Como comunicar más noticias

revisão bibliográfica

Abstract

Introduction: To present bad news to patients and their relatives in hospitals is one of the most
difficult and important tasks which health
teams and specially doctors, face. Despite of its relevance, many
professionals still lack on sufficient information and preparation to deal with these situations.
Purpose: To carry through a reconsideration of literature in order to organize the best information as
for the factors associated with the difficulties in presenting bad news as well as the steps suggested
for a good communication of the same kind.
Method: A research in electronic database (Medline) was carried through by means of the key
words: bad news; physician-patients relations; communication, with amendment for pairs of joined
articles.
Results: 16 relative articles to the subject had been revised. The main
factors that complicate the communication between the health team and the doctor, in presenting bad
news are: an apprehension in how the bad news will affect the patient; of causing pain to the patient
or of being judged as guilty by him; a concern of therapeutically imperfection, of judicial problem,
of the unknown, of having to say "I do not know" and expressing his emotions. To facilitate the
announcement of the bad news, studies suggest: to establish an adequate doctor health team- patient
relation; to carefully get to know the medical history; to view the patient as a person; to prepare the
setting; systematize your time; to take care of specific aspects of the communication; to realize what
and how much the patient is willing to acknowledge; to encourage and validate feelings; to give
attention and concern for the family; to the plan the future and the follow up; to work on one’s own
feelings. Discussion: Even though it is an important theme to the clinical practice and even though
there are guides to various professional groups (Vandekief, 2001) the “means to present bad news”
have a few studies. The clinical effectiveness of many recommendations were not empirically
demonstrated – less than 25% of publications on how to give out bad news are based on original
studies and these commented studies have methodological limitations. Many researches have shown,
however, that an education for residents and students focused on the development of the ability on presenting bad news can contribute to minimize this hiatus.