目的:生育工作人员和患者认为生育护理中的坏消息是什么?
结论:工作人员和患者同意坏消息是任何使患者不太可能自发获得父母身份或获得成功治疗的新闻,但是他们对新闻有多糟糕的评价受到特定新闻特征和传播背景的不同影响。
背景:生育护理中普遍存在坏消息,但是工作人员感到没有准备好分享它,十分之四的患者对此做出了意想不到的情感或身体反应。研究非常关注如何分享坏消息,但对于被认为是坏消息的新闻来说要少得多,尽管这可能决定了它的交付要素。
方法:两个横截面,在线,混合方法调查(2022年1月7日至7月16日)分发给英国和欧洲的生育工作人员和患者.
方法:员工入选标准是从事生育保健工作的医疗保健专业人员,并且每月至少分享一次坏消息。患者的纳入标准是成年人,在过去2个月内,工作人员分享或解释了有关其生育护理的坏消息。调查是使用Qualtrics以英语创建的,由患者和医疗保健专业人员审查,并通过社交媒体传播,多产,生育组织,和科学社会。患者被问到,关于上次和他们分享坏消息,\'坏消息是什么?\'和\'您认为生育保健方面还有什么坏消息?\'。工作人员被要求“列出你与病人分享的三个最具挑战性的坏消息”。对工作人员和患者数据分别进行主题分析,以产生基本代码,分为子主题和主题。将患者和工作人员数据中出现的主题进行比较并合成为元主题。
结果:三百三十四名员工参与了调查,286同意,和217完成(65%的完成率)。三百四十四名患者参加了调查,304同意,完成222项(完成率为64%)。85%的参与者是女性,62%居住在欧洲,59%在私人护理中。员工平均年龄为45.2岁(标准差=12.0),44%是胚胎学家或实验室技术人员,40%是临床医生(医生,顾问,或医生),和8%的护士或助产士。患者平均年龄为32.2岁(SD=6.4),54%有孩子。工作人员的答案源自100个代码,19次主题和6个主题。病人的答案产生了196个代码,34次主题,7个主题工作人员和患者的主题被整合到三个元主题中,反映了坏消息的主要主题。这些是诊断和阴性治疗事件和结果,无法进行(更多)治疗,以及扰乱沟通的护理和患者因素。工作人员和患者一致认为,一些新闻特征(不确定,破坏性的,最终)使新闻更具挑战性,但与其他特征(例如意外/预期)有关的观点不一致。患者因素使坏消息对工作人员更具挑战性(例如困难的情绪),而护理因素使坏消息对患者更具挑战性(例如混乱的护理)。
结论:参与者是自我选择的,大多数是来自欧洲私人诊所的女性。工作人员和患者的问题不同,专注于对新闻的主观感知,并没有衡量新闻的影响。
结论:生育新闻的不良不仅是新闻损害父母目标的程度的产物,还包括其特征(时间,自然,号码)和新闻传递的上下文。关于在生育护理中分享坏消息的指导需要超越放松过程,让患者也考虑工作人员的经验。指南可能需要根据新闻功能和上下文进行调整。
背景:卡迪夫大学资助了这项研究。S.G.,J.B.,O\'。H.,和A.D.报告来自威尔士高等教育资助委员会和欧洲人类生殖和胚胎学学会(ESHRE)的资助,以开发fertiShare:共享坏消息的生育保健在线学习课程。fertiShare将根据知识共享署名-非商业-共享4.0国际许可证(CCBY-NC-SA4.0)分发。没有报告与这项工作有关的其他冲突。
背景:不适用。
OBJECTIVE: What do fertility staff and patients think is bad news in fertility care?
CONCLUSIONS: Staff and patients agree bad news is any news that makes patients less likely to achieve parenthood spontaneously or access and do successful treatment, but their appraisals of how bad the news is are differently influenced by specific news features and the context of its delivery.
BACKGROUND: Bad news is common in fertility care, but staff feel unprepared to share it and four in 10 patients react to it with unanticipated emotional or physical reactions. Research has paid much attention to how bad news should be shared, but considerably less to what news is perceived as bad, despite the fact this may dictate elements of its delivery.
METHODS: Two cross-sectional, online, mixed-method surveys (active 7 January-16 July 2022) were distributed to fertility staff and patients across the UK and Europe.
METHODS: Staff inclusion criteria were being a healthcare professional working in fertility care and having experience of sharing bad news at least once a month. Patients\' inclusion criteria were being adults and having had a conversation in which staff shared or explained bad news concerning their fertility care within the last 2 months. Surveys were created in English using Qualtrics, reviewed by patients and healthcare professionals, and distributed via social media, Prolific, fertility organizations, and scientific societies. Patients were asked, regarding the last time bad news were shared with them, \'What was the bad news?\' and \'What other news would you consider bad news in fertility care?\'. Staff were asked to \'List the three most challenging topics of bad news you share with your patients\'. Staff and patient data were separately thematically analysed to produce basic codes, organized into sub-themes and themes. Themes emerging from patients\' and staff data were compared and synthesized into meta themes.
RESULTS: Three hundred thirty-four staff accessed the survey, 286 consented, and 217 completed (65% completion rate). Three hundred forty-four patients accessed the survey, 304 consented, and 222 completed (64% completion rate). Eighty-five percent of participants were women, 62% resided in Europe, and 59% were in private care. Average staff age was 45.2 (SD = 12.0), 44% were embryologists or lab technicians, 40% were clinicians (doctors, consultants, or physicians), and 8% nurses or midwifes. Average patient age was 32.2 (SD = 6.4) and 54% had children. Staff answers originated 100 codes, 19 sub-themes and six themes. Patients\' answers produced 196 codes, 34 sub-themes, and 7 themes. Staff and patient themes were integrated into three meta-themes reflecting main topics of bad news. These were Diagnosis and negative treatment events and outcomes, Inability to do (more) treatment, and Care and patient factors disrupting communication. Staff and patients agreed that some news features (uncertain, disruptive, definitive) made news more challenging but disagreed in relation to other features (e.g. unexpected/expected). Patient factors made bad news more challenging to staff (e.g. difficult emotions) and care factors made bad news more challenging to patients (e.g. disorganized care).
CONCLUSIONS: Participants were self-selected, and most were women from private European clinics. Questions differed for staff and patients, focused on subjective perceptions of news, and did not measure news impact.
CONCLUSIONS: The badness of fertility news is not only a product of the extent to which the news compromises parenthood goals but also of its features (timing, nature, number) and the context in which the news is delivered. Guidance on sharing bad news in fertility care needs to go beyond easing the process for patients to also consider staff experiences. Guidance may need to be tailored to news features and context.
BACKGROUND: Cardiff University funded the research. S.G., J.B., O\'.H., and A.D. report funding from the Higher Education Funding Council for Wales and the European Society for Human Reproduction and Embryology (ESHRE) to develop fertiShare: a sharing bad news eLearning course for fertility care. fertiShare will be distributed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). No other conflicts are reported in relation to this work.
BACKGROUND: N/A.