bims-paceca Biomed News
on Patient-centred care
Issue of 2022‒08‒28
eighteen papers selected by
Rob Penfold
Queensland Health
  1. How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective.
  2. Shared decision making in cardiology: a systematic review and meta-analysis.
  3. Can online health information sources really improve patient satisfaction?
  4. Research progress on digital health literacy of older adults: A scoping review.
  5. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review.
  6. Effective healthcare communication with children and young people: a systematic review of barriers and facilitators.
  7. An Exploration Into Patients' Experiences That Make Them Feel Safe During Hospitalization: A Qualitative Study.
  8. Health Literacy and Ophthalmology: A scoping review.
  9. Reimagining digital healthcare with a patient-centric approach: The role of user experience (UX) research.
  10. Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach.
  11. Using Photographs to Bring Dignity to Patients and Help Clinicians Find Meaning and Joy in Work.
  12. A systematic literature review to clarify the concept of vaccine hesitancy.
  13. The Ward Round: Patients' Perceptions of a Patient-Centered Approach and Their Suggestions for Improved Participation.
  14. Hidden in plain sight.
  15. Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review.
  16. The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews.
  17. Rethinking patient-oriented research.
  18. Breaking bad news.
  1. Patient Educ Couns. 2022 Aug 18. pii: S0738-3991(22)00388-3. [Epub ahead of print]
    How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective.
    Guendalina Graffigna, Serena Barello.
      OBJECTIVE: To propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems.DISCUSSION: This paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some "points of attention" that need to be addressed to support patient engagement implementation in healthcare organisations.
    CONCLUSION AND PRACTICE IMPLICATIONS: Understanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings.
    Keywords:  Medical humanities; Participatory health; Participatory medicine; Patient engagement
    DOI:  https://doi.org/10.1016/j.pec.2022.08.009
  2. Heart. 2022 Aug 25. pii: heartjnl-2022-321050. [Epub ahead of print]
    Shared decision making in cardiology: a systematic review and meta-analysis.
    Panagiota Mitropoulou, Nicolai Grüner-Hegge, Johannes Reinhold, Charikleia Papadopoulou.
      OBJECTIVES: To evaluate the effectiveness of interventions to improve shared decision making (SDM) in cardiology with particular focus on patient-centred outcomes such as decisional conflict.METHODS: We searched Embase (OVID), the Cochrane library, PubMed and Web of Science electronic databases from inception to January 2021 for randomised controlled trials that investigated the effects of interventions to increase SDM in cardiology. The primary outcomes were decisional conflict, decisional anxiety, decisional satisfaction or decisional regret; a secondary outcome was knowledge gained by the patients.
    RESULTS: Eighteen studies which reported on at least one outcome measure were identified, including a total of 4419 patients. Interventions to increase SDM had a significant effect on reducing decisional conflict (standardised mean difference (SMD) -0.211, 95% CI -0.316 to -0.107) and increasing patient knowledge (SMD 0.476, 95% CI 0.351 to 0.600) compared with standard care.
    CONCLUSIONS: Interventions to increase SDM are effective in reducing decisional conflict and increasing patient knowledge in the field of cardiology. Such interventions are helpful in supporting patient-centred healthcare and should be implemented in wider cardiology practice.
    Keywords:  meta-analysis
    DOI:  https://doi.org/10.1136/heartjnl-2022-321050
  3. Front Public Health. 2022 ;10 940800
    Can online health information sources really improve patient satisfaction?
    Yide Sun, Jiajun Yu, Ya-Ling Chiu, Yuan-Teng Hsu.
      Internet information has become the main way for individuals to obtain health information. The purpose of this paper is to explore the role online information sources play in health decision-making. Specifically, we investigated the relationship between online information sources and patient satisfaction, as well as their moderating effects as compared to those of other information sources. Using logistical regression analysis, we conducted the longitudinal data on 54,027 doctors and 952,877 online doctor reviews from 3,525 hospitals in 31 provinces to test a proposed research model. The results showed that patient satisfaction was generally lower for individuals who found a doctor through online information sources. Therefore, we suggest that patients consider the doctor quality, the doctor popularity, and patient involvement. In addition, we found that the doctor popularity had a negative moderating effect between online information sources and patient satisfaction, while patient involvement had a positive moderating effect between online information sources and patient satisfaction. The study provides strategic guidance and practical implications for policies, online healthcare community managers, and patients.
    Keywords:  decision-making; internet information; online healthcare community; online information sources; patient satisfaction
    DOI:  https://doi.org/10.3389/fpubh.2022.940800
  4. Front Public Health. 2022 ;10 906089
    Research progress on digital health literacy of older adults: A scoping review.
    Xinxin Wang, Wei Luan.
      With the rapid development of digital health today, the lack of digital health literacy in older adults is an urgent problem. It is crucial that older adults adapt to the digital reform in medical treatment, pension, health management, and other fields. Therefore, we reviewed the current development status of digital health literacy among older adults. A total of 47 articles were included in this scoping review. Our findings revealed that research on digital health literacy in older adults is still in its infancy. Further development is warranted especially in terms of assessment tools and intervention methods.
    Keywords:  digital health literacy; e-health literacy; older adults; older people; scoping review
    DOI:  https://doi.org/10.3389/fpubh.2022.906089
  5. Med Care Res Rev. 2022 Aug 24. 10775587221118435
    Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review.
    Minakshi Raj, Amber L Stephenson, Matthew J DePuccio, Erin E Sullivan, Will Tarver, Bram Fleuren, Samuel C Thomas, Ann Scheck McAlearney.
      More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
    Keywords:  care partners; caregivers; family-centered care; scoping review; teamwork
    DOI:  https://doi.org/10.1177/10775587221118435
  6. Arch Dis Child. 2022 Aug 25. pii: archdischild-2022-324132. [Epub ahead of print]
    Effective healthcare communication with children and young people: a systematic review of barriers and facilitators.
    Alice Navein, James McTaggart, Xanthe Hodgson, Joanna Shaw, Dougal Hargreaves, Eva Gonzalez-Viana, Agnesa Mehmeti.
      OBJECTIVE: To identify children and young people's preferences for effective healthcare communication.DESIGN: A systematic review of qualitative studies was conducted to identify evidence from children and young people on effective healthcare communication. Electronic databases and reference lists of relevant articles were searched to July 2020.
    RESULTS: A total of 13 studies were included. Five major themes were identified: medical information (timing, amount, coordination and futures), person not patient (creating relationships, time, nurse involvement, sensitivity), type of communication (creative and interactive, behavioural, talking and listening, written communication), consultations (first impressions, with and without parents, actively promoting involvement, open and honest, age appropriate) and communication with parents (using parental knowledge, support).
    CONCLUSIONS: Research in this area remains sparse and consistent implementation is debateable. Children and young people articulate a preference for two-way healthcare communication. General principles for effective communication are identified as well as the need to avoid making assumptions and to tailor approaches to individuals. Establishing and maintaining relationships is essential and requires time and resources. Parents and carers have a positive role in healthcare communication which needs to be balanced with the needs and rights of children. All these factors also apply to children with communication difficulties or from marginalised groups, but additional extra support may be required.
    PROSPERO REGISTRATION NUMBER: CRD42019145539.
    Keywords:  Adolescent Health; Child Health; Child Health Services; Nursing Care; Primary Health Care
    DOI:  https://doi.org/10.1136/archdischild-2022-324132
  7. J Korean Med Sci. 2022 Aug 22. 37(33): e256
    An Exploration Into Patients' Experiences That Make Them Feel Safe During Hospitalization: A Qualitative Study.
    Seung Gyeong Jang, Eunji Park, Jessie Lee, Ji Eun Choi, Sang-Il Lee, Haerim Han, Eunjung Park, Won Lee.
      BACKGROUND: Patient safety is a crucial indicator of health care quality. It is necessary to check the subjective perception of patient safety from the patient's point of view as a consumer of healthcare services. To identify patients' experiences of safety and the themes that constitute the patients' feeling of safety during hospitalization.METHODS: A qualitative study, comprising five focus group discussions (seven people each), was conducted in South Korea between May and July 2018. Patients who were hospitalized for at least three days within one year were included. Researchers analyzed the transcribed script, and a content analysis was performed to describe patients' hospitalized experiences of safety.
    RESULTS: A total of 35 patients with an average age of 45.4 years participated in the study, and had experience of hospitalization for up to 32 days. The findings revealed four core themes and 14 sub-themes. Patients wanted to take initiative in controlling his/her reception of information and wanted healthcare providers to make the patient feel safe. Patients felt safe when hospitals provided unstinted and generous support. Also, public sentiment about national healthcare and safety made an effect on patient safety sentiment.
    CONCLUSION: Patients felt safe during hospitalization not only because of the explanation, attitude, and professionalism of the healthcare providers but also because of the support, system, and procedure of the medical institution. Healthcare providers and medical institutions should strive to narrow the gap in patient safety awareness factors through activities with patients. Furthermore, the government and society should make an effort to create a safe medical environment and social atmosphere.
    Keywords:  Patient Experience; Patient Safety; Patient Satisfaction; Qualitative Research; Quality of Care
    DOI:  https://doi.org/10.3346/jkms.2022.37.e256
  8. Surv Ophthalmol. 2022 Aug 19. pii: S0039-6257(22)00117-5. [Epub ahead of print]
    Health Literacy and Ophthalmology: A scoping review.
    Mina Iskander, Galen Hu, Sara Coulon, Azizi A Seixas, Richard McGowan, Lama A Al-Aswad.
      As of 2020, it is estimated that 43.3 million people are blind, and an additional 553 million have mild to severe vision impairment.50 At least 1 billion worldwide have a vision impairment that could have been prevented or has yet to be addressed.54 Poor health literacy may be a significant contributor to the prevalence of eye disease. With implications on disease burden, progression, and health outcomes, a greater understanding of the role health literacy plays in ophthalmology is needed. This is the first scoping review to assess the impact of health literacy on eye health outcomes and blindness, including ocular screening rates/follow-up rates, treatment adherence, and self-care practices. PubMed, Embase, and CINAHL databases were searched systematically through November 12, 2021, and we evaluated the association between health literacy and ophthalmic outcomes in 4 domains: clinical outcomes, treatment adherence rates, screening/follow-up rates, and self-care practices. There is evidence to suggest that health literacy is associated with ophthalmic outcomes in all these domains. To better understand how health literacy impacts eye health, further longitudinal studies examining the effect of health literacy (using standardized health literacy measures) on ophthalmic outcomes are needed. We believe a specific ophthalmic health literacy survey could help achieve this goal and help target interventions to ultimately improve outcomes among ophthalmology patients.
    Keywords:  Eye Diseases; Health knowledge; Health literacy; Ophthalmology; The European Health Literacy Survey Questionnaire; The Rapid Estimate of Adult Literacy in Medicine; The Test of Functional Health Literacy
    DOI:  https://doi.org/10.1016/j.survophthal.2022.08.007
  9. Front Digit Health. 2022 ;4 899976
    Reimagining digital healthcare with a patient-centric approach: The role of user experience (UX) research.
    Rose M Gilbert.
      
    Keywords:  Amazon; customer focus; digital; healhcare; innovation; patient centric; patient involvement; user research
    DOI:  https://doi.org/10.3389/fdgth.2022.899976
  10. BMJ Open Qual. 2022 Aug;pii: e001810. [Epub ahead of print]11(3):
    Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach.
    Jenna Lauren Elizabeth Cook, Evie Fioratou, Peter Davey, Lynn Urquhart.
      This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains by the end of April 2021. Pre-intervention most patients received verbal instructions and only a minority received written information. Through staff interviews, we identified the electronic discharge document (EDD) as a practical source of written information. However, testing with patients showed that the format required substantial redesign to be written in patient-friendly language, using signposting, spacing information out and avoiding jargon. The effect of this intervention was assessed with a structured telephone questionnaire, which included both a patient self-rated score and a comparative understanding score to assess true patient understanding of the revised EDD. Pre-intervention 29 discharged patients were interviewed across 10 days and post-intervention 10 patients were interviewed in 7 days. Patients consistently over-rated their understanding of discharge information. Only one patient achieved the aim of comparative understanding >4 across all domains post-intervention. Understanding improved across all but one of the domains, the exception being medication changes. An important unanticipated consequence was that interviews identified inconsistencies in EDD information and gaps in patient understanding, which required escalation to the SSU team. In summary, this intervention improved patient understanding across four of the five domains. However, further work is required on process reliability for the redesigned EDD and on improving understanding of medication changes. Furthermore, the interviews revealed clinically important inconsistencies in EDD information and gaps in patient understanding.
    Keywords:  Communication; Healthcare quality improvement; Human factors; Patient Discharge; Patient education
    DOI:  https://doi.org/10.1136/bmjoq-2021-001810
  11. J Palliat Med. 2022 Aug 23.
    Using Photographs to Bring Dignity to Patients and Help Clinicians Find Meaning and Joy in Work.
    Ali Mendelson, Bryce Bandfield, Julie Hevezi, Jason Gable, Judy E Davidson, Gary Buckholz.
      Background: The importance of dignity in health care is well described, yet limited interventions exist to improve dignity, particularly patient-driven interventions. Objectives: To test the hypothesis that patient-selected photographs at the bedside would impact patients' sense of dignity and clinicians' sense of meaningful work, stimulate conversation between patients and clinicians, and serve as a visual and patient-driven complement to the Patient Dignity Question (PDQ). Methods: Patients admitted to three units at an academic medical center displayed photographs above their head of bed and were interviewed for this study. We used thematic content analysis to compare themes extracted from patient interviews, the PDQ, and clinician surveys. Results: Eight themes emerged from patient interviews (n = 19): conveying goals, joy, capturing the patient's spirit, faith and spirituality, sense of belonging, physical appearance and health, stimulating conversation and meaningful connections, and humanizing the patient. The same themes emerged from the PDQ, with the exception of physical appearance and health. Notably, analysis of the clinician surveys (n = 40) yielded six similar themes: conveying goals, joy, stimulating conversation and meaningful connections, humanizing the patient, meaningful work, and compassion and empathy. Conclusions: Patient-selected photographs at the bedside impact both patients and clinicians by stimulating conversation and meaningful connections, humanizing patients, and fostering meaning and joy in work. Photographs and the PDQ provide a similar window into personhood, thereby supporting the use of a photograph as a visual and patient-driven complement to the PDQ.
    Keywords:  burnout; compassion; dignity; empathy; goals of care; physical appearance
    DOI:  https://doi.org/10.1089/jpm.2022.0161
  12. Nat Hum Behav. 2022 Aug 22.
    A systematic literature review to clarify the concept of vaccine hesitancy.
    Daphne Bussink-Voorend, Jeannine L A Hautvast, Lisa Vandeberg, Olga Visser, Marlies E J L Hulscher.
      Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
    DOI:  https://doi.org/10.1038/s41562-022-01431-6
  13. Patient Prefer Adherence. 2022 ;16 2203-2211
    The Ward Round: Patients' Perceptions of a Patient-Centered Approach and Their Suggestions for Improved Participation.
    Linda Aronsson, Angelica Frithiof, Annie Röstedal, Charlotte Rudberg, Wilhelmina Ekström.
      Purpose: To explore, through a learning activity for healthcare students, how patients perceived the ward round and its patient-centered approach.Patients and Methods: Patients admitted for elective orthopedic surgery were invited to participate in the study, which involved answering a survey comprising seven intersectional questions and eight free text questions. In addition, medical and nursing students did semi-structured interviews with the patients, covering the same free text questions. Twenty-three patients answered the survey, of whom fifteen also completed the interviews. The results from the interviews were explored using a thematic content analysis.
    Results: Forty-three percent (10/23) of the patients strongly agreed or agreed that their knowledge of patient-centered ward round was sufficient to be able to participate actively, and thirty percent (7/23) indicated they had good knowledge of the laws and regulations governing the care of patients. Most of the patients felt satisfied with how their own and their relatives' experiences were taken into account. The categories information and to be listened to were mentioned repeatedly by patients as priorities for patient-centered ward rounds. The interview analysis revealed four main categories: preparation, communication, organization, and safety as important and in need of improvement.
    Conclusion: Less than half of the patients surveyed felt they could participate in the ward round, which indicates that there is an opportunity for improvement and development. Better information and communication about legal rights, as well as about the structure and content of the ward round, could be valuable to patients before admission. It is also important to find a way for patients' individual wishes to be more fully and easily conveyed to medical staff. Creating a more tailor-made ward round for each patient and fulfilling a patient-centered approach will likely entail a substantial organizational and mental shift.
    Keywords:  learning activity; patient perception; patient representative; patient-centered; ward round
    DOI:  https://doi.org/10.2147/PPA.S343955
  14. Int J Psychiatry Med. 2022 Aug 26. 912174221123443
    Hidden in plain sight.
    Madeleine Maras.
      When the unexpected occurs, humans become most attentive and open, and health care for the critically ill tends to highlight this point. This essay tells the story of a patient in the ICU who revealed the critical importance of remaining receptive to human connection, and he showed that oftentimes what is needed above all else is understanding, rather than numbers or medications. The greatest challenge, perhaps, is to maintain this truly patient-centered focus even in the absence of the unexpected.
    Keywords:  enid balint; enid balint essay contest; essay contest
    DOI:  https://doi.org/10.1177/00912174221123443
  15. Prev Chronic Dis. 2022 Aug 25. 19 E54
    Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review.
    Leslie Cunningham-Sabo, Angela Tagtow, Sirui Mi, Jessa Engelken, Kiaya Johnston, Dena R Herman.
      INTRODUCTION: Policy, systems, and environmental (PSE) change approaches frequently address healthy eating and active living (HEAL) priorities. However, the health effects of PSE HEAL initiatives are not well known because of their design complexity and short duration. Planning and evaluation frameworks can guide PSE activities to generate collective impact. We applied a systematic mapping review to the Individual plus PSE Conceptual Framework for Action (I+PSE) to describe characteristics, achievements, challenges, and evaluation strategies of PSE HEAL initiatives.METHODS: We identified peer-reviewed articles published from January 2009 through January 2021 by using CINAHL, Web of Science, MEDLINE, PsycINFO, and CAB Abstracts databases. Articles describing implementation and results of PSE HEAL initiatives were included. Activities were mapped against I+PSE components to identify gaps in evaluation efforts.
    RESULTS: Independent reviewers examined 437 titles and abstracts; 52 peer-reviewed articles met all inclusion criteria. Twenty-four focused on healthy eating, 5 on active living, and 23 on HEAL. Descriptive analyses identified federal funding of initiatives (typically 1-3 years), multisector settings, and mixed-methods evaluation strategies as dominant characteristics. Only 11 articles reported on initiatives that used a formal planning and evaluation framework. Achievements focused on partnership development, individual behavior, environmental or policy changes, and provision of technical assistance. Challenges included lack of local coalition and community engagement in initiatives and evaluation activities and insufficient time and resources to accomplish objectives. The review team noted vague or absent descriptions of evaluation activities, resulting in questionable characterizations of processes and outcomes. Although formation of partnerships was the most commonly reported accomplishment, I+PSE mapping revealed a lack of engagement assessment and its contributions toward initiative impact.
    CONCLUSION: PSE HEAL initiatives reported successes in multiple areas but also challenges related to partnership engagement and community buy-in. These 2 areas are essential for the success of PSE HEAL initiatives and need to be adequately evaluated so improvements can be made.
    DOI:  https://doi.org/10.5888/pcd19.210466
  16. Life (Basel). 2022 Aug 17. pii: 1253. [Epub ahead of print]12(8):
    The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews.
    Erika Renzi, Valentina Baccolini, Giuseppe Migliara, Corrado De Vito, Giulia Gasperini, Angelo Cianciulli, Carolina Marzuillo, Paolo Villari, Azzurra Massimi.
      Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.
    Keywords:  chronic diseases; eHealth; self-care
    DOI:  https://doi.org/10.3390/life12081253
  17. CMAJ. 2022 Aug 22. 194(32): E1119-E1120
    Rethinking patient-oriented research.
    David J T Campbell.
      
    DOI:  https://doi.org/10.1503/cmaj.220536
  18. Nurs Stand. 2022 Aug 22.
    Breaking bad news.
    Aby Mitchell.
      Nurses are often faced with situations in their practice where they have to break bad news to patients and their families. Such conversations are complex and can be challenging for all parties. It is essential that nurses are equipped with the skills required to manage such situations effectively to ensure optimal outcomes and quality of care for patients and their families. This article discusses some of the barriers to breaking bad news effectively to patients and the communication skills required to engage in challenging conversations. It also describes two mnemonic protocols that can be used by nurses to structure challenging conversations with patients face to face and over the phone.
    Keywords:  active listening; breaking bad news; communication; families; non-verbal communication; nurse-patient relations; patients; professional
    DOI:  https://doi.org/10.7748/ns.2022.e11898
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