Idea Transcript
· DIAGNOSIS - THE CANCER
BREAKING BAD NEWS OF CANCER PATIENTS' PERCEPTIONS IN SERIAN DISTRICT
I
Mathew Anak Gabriel Bain
Master of Public Health
2012
ACKNOWLEDGEMENTS
I am deeply indebted to my supervisors, Dr. Cheah Whye Lian and Associate
Professo~
Co.
Chang Ching Thon for their constant assistance, patience and guidance in order to complete this thesis, without which the whole thesis would not be possible. I would like to extend my appreciation to all the lecturers and staff at the faculty of Me and Health Science, UNIMAS and my fellow colleagues for helping out during this resem' ·h. I would also like to thank Dr. Jackson Wong Sonn Tag, the Director of Serian Hospit.al and all the staffs of the ho~pital for their kind
assistan~e,
patience and support during the
C(H1 tJur~t
of this study. Not forgetting, my beloved family for their patience, love and constant support. I would also like to extend my gracious gratitude to GOD Almighty for HIS cons
aI t
blessings and guidance in my journey. Last but not least, I would like to offer my sincere gratitude to all cancer patients from Serian district who had participated in this study, for their kind co-operation, patience and support and for spending their precious time to help making this study a success, to whom I am forever grateful.
I
oJ
I
ABSTRACT
This study aimed to assess the perceptions of cancer patients on the breaking of bad news of cancer diagnosis. The research method used was a cross sectional study on cancer patients in Serian district using Breaking bad news Assessment Schedule (BAS) questionnaire. It was conducted using snowballing sampling among cancer patients in Serian district. Face to face
'I
interview was conducted after the consent was obtained. Data was entered and analyzed using SPSS version 19. A total of 134 patients participated in this study. Majority were comfortable with the current method of breaking bad·news. The main aspects found were, the importance usage· of body language, management of time and identifying patients' key area of concerns. There were significant difference between sex and information giving (p=O.028) and general consideration (p=O.O 16) and also between age and setting the scene (p=O.042). It also illustrated that there were significant difference between the types of cancer and the setting of scene (p=O.OI8), breaking bad news techniques (p=O.OlO), eliciting concerns (p=O.003) and information giving (p=O.004). Good and effective communication skill of breaking bad news is vital to the management of cancer patients. As the incidence of new cases ·of cancer increase every year, the importance of delivering the bad news becomes more pertinent and essential. Future, study also must be conducted to identify which specific aspect of ~
.
communication should be placed more emphasis acCording to the perception of Malaysian cancer patients and formal training and guidelines be formulated on our local characteristics and specific factors for cancer patients in Malaysia.
Keywords: breaking bad news, patients' perception, cancer
II
ABSTRAK
Kajian ini bertujuan untuk menilai persepsi pesakit-pesakit kanser terhadap penyampaian berita buruk berkenaan diagnosa kanser. Kajian ini dijalankan menggunakan teknik kajian keratan rentas terhadap pesakit-pesakit kanser di daerah Serian dengan menggunakan borang kaji selidik BAS (Breaking bad news Assessment Schedule). Pesakit-pesakit kanser di daerah Serian dipilih melalui
proses "snowballing". Sesi temuramah telah dijalankan secara
seorang-perseorangan setelah kebenaran diberikan. Semua maklumat telah dimasukkan dan dianalisa melalui SPSS versi 19. Seramai 134 orang telah menyertai kajian ini. Majoritl pesakit berasa selesa dengan cara penyampain berita buruk yang sedia ada. Aspek - aspek penting yang dikenalpasti melalui kajian ini, adalah kepentingan gerak geri badan, pengurusan masa dan mengenalpasti masalah-masalah yang merisaukan pesakit. MeLalui kajian ini, terdapat beberapa perbezaan yang ketara diantara faktor jantina dengan proses penyampaian maklumat (p=O.028) dan umum (p=O.016) dan juga antara faktor umur dan penyampaian maklumat (p=O.042). Kajian ini juga mendapati bahawa ada perbezaan ketara diantara jenis-jenis kanser dan penyediaan lokasi (p=O.O 18), penyampaian diagnosa (p=O.OlO), mendalami kerisauan pesakit (p=O.003), penyampaian maklumat (p=O.004). Cara I
.
.
penyampaian berita"buruk yang baik dan efektif adalah amat penting di dalam pengurusan pesakit-pesakit kanser. Disebabkan oleh peningkatan
kes-kes kanser setiap tahun,
kepentingan ini menjadi semakin ketara. Kajian selanjutnya perlu dilakuan untuk mengenalpasti dengan lebih dalam, aspek-aspek spesifik yang perlu diperbaiki and dipentingkan mengikut persepsi pesakit-pesakit kanser di Malaysia dan seterusnya boleh digunakan untuk membuat kursus latihan serta garis panduan berkenaan dengan hal ini. rerkataan penting: penyampaian berita buruk, persepsi pesakit, kanser
III
Pusat Khidmat Maklumat Akademik UNlVERSm MALAYSIA SARAWAK
TABLE OF CONTENTS
I
ACKNOWLEDGEMENTS
ABSTRACT
ii
ABSTRAK
iii
TABLE OF CONTENTS
iv
LIST OF TABLES
vii
LIST OF APPENDICES
viii
CHAPTER 1- INTRODUCTION
1.0
Introduction
1
1.1
Background of study
1
1.2
Statement of problem
2
1.3
Research questions
4
1.4
Objectives
5
1.5
Research hypothesis
5
1.6
Significance of study
6
I
1.7
"
Operational definitions
6
\
CHAPTER 2- LITERATURE REVIEW
2.0
Introduction
8
2.1
Cancer communication
8
2.2
Breaking bad news- patients' perceptions
10
2.3
Doctors in breakipg bad news
11
IV
l
I
2.4
Breaking bad news approach
13
2.5
Conclusion
16
CHAPTER3-METHODOLOGY
3.0
Introduction
17
3.1
Research design
17
3.2
Research setting
18
3.3
Population of the study
18
-3.3.1
Inclusion criteria
' 18
. 3.3.2 Exclusion criteria
18
3.4
Sample size determination
19
3.5
Sampling method
20
3.6
Data collection method
21
3.7
Ethical approval
21
3.8
Analysis and interpretation
22
3.9
Application of the findings
22
3.10
Conclusion
23
•
CHAPTER4-RESULTS
4.0
Introduction
24
4.1
Socio-demographic characteristics of the respondents
24
4.2
Health profiles of the respondents
25
4.3
Perception of cancer patients on breaking bad news
27
4.4
Detailed results of BAS questionnaire score
27
"
v
4.5
Relationship of sub sections of BAS questionnaire with socio demographic and health profiles of the respondents
30
CHAPTER 5- DISCUSSION
5.0
Introduction
33
5.1
Discussion on findings
33
CHAPTER 6- CONCLUSION
6.1
Introduction
37
6.2
Summary
37
6.3
Limitations
38
6.4
Conclusion
38
40
REFERENCES
vi
•
I
I
LIST OF TABLES
Table 3.1
Sample size (n) for various Confidence levels
20
Table 4.1
Socio-demographic characteristics of the respondents
2S
Table 4.2
Health profiles of respondents
26
Table 4.3
Respondents' score on BAS questionnaire
27
Table 4.4
Analysis of BAS questionnaire
: .9
Table 4.5
Relationship of sub sections of BAS questionnaire with 3~
socio-demographic factors and health profiles of respondents
•
Vll
. LIST OF APPENDICES
Appendix
Title
Appendix I
Informed Consent Form
47
Appendix 2
Borang Kebenaran Maklum
49
Appendix 3
Patient Information Sheet
51
Appendix 4
Surat Maklwnat Pesakit
53 .•! .
Appendix 5
BAS Questionnaire
55
Appendix 6
Borang Kaji Selidik BAS
60
Appendix 7
Approval from the author 'to use BAS questionnaire in this study
65
Appendix 8
Ethical approval from Ministry of Health Malaysia
66
Appendix 9
National Institutes of Health Approval for conducting research
in the Ministry of Health Malaysia
Appendix 10
•
67
Serian Hospital Director's approval to conduct research in
68
Serian Hospital
Vlll
,
.
I
CHAPTER 1
INTRODUCTION
1.0 Introduction --
.-.' .
. ': .
.
This first chapter provides an overview of the background of the study in Se~tion l. i . Section 1.2 describes .the problem statement, .Section 1.3 lists out the research questions, and Section 1.4 focuses on the objectives of the study, Section 1.5 outlines the research hypothesis, Section 1.6 describes the significance of the study and Section 1.7 explains the operational definition.
•
L 1 Background of the study
Breaking bad news has always been an extra burden for medical officers and specialists, especially when dealing with diagnosis of cancer or imminent death. Bad news is defined as "any news that drastically and negatively alters the patient's view of her or his future (Buckman, 1984). Bad news can also be understood as one which is pertaining to a situation where there is feeling of no hope, a threat to a person's mental or physical wellbeing, and a risk of upsetting an established lifestyle or where a message is given which conveys to an individual fewer choices in his or her life (Bor et aI., 1993). This complexity can create serious miscommunicati