transpose the interactional practices of physicians with a view to the implementation of a virtual agent by computer scientists.

Contexte. Objectifs principaux : explorer l’expérience vécue vécu des neurologues et des patients des annonces de mauvaises nouvelles dans la sclérose en plaques, le vécu de la pathologie ainsi que de la qualité de leur relation dans le contexte du suivi d’un projet thérapeutique, et d’envisager la création d’un outil clinique réflexif pour les neurologues destiné à contribuer au maintien d’une relation de qualité durant l’ensemble du parcours de soins. Méthodologie. Étude qualitative multicentrique ; analyse des verbatims : 63 entretiens cliniques de recherche - 35 patients et 20 entretiens - 20 neurologues ; 3 entretiens - relecture d’items ; triangulation méthodologique ; triangulation des observateurs/résultats ; analyse IPA et analyse clinique d’orientation psychodynamique. Résultats. Les annonces de mauvaises nouvelles dans la SEP sont vécues comme des expérience anxiogènes pour la majorité des neurologues de la recherche, des situations source de frustration et parfois d’impuissance. Les impacts psychiques engendrés par les annonces de mauvaises nouvelles, la perception dans certains cas d’une relation au médecin dénuée d’empathie, le sentiment d’impuissance lié au caractère imprévisible de l’évolution de cette maladie progressivement handicapante ainsi qu’une défiance quant à l’efficacité des traitements proposés expliquent en partie la fragilité de l’alliance thérapeutique avec le neurologue et les réactions psychologiques parfois extrêmes des patients qui en découlent. Conclusion et ouverture. Résultats obtenus : engager une réflexion éthique sur les informations à transmettre au patient, et proposer une formation aux neurologues basée sur l’outil élaboré / Context. This research aims to explore the neurologist’s and patient’s lived experiences of breaking bad news in multiple sclerosis and the lived experience of this disease, to understand the basic conditions of their relationship, and to create reflective clinical tools aimed at helping neurologists to maintain the quality of their relationship with the patients. Methodology. Multicentre qualitative study presents the results obtained from the analysis of 83 clinical research interviews with 35 patients and 20 neurologists, using IPA and a clinical psychodynamic. Results. Breaking bad news (BBN) in multiple sclerosis are lived as stressful experience for the majority of the neurologists of the research, a situations lived with frustration and sometimes powerlessness. Psychic impacts engendered by the BBN, the perception in certain cases of a relation to the doctor divested of empathy, the feeling of powerlessness linked to the unpredictable character of the evolution of this gradually crippling disease as well as a mistrust as for the efficiency of the proposed treatments explain partially the fragility of the therapeutic alliance with the neurologist and sometimes the extreme psychological reactions of the patients. Conclusion and opening. Results obtained : engage an ethical reflection on the information to transmit to the patient, and to suggest training to neurologists based on the tool created in tis research

Si l’importance de la communication dans la prise en charge des patients en oncologie n’est plus à démontrer, elle n’en demeure pas moins une difficulté pour les soignants. Les soignants se retrouvent fréquemment confrontés à des contextes communicationnels complexes pour lesquels ils se sentent bien souvent démunis et insuffisamment formés. Des formations adaptées et spécifiques sont nécessaires afin d’assurer un changement durable des stratégies de communication utilisées par les soignants dans leur pratique clinique. Cette thèse vise à apporter une contribution à la formation des soignants à la communication en oncologie et à l’étude du transfert des compétences dans la pratique clinique. Ce travail de thèse porte sur l’analyse de deux contextes de communication différents :l’annonce de mauvaises nouvelles et la communication autour des traitements. Au travers de ces deux contextes, trois objectifs ont été poursuivis :(a) la modélisation d’un programme de formation adapté à un contexte de communication spécifique, (b) l’évaluation de l’efficacité de ce programme de formation ou l’évaluation du transfert des compétences apprises dans la pratique clinique et (c) l’évaluation de l’impact de ce programme de formation à la communication sur le patient (et sur le proche) simulé ou réel.Dans le cadre de ce travail de thèse, nous avons donc pu évaluer l’efficacité de deux formations à la communication spécifiquement développées pour ces deux contextes de communication. La formation à l’annonce de mauvaises nouvelles a permis une amélioration de la répartition du temps consacré à chaque phase du processus d’annonce ainsi que l’acquisition de stratégies de communication. Elle a également permis une augmentation de l’activation physiologique des médecins, reflétant un meilleur niveau d’engagement cognitif et émotionnel dans la tâche. Concernant la formation à la communication donnée en radiothérapie aux équipes multidisciplinaires, elle a permis le transfert des compétences acquises durant la formation dans la pratique clinique. Ces formations ont également montré un impact sur les patients et les proches réels ou simulés en permettant que les soignants leur laissent plus de place pour s’exprimer. La formation à la communication en radiothérapie a également montré un impact sur la satisfaction des patients. Ce travail de thèse souligne l’importance de développer des formations à la communication spécifiques aux différents contextes communicationnels ainsi que la nécessité de travailler à l’optimisation du transfert des compétences acquises durant ces formations dans la pratique clinique. / Doctorat en Sciences psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

SJUKSKÖTERSKORS UPPLEVELSER OCH ERFARENHETER AV BRYTPUNKTSSAMTAL MED PATIENT I LIVETS SLUTSKEDELITTERATURSTUDIEHolgersson M, Johannesson J. Sjuksköterskors upplevelser och erfarenheter av brytpunktssamtal med patient i livets slutskede. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Universitet: Fakulteten för Hälsa och samhälle, Institutionen för vårdvetenskap, 2020.Vid ett brytpunktssamtal har sjuksköterskorna en framträdande och viktig roll. Då patienten är i livets slutskede och vården går från botande till lindrande är det viktigt att det sker i rätt tid och på rätt sätt. Sjuksköterskors medverkan vid brytpunktssamtalet ska medföra en trygghet för patient och anhörig och genom sin kännedom om patienten kan sjuksköterskorna bidra till en bättre omvårdnad vid livets slut. Syfte: Syftet med studien var att undersöka sjuksköterskors upplevelser och erfarenheter runt brytpunktssamtal med patienter i livets slutskede. Metod: En litteraturstudie utfördes där tio artiklar med kvalitativ design som svarade upp mot syftet valdes ut. En innehållsanalys genomfördes där artiklarna granskades och syntetiserades ner till ett resultat. Resultat: Resultatet mynnade ut i fyra huvudteman: Kommunikation inom teamet och med patient och anhörig. Interaktionen i teamet och med patient och anhörig. Relationer och upplevelser i mötet med patient och anhörig och slutligen sjuksköterskors upplevelser och känslor i sitt arbete med patienten före, under och efter brytpunktssamtal. Sjuksköterskorna i studien efterlyste mer utbildning i att hantera sin roll vid brytpunktsamtal. Sjuksköterskorna har ofta vårdat patienten under en längre tid och har skapat en relation och lärt sig vad som är viktigt för just den patienten vilket är en stor tillgång under brytpunksamtalet för att tillgodose patientens önskemål och skapa förutsättningar för god omvårdnad. Konklusion: Kommunikation i teamet och förberedelser är viktigt i arbetet runt patient och anhörig vid brytpunktssamtal. Sjuksköterskorna behöver utbildning och erfarenhet av brytpunktssamtal för att känna sig trygg i sin roll för att utgöra ett bra och tydligt stöd för patient och anhörig i brytpunktssamtal. Nyckelord: Brytpunktssamtal, erfarenheter, palliativ vård, sjuksköterskor, upplevelser. / NURSÉS EXPERIENCES IN BREAKING BAD NEWS DIALOGUES WITH PATIENTS IN THE END OF LIFEA LITERATURE REVIEWHolgersson M, Johannesson J. Nursés experiences in breaking bad news dialogues with patients in the end of life. Degree Project in nursing 15 credit points, Malmö University: Faculty of Health and Society, Department of Care Science, 2020.The nurses has a prominent and important role in breaking bad news dialogues. As the patient is in the final stage of life and the care goes from curative to palliative, it is important that this is done at the right time and in the right way. The nurse´s participation in breaking bad news dialogues should bring a feeling of safety for both the patient and relatives and through the knowledge of the patient the nurses can contribute to a better care in the final stages of life. Purpose: The purpose with the study was to analyze nurses experience and knowledge about breaking bad news dialogues with patients in the final stages of life. Method: A literature study was conducted where ten articles of qualitative design that responded to the purpose were selected. A content analysis was done where the articles were reviewed and synthesized down to a result. Result: The outcome resulted in four main themes. Communication within the team and with patient and relatives. The interaction in the team and with the patient and relatives. Relationships and experiences in the meeting with patient and relative and finally the nurse´s experiences and emotions in their work with the patient before, under and after breaking the bad news. The nurse has often cared for the patient during a longer period of time and has created a relationship and learned what is important for that particular patient which is a huge asset during the breakpoint dialogue to meet the patient´s wishes and create conditions for good nursing. Conclusion: Communication in the team and preparation are important in the work regarding patient and relatives in breaking bad news dialogues. The nurse need education and experience in breaking bad news dialogues to feel safe in her role to be a good and distinct support for patient and relative in breaking bad news dialogues. Keyword: Breaking bad news, life experiences, lived experiences, nurses, palliative care.

Objective This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. Methods This randomized control study (N = 66) compared intervention and control groups of students (n = 28) and residents’ (n = 38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. Results Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p = 0.007, r = −0.47; breast cancer (BC), p = 0.003, r = −0.53), attention to patient responses after BBN (CC, p < 0.001, r = −0.74; BC, p = 0.001, r = −0.65), and addressing feelings (BC, p = 0.006, r = −0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r = −0.43), communication related to emotions (p = 0.034, r = −0.30), determining patient's readiness to proceed after BBN and communication preferences (p = 0.041, r = −0.28), active listening (p = 0.011, r = −0.37), addressing feelings (p < 0.001, r = −0.65), and global interview performance (p = 0.001, r = −0.51). Conclusion This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. Practice implications Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.

Background: The vast majority of infants born with congenital heart disease (CHD) reach adulthood because of the developments in cardiology in recent decades. This thesis aims to describe the psychosocial situation of child/adolescent cardiac patients and their families, investigate the situation faced by parents and siblings initially and over time, investigate the approaches paediatric cardiologists use in encountering the family, and describe the teamwork occurring in paediatric cardiology teams (PCTs) in Sweden. Theoretical framework: The theoretical framework was based on a quality of life model applied to children, a stress-coping model, and a psychosocial approach including support, profession, and teamwork. Methods: The research combines quantitative data collection/analysis and qualitative research interviews/content analysis. Results: Complexity: The three grades of medical complexity differed regarding the number and severity of psychosocial symptoms, the children with the most complex CHD having the most severe symptoms. The most frequent symptoms in the whole patient group regarding various spheres were: healthcare and treatment-related needs in the external sphere, family symptoms in the interpersonal sphere, and mental/psychosomatic symptoms in the personal sphere. Coping: Being informed of a child’s/sibling’s heart disease has emotional consequences, so information, communication, and support are essential. Breaking the news of a child’s disease can be described as a turning point still significant after ten years. The professionalism of the doctor’s approach in breaking the news is crucial. Profession: Among paediatric cardiologists, how to break bad news to a family is an important concern, evident in findings regarding the significance of trust and confidence and the use of various emotional positions. Paediatric cardiologists commonly wish to be skilled at handling this situation, and attaining the needed skills calls for reflection, education, and sharing experience. Team: PCTs in Sweden aim and try to work in a structured way. In PCTs, there is a need for leadership, resource coordination, coaching, and a forum for joint reflection. Dependence on the physician on the team was identified in all PCTs. The challenge of managing increasing complexity at both the family and system levels requires interprofessional teams. Conclusions: These studies illustrate the psychosocial complexity and the need of psychosocial support. Emotional consequences, communication, information and support are essential both for the children, parents/families and for the professionals. To manage this complexity organizational alteration action plans are required. There is a need for a forum to stimulate dialogue and common reflection in the local PCT and at the regional and national centres.