Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T23:55:40.010Z Has data issue: false hasContentIssue false

Breaking bad news: an interview study of paediatric cardiologists

Published online by Cambridge University Press:  28 January 2011

Anna-Lena Birkeland
Affiliation:
Division of Paediatrics, Department of Clinical Sciences, Umea University, Umea, Sweden
Lars Dahlgren
Affiliation:
Department of Sociology, Umea University, Umea, Sweden
Bruno Hägglöf
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Umea University, Umea, Sweden
Annika Rydberg*
Affiliation:
Division of Paediatrics, Department of Clinical Sciences, Umea University, Umea, Sweden
*
Correspondence to: Assoc. Professor A. Rydberg, Department of Clinical Sciences, Paediatrics, Umeå University, S-90185 Umeå, Sweden. Tel: +46 90 785 2104; Fax: +46 90 7852522; E-mail: [email protected]

Abstract

Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.

Method

A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.

Results

Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.

Conclusions

Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rice, MJ, McDonald, RW, Reller, MD, Sahn, DJ. Pediatric echocardiography: current role and a review of technical advances. J Pediatr 1996; 128: 114.CrossRefGoogle Scholar
2. Lazarus, RS. Stress and Emotion: A New Synthesis. Free Association Books, London, 1999.Google Scholar
3. Birkeland, A-L, Rydberg, A, Hägglöf, B. The complexity of the psychosocial situation in children and adolescents with heart disease. Acta Paediatrica 2005; 94: 14951501.CrossRefGoogle ScholarPubMed
4. Menahem, S. Counselling strategies for parents of infants with congenital heart disease. Cardiol Young 1998; 8: 400407.CrossRefGoogle ScholarPubMed
5. Bradbury, ET, Kay, SP, Tighe, C, Hewison, J. Decision-making by parents and children in paediatric hand surgery. Br J Plast Surg 1994; 47: 324330.CrossRefGoogle ScholarPubMed
6. Jackson, C, Cheater, FM, Reid, I. A Systematic Review of Decision Support Needs of Parents Making Child Health Decisions. Health Expert 2008; 11: 232251.CrossRefGoogle ScholarPubMed
7. Kvale, S. Interviews: An Introduction to Qualitative Research Interviewing. Sage Publications, London, 1996.Google Scholar
8. Ragin, C. Constructing Social Research. Pine Forge Press, London, 1994.Google Scholar
9. Lincoln, YS, Guba, EG. Naturalistic Inquiry. Sage Publications, London, 1985.CrossRefGoogle Scholar
10. Dahlgren, L, Emmelin, M, Winkvist, A. Qualitative Methodology for International Public Health. Epidemiology and Public Health Sciences. Umeå University, Umeå, 2007.Google Scholar
11. Birkeland, A-L, Rydberg, A, Hägglöf, B, Dahlgren, L. Facing bad news – a longitudinal study focusing on children with congenital heart disease and their families. Manuscript submitted.Google Scholar
12. Becker, H, Geer, B, Hughes, EC, Strauss, AL. Boys in White. University of Chicago Press; 1961, 419445.Google Scholar
13. Abbott, A. The System of Professions: An Essay on the Division of Expert Labor. University of Chicago Press, Chicago and London, 1988.CrossRefGoogle Scholar
14. Holm, U. Empati. Att förstå andra människors känslor [Empathy: Understanding Other People's Feelings]. Natur och Kultur, Stockholm, 2001.Google Scholar
15. Andersson, SO. Mötet och samtalet [The meeting and the conversation]. In: Bjöörn Fossum (ed.) Kommunikation. Samtal och bemötande i vården [Communication. Conversations and Reception in Healthcare]. Studentlitteratur, Lund, 2007, 111113.Google Scholar
16. Hansböl, G, Krejsler, J. Konstruktion af professional identitet – en kulturkamp mellem styrning og autonomi. I: et markedssamfund. [Construction of professional identity – a cultural struggle between control and autonomy. I: a market society]. In: L. Moos et al. Relationsprofessioner. [Relation Professions]. Danish Pedagogical University, Copenhagen, 2004, 324325.Google Scholar
17. Molander, A, Terum, LI. Profesjonsstudier – en introduksjon [Occupational studies – an introduction]. In: Anders Molander A Terum LI (eds) Profesjonsstudier [Occupational Studies]. Universitetsforlaget, Oslo, 2008.Google Scholar
18. Fallowfield, LJ. Giving sad and bad news. Lancet 1993; 341: 476478.CrossRefGoogle ScholarPubMed
19. Bone, D. Dilemmas of emotion work in nursing under market-driven health care. International Journal of Public Sector Management 2002; 15: 140150.CrossRefGoogle Scholar
20. Luhmann, N. Familiarity, Confidence, Trust: Problems and Alternatives. Blackwell, Oxford, 1990.Google Scholar
21. Giddens, A. The Consequences of Modernity. Polity Press, Cambridge, 1991.Google Scholar
22. Rosenbaum, ME, Fergusson, KJ, Lobas, JG. Teaching medical students and residents skills for delivering bad news: a review of strategies. Acad Med 2004; 79: 107117.CrossRefGoogle ScholarPubMed
23. Schön, D. The Reflective Practitioner: How Professionals Think in Action. Temple Smith, London, 1983.Google Scholar
24. Plack, MM, Greenberg, L. The reflective practitioner: reaching for excellence in practice. Pediatrics 2005; 116: 15461552.CrossRefGoogle ScholarPubMed
25. Balint, M. (1957). The Doctor, His Patient and the Illness. Churchill Livingstone, London, 1972.Google Scholar
26. Balint 1072 International Federation, http://www.balintinternational.com/index.html20100220Google Scholar
27. Leigh, A, Maynard, M. Leading Your Team: How to Involve and Inspire Teams. Brain Books, Jönköping, 2002.Google Scholar
28. Kendall, L, Sloper, P, Lewin, RJP, Parsons, JM. The views of parents concerning the planning of services for rehabilitation of families of children with congenital cardiac disease. Cardiol Young 2003; 13: 2027.CrossRefGoogle ScholarPubMed