Conversaciones difíciles en medicina: el profesionalismo y humanismo en el arte de comunicar malas noticias
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dic 16, 2019
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Fritz Eduardo Gempeler
Lilian Torregrosa
https://orcid.org/0000-0002-5392-7083
Jose Miguel Silva
https://orcid.org/0000-0001-5749-6340
https://orcid.org/0000-0002-5392-7083
Jose Miguel Silva
https://orcid.org/0000-0001-5749-6340
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Resumen
La idea que la comunicación de un médico hacía referencia a sus “buenas maneras” o su habilidad para llevar a cabo una historia clínica, ha dado paso a una reconceptualización de esta competencia, como una habilidad clínica fundamental que se puede desarrollar y medir. La habilidad para comunicar malas noticias a pacientes y familiares no se considera hoy una competencia opcional, por el contrario, subestimar su importancia ha contribuido a la percepción creciente en los últimos años, de una medicina deshumanizada. Con el fin de apoyar a médicos, estudiantes y otros profesionales de la salud que manifiestan su inseguridad y angustia al momento de afrontar estas situaciones, se han desarrollado varias estrategias educativas y protocolos que permiten consolidar la competencia del médico en este arte.
Keywords
Ethics, Medical ; Bioethics ; Physician-Patient relations. Professionalism, HumanismEtica Médica, Bioetica, Relación Medico-Paciente, Profesionalismo, Humanismo
References
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2-Teutsch C. Patient-doctor communication Med Clin North Am. 2003; 87:1115-45.
3-Kavic MS. Competency and the six core competencies. Journal of the Society of Laparoendoscopic Surgeons, 2002 ; 6 : 95–97. https://www.acgme.org/Portals/0/PDFs/Milestones/InterpersonalandCommunicationSkillsPediatrics.pdf consultado el 12 de mayo de 2019
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7-Abbaszadeh A, Ehsani SR, Begjani J, et al. Nurses' perspectives on breaking bad news to patients and their families: a qualitative content analysis. J Med Ethics Hist Med. 2014; 12: 7-18
8-Arbabi M, Roozdar A, Taher M, et al. How to break bad news: physicians' and nurses' attitudes. Iran J Psychiatry. 2010; 5:128-33
9-WhippenDA, Canellos GP. Burnout síndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9:1916-1920
10-Morgans AK, Schapira L. Confronting Therapeutic Failure: A Conversation Guide. Oncologist. 2015;20:946-51.
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12-Schildmann J, Cushing A, Doyal L, et al. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med. 2005;19:93-8.
13-Fujimori M, Oba A, Koike M, et al. Communication skills training for Japanese oncologists on how to break bad news, J Cancer Educ 2003; 18 :194-201
14-Baile WF, Lenzi R, Parker PA, et al. Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002; 20: 2189-96
15-Meunier J, Merckaert I, Libert Y, et al. The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task. Patient education and counseling. 2013;93:40-7
16-Buckman R. Breaking bad news: why is it still so difficult?, Br Med J. 1984;288 : 1597-9
17-Takayama T, Yamazaki Y, Katsumata N. Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting, Soc Sci Med 2001;53:1335-50
18-Schofield PE, Butow PN, Thompson JF, et al. Psychological responses of patients receiving a diagnosis of cancer, Ann Oncol , 2003;14 :48-56
19-Morita T, Akechi T, Ikenaga Y, et al. Communication about the ending of anticancer treatment and transition to palliative care, Ann Oncol. 2004; 15: 1551-7
20-Drane JF, Honesty in Medicine: should doctors tell the truth?
http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth
consultado 12 mayo 2019. Ethics at a Glance Veracity
21-Liénard A, Merckaert I, Libert Y, et al. Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program. Br J Cancer 2010;103:171-7
22-Moore PM, Rivera Mercado S, Grez Artigues M, et al. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2013;28:3:CD003751.
23-Karkowsky CE, Landsberger EJ, Bernstein PS. Breaking Bad News in Obstetrics: A Randomized Trial of Simulation Followed by Debriefing or Lecture. J Matern Fetal Neonatal Med. 2016; 20:1-20.
24-Bowyer M, Rawn L, Hanson J, et al. Combining high-fidelity human patient simulators with a standardized family member: a novel approach to teaching breaking bad news. Stud Health Technol Inform. 2006;119:67–72
25-Baer AN, Freer JP, Milling DA, et al. Breaking bad news: use of cancer survivors in role-playing exercises. J Palliat Med. 2008;11:885-92.
26-Skye EP1, Wagenschutz H, Steiger JA, et al. Use of interactive theater and role play to develop medical students' skills in breaking bad news. J Cancer Educ. 2014; 29:704-8
27-Maguire P. Barriers to psychological care of the dying. BMJ 1985;291:1711-1713.
28-Baile WF, Kudelka AP, Beale EA et al. Communication skills training in oncology. Description and preliminary out-comes of workshops in breaking bad news and managing patient reactions to illness. Cancer 1999; 86:887-897
29-Ramirez AJ, Graham J, Richards MA et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995;71:1263-1269
30-Ptacek JT, Eberhardt TL. Breaking bad news. A review of the literature. JAMA 1996;276:496-502.
31-Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992:15. Cap 4 pg 65 - 97
32-Maguire P, Faulkner A. Communicate with cancer patients: 1. Handling bad news and difficult questions. BMJ 1988;297:907-909.
33-Buckman R. Breaking bad news: the S-P-I-K-E-S strategy. Commun Oncol 2005;2:138–142.
34-Miller SM. Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 1995;76:167-177
35-Lind SE, DelVecchio-Good MJ, Seidel S, et al. Telling the diagnosis of cancer. J Clin Oncol 1989;7:583-589
36-Sardell AN, Trierweiler SJ. Disclosing the cancer diagnosis. Procedures that influence patient hopefulness. Cancer 1993;72:3355-3365
37-Matthews DA, Suchman AL, Branch WT. Making “conneixons”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med 1993;118:973-977.
38-Suchman AL. A model of empathic communication in the medical interview. JAMA 1997;277:678-682.
2-Teutsch C. Patient-doctor communication Med Clin North Am. 2003; 87:1115-45.
3-Kavic MS. Competency and the six core competencies. Journal of the Society of Laparoendoscopic Surgeons, 2002 ; 6 : 95–97. https://www.acgme.org/Portals/0/PDFs/Milestones/InterpersonalandCommunicationSkillsPediatrics.pdf consultado el 12 de mayo de 2019
4-Makoul G. Communication Skills Education in Medical School and Beyond. JAMA. 2003;289:93. doi:10.1001/jama.289.1.93
5-Moore PJ, Adler NE, Robertson PA. Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med.2000;173:244-250.
6-Kohn LT, Corrigan JM, Donaldson MS, eds; Committee on Quality of Health Care in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington DC: National Academies Press; 2000.
7-Abbaszadeh A, Ehsani SR, Begjani J, et al. Nurses' perspectives on breaking bad news to patients and their families: a qualitative content analysis. J Med Ethics Hist Med. 2014; 12: 7-18
8-Arbabi M, Roozdar A, Taher M, et al. How to break bad news: physicians' and nurses' attitudes. Iran J Psychiatry. 2010; 5:128-33
9-WhippenDA, Canellos GP. Burnout síndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol 1991;9:1916-1920
10-Morgans AK, Schapira L. Confronting Therapeutic Failure: A Conversation Guide. Oncologist. 2015;20:946-51.
11-Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs. 2017;73:1632-1645.
12-Schildmann J, Cushing A, Doyal L, et al. Breaking bad news: experiences, views and difficulties of pre-registration house officers. Palliat Med. 2005;19:93-8.
13-Fujimori M, Oba A, Koike M, et al. Communication skills training for Japanese oncologists on how to break bad news, J Cancer Educ 2003; 18 :194-201
14-Baile WF, Lenzi R, Parker PA, et al. Oncologists' attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol. 2002; 20: 2189-96
15-Meunier J, Merckaert I, Libert Y, et al. The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task. Patient education and counseling. 2013;93:40-7
16-Buckman R. Breaking bad news: why is it still so difficult?, Br Med J. 1984;288 : 1597-9
17-Takayama T, Yamazaki Y, Katsumata N. Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting, Soc Sci Med 2001;53:1335-50
18-Schofield PE, Butow PN, Thompson JF, et al. Psychological responses of patients receiving a diagnosis of cancer, Ann Oncol , 2003;14 :48-56
19-Morita T, Akechi T, Ikenaga Y, et al. Communication about the ending of anticancer treatment and transition to palliative care, Ann Oncol. 2004; 15: 1551-7
20-Drane JF, Honesty in Medicine: should doctors tell the truth?
http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth
consultado 12 mayo 2019. Ethics at a Glance Veracity
21-Liénard A, Merckaert I, Libert Y, et al. Is it possible to improve residents breaking bad news skills? A randomised study assessing the efficacy of a communication skills training program. Br J Cancer 2010;103:171-7
22-Moore PM, Rivera Mercado S, Grez Artigues M, et al. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev. 2013;28:3:CD003751.
23-Karkowsky CE, Landsberger EJ, Bernstein PS. Breaking Bad News in Obstetrics: A Randomized Trial of Simulation Followed by Debriefing or Lecture. J Matern Fetal Neonatal Med. 2016; 20:1-20.
24-Bowyer M, Rawn L, Hanson J, et al. Combining high-fidelity human patient simulators with a standardized family member: a novel approach to teaching breaking bad news. Stud Health Technol Inform. 2006;119:67–72
25-Baer AN, Freer JP, Milling DA, et al. Breaking bad news: use of cancer survivors in role-playing exercises. J Palliat Med. 2008;11:885-92.
26-Skye EP1, Wagenschutz H, Steiger JA, et al. Use of interactive theater and role play to develop medical students' skills in breaking bad news. J Cancer Educ. 2014; 29:704-8
27-Maguire P. Barriers to psychological care of the dying. BMJ 1985;291:1711-1713.
28-Baile WF, Kudelka AP, Beale EA et al. Communication skills training in oncology. Description and preliminary out-comes of workshops in breaking bad news and managing patient reactions to illness. Cancer 1999; 86:887-897
29-Ramirez AJ, Graham J, Richards MA et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer 1995;71:1263-1269
30-Ptacek JT, Eberhardt TL. Breaking bad news. A review of the literature. JAMA 1996;276:496-502.
31-Buckman R. Breaking Bad News: A Guide for Health Care Professionals. Baltimore: Johns Hopkins University Press, 1992:15. Cap 4 pg 65 - 97
32-Maguire P, Faulkner A. Communicate with cancer patients: 1. Handling bad news and difficult questions. BMJ 1988;297:907-909.
33-Buckman R. Breaking bad news: the S-P-I-K-E-S strategy. Commun Oncol 2005;2:138–142.
34-Miller SM. Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease. Implications for cancer screening and management. Cancer 1995;76:167-177
35-Lind SE, DelVecchio-Good MJ, Seidel S, et al. Telling the diagnosis of cancer. J Clin Oncol 1989;7:583-589
36-Sardell AN, Trierweiler SJ. Disclosing the cancer diagnosis. Procedures that influence patient hopefulness. Cancer 1993;72:3355-3365
37-Matthews DA, Suchman AL, Branch WT. Making “conneixons”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med 1993;118:973-977.
38-Suchman AL. A model of empathic communication in the medical interview. JAMA 1997;277:678-682.
Cómo citar
Gempeler, F. E., Torregrosa, L., & Silva, J. M. (2019). Conversaciones difíciles en medicina: el profesionalismo y humanismo en el arte de comunicar malas noticias. Universitas Medica, 61(1). https://doi.org/10.11144/Javeriana.umed61-1.conv
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