%0 Journal Article
%~ PubMed
%A Shaw, Joanne M
%A Brown, Rhonda F
%A Dunn, Stewart M
%T A qualitative study of stress and coping responses in doctors breaking bad news.
%B Patient Education and Counseling
%D 2013
%C Ireland
%I Elsevier Ireland Ltd.
%V 91
%N 2
%P 243-248
%@ 1873-5134
%X 
%Z FOR Codes: 1103 1701


%0 Journal Article
%~ PubMed
%A Shaw, Joanne
%A Dunn, Stewart
%A Heinrich, Paul
%T Managing the delivery of bad news: An in-depth analysis of doctors' delivery style.
%B Patient Education and Counseling
%D 2012
%C Ireland
%I Elsevier Ireland Ltd
%V 87
%N 2
%P 186-192
%@ 1873-5134
%X OBJECTIVE: The purpose of this study was to identify and describe the delivery styles doctors typically use when breaking bad news (BBN). METHODS: Thirty one doctors were recruited to participate in two standardised BBN consultations involving a sudden death. Delivery styles were determined using time to deliver the bad news as a standardised differentiation as well as qualitative analysis of interaction content and language style. Communication performance was also assessed. RESULTS: Analysis of BBN interactions revealed three typical delivery styles. A blunt style characterised by doctors delivering news within the first 30s of the interaction; Forecasting, a staged delivery of the news within the first 2min and a stalling approach, delaying news delivery for more than 2min. This latter avoidant style relies on the news recipient reaching a conclusion about event outcome without the doctor explicitly conveying the news. CONCLUSION: Three typical bad news delivery styles used by doctors when BBN were confirmed both semantically and operationally in the study. The relationship between delivery style and the overall quality of BBN interactions was also investigated. PRACTICE IMPLICATIONS: This research provides a new template for approaching BBN training and provides evidence for a need for greater flexibility when communicating bad news.
%Z FOR Codes: 110399 110399


%0 Journal Article
%~ PubMed
%A Tolerton, Sarah K
%A Shaw, Joanne
%A O'Reilly, Amanda
%A Dunn, Stewart
%A Boyle, Frances M
%T Exploring consent to randomized placebo-controlled clinical trials in oncology.
%B Asia Pacific Journal of Clinical Oncology
%D 2011
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 7
%N 3
%P 300-306
%@ 1743-7563
%X Aims:??? Randomized placebo-controlled trials are critical for advancing knowledge in oncology, yet little is known about optimal communication for informed consent. This study aimed to identify patient preferences for and satisfaction with three consultation styles (information-focused, emotion-focused and collaborative) in simulated discussions of four clinical trial concepts (randomization, placebo, tissue analysis and oncologists'' recommendation). Methods:??? In total 75 Australian cancer patients and carers, or both, viewed videotaped simulated consultations with a doctor and patient discussing a randomized, placebo-controlled trial. Their satisfaction and preferences for both consultation style and information were assessed. The patients'' characteristics and decision-making preferences were also evaluated as potential predictors for consultation style preference. Results:??? Participants preferred a collaborative consultation style when discussing randomization (74.6%), placebo (71.4%) and oncologist''s recommendation (77%). However an emotion-focused consultation style was preferred when discussing tissue analysis (81%). The participants represented a highly information-seeking group, although most favoured collaborative or passive roles in treatment decision-making. Limited variables were identified that predict consultation style preference. Conclusion:??? While supporting the value of a collaborative approach to clinical trial communications, the study finding that tissue analysis requires a more emotion-focused approach highlights a new focus for trial communication and confirms the need for doctors to remain flexible in their consultation style.
%Z FOR Codes: 111204


%0 Journal Article
%~ PubMed
%A Livingston, Patricia M
%A White, Victoria M
%A Hayman, Jane
%A Maunsell, Elizabeth
%A Dunn, Stewart M
%A Hill, David
%T The psychological impact of a specialist referral and telephone intervention on male cancer patients: a randomised controlled trial.
%B Psycho-oncology
%D 2010
%C United Kingdom, United States
%I John Wiley & Sons Ltd.
%V 19
%N 6
%P 617-25
%@ 1099-1611
%X To examine the psychological impact of a referral and telephone intervention, involving information and support, among men with colorectal cancer (CRC) and prostate cancer.
%Z FOR Codes: 111299


%0 Journal Article
%~ PubMed
%A Brown, Rhonda
%A Dunn, Stewart
%A Byrnes, Karen
%A Morris, Richard
%A Heinrich, Paul
%A Shaw, Joanne
%T Doctors' stress responses and poor communication performance in simulated bad-news consultations.
%B Academic Medicine
%D 2009
%C United States
%I Lippincott Williams & Wilkins
%V 84
%N 11
%P 1595-1602
%@ 1938-808X
%X PURPOSE: No studies have previously evaluated factors associated with high stress levels and poor communication performance in breaking bad news (BBN) consultations. This study determined factors that were most strongly related to doctors'' stress responses and poor communication performance during a simulated BBN task. METHOD: In 2007, the authors recruited 24 doctors comprising 12 novices (i.e., interns/residents with 1-3 years'' experience) and 12 experts (i.e., registrars, medical/radiation oncologists, or cancer surgeons, with more than 4 years'' experience). Doctors participated in simulated BBN consultations and a number of control tasks. Five-minute-epoch heart rate (HR), HR variability, and communication performance were assessed in all participants. Subjects also completed a short questionnaire asking about their prior experience BBN, perceived stress, psychological distress (i.e., anxiety, depression), fatigue, and burnout. RESULTS: High stress responses were related to inexperience with BBN, fatigue, and giving bad versus good news. Poor communication performance in the consultation was related to high burnout and fatigue scores. CONCLUSIONS: These results suggest that BBN was a stressful experience for doctors even in a simulated encounter, especially for those who were inexperienced and/or fatigued. Poor communication performance was related to burnout and fatigue, but not inexperience with BBN. These results likely indicate that burnout and fatigue contributed to stress and poor work performance in some doctors during the simulated BBN task.
%Z FOR Codes: 110319


%0 Journal Article
%~ PubMed
%A Brown, R F
%A Valpiani, E M
%A Tennant, C C
%A Dunn, S M
%A Sharrock, M
%A Hodgkinson, S
%A Pollard, J D
%T Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis.
%B Psychology and psychotherapy
%D 2009
%C United Kingdom
%I The British Psychological Society
%V 82
%N Pt 1
%P 41-56
%@ 1476-0835
%X OBJECTIVES: No longitudinal studies have concurrently evaluated predictors of anxiety, depression, and fatigue in people with multiple sclerosis (PwMS). This study determined factors that best predicted anxiety, depression, and fatigue in MS patients from a large pool of disease, cognitive, life-event stressor (LES), psychosocial, life-style, and demographic factors. DESIGN: A 2-year prospective longitudinal study evaluated predictors of psychological distress and fatigue in PwMS. METHODS: One hundred and one consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. LES, anxiety, depression, and fatigue were assessed at baseline and at 3-monthly intervals for 2-years. Disease, cognitive, demographic, psychosocial, and life-style factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS: Depression strongly predicted anxiety and fatigue, and anxiety and fatigue strongly predicted later depression. Psychological distress (i.e. anxiety, depression) was also predicted by a combination of unhealthy behaviours (e.g. drug use, smoking, no exercise, or relaxation) and psychological factors (e.g. low optimism, avoidance coping), similar to the results of community-based studies. However, state-anxiety and fatigue were also predicted by immunotherapy status, and fatigue was also predicted by LES and demographics. CONCLUSIONS: These results suggest that similar factors might underpin psychological distress and fatigue in MS patients and community-well samples, although MS treatment factors may also be important. These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety, depression, or fatigue.
%Z FOR Codes: 1109


%0 Journal Article
%~ PubMed
%A Iedema, Rick
%A Jorm, Christine
%A Wakefield, John
%A Ryan, Cherie
%A Dunn, Stewart
%T Practising Open Disclosure: clinical incident communication and systems improvement.
%B Sociology of health & illness
%D 2008
%C United Kingdom
%I Wiley-Blackwell
%V 31
%N 0
%P 262-77
%@ 1467-9566
%X This article explores the way that professionals are being inducted into articulating apologies to consumers of their services, in this case clinicians apologising to patients. The article focuses on the policy of Open Disclosure that is being adopted by health care organisations in the US, Canada, the UK and Australia and other nations. Open Disclosure policy mandates ''open discussion of clinical incidents'' with patient victims. In Australia, Open Disclosure policy implementation is currently being complemented by intensive staff training, involving simulation of apology scenarios with actor-patients. The article presents an analysis of data collected from such training sessions. The analysis shows how simulated apologising engages frontline staff in evaluating the efficacy of their disclosures, and how staff may thereby be inducted into reconciling their affective and reflexive sensibilities with their organisational and professional responsibilities, and thereby produce the required organisational apology. The article concludes that Open Disclosure, besides potentially relaxing tensions between clinicians and consumers, may also affect how staff experience and enact their role in the overall system of health care organisation.
%Z FOR Codes: 111709