Steps And Elements Of Breaking Bad News In Doctor-patient Communication Based On Chinese Context

In recent years,intensified conflicts between doctors and patients.These emerging conflicts not only poses a great threat to the personal safety of doctors,but also causes great harm to the positive development of the relationship between doctors and patients,and social trust is even more in crisis.Regarding the actual situation of the domestic doctor-patient relationship,both the medical field and the public media field are advocating mutual understanding and facilitating effective dialogues between doctors and patients.Breaking bad news is a significant scenario for doctor-patient communication,especially when breaking bad news involve the first occurrence,recurrence,transmission or failure of diagnosis and treatment of major diseases.It is an important field of doctor-patient conflict and test the skills as well as effectiveness of communication to a great extent.Based on this,this study uses non-participatory observation method and text analysis method.According to the non-participatory observation,the researcher found that,in the Chinese context,there are four major dilemmas for doctors in the process of breaking bad news which involve major diseases and end-of life of patients.First,family members have great obstacles to breaking bad news.Second,doctors lack knowledge and practice of the interactivity of communication.Third,doctors have insufficient understanding of the interactive process for breaking bad news.Fourthly,doctors are not skilled in identification and usage of non-verbal symbols.This study,which is conducted under the framework of interpersonal communication,using the SPIKES Model as a specific theoretical analysis framework.The researchers conducted non-participatory observations on 25 communication cases model hospitals in this field,and implemented further textual analysis of the involved non-verbal symbols,revealing the specific steps and elements in breaking bad news.Specifically including:First,in terms of the role of family members,as an important communication object,they exist in all steps of the SPIKES model.In each step of breaking bad news,the doctor regards both the family and the patient as the communication object.In the use of various elements,doctors communicate with family members,pay attention to the response,and generate guidance based on the interests of patients.This is an important response to the issue of the role of the family.Second,in terms of the nature of communication,the step of “Assessing the patient’s perception” is the prerequisite for medical staff in the “Giving knowledge and information to the patient”,and is a full response to the nature of communication and interaction.The elements of this step include: doctors need to use open-ended questions and multi-angle asking to assess the patient’s cognition,and adjust the next communication plan in real time.Third,in terms of the process of communication,the research has the following findings.The real “Giving knowledge and information to the patient” step is a procedural presentation,and the doctor usually arrives two to three times.Only by establishing a trust relationship during the step of “Assessing the patient’s knowledge of the condition”,the effect can reach the step of “Giving knowledge and information to the patient” to achieve successful notification.Breaking bad news in an emergency situation further highlights the importance of the completion of the step “Assessing the patient’s perception”.Fourth,in terms of emotion-based communication,the study found that it does not only occur in the “Addressing the patient’s emotions with empathic responses” step,but in the whole process of communication.Its specific elements include: the doctor promptly recognizes the nonverbal signs shown by the patient and the potential emotional response.Doctors themselves give full play to the role of non-verbal symbols in emotional expression by consciously controlling body language,mastering and using non-verbal communication skills.This research makes further makes important additions and revisions to the SPIKES model based on the Chinese context.In the Chinese context,between “Setting the communication environment”,and “Assessing the patient’s cognition of the condition”,the step of “Assessing the family’s cognition of bad news notification” should be added,which means the original SPIKES model should be adjusted to the SFPIKES model.This adjustment expands its communication objects in the Chinese context,revealed that family members,not just patients,are the communication objects that must be faced during the whole step of breaking bad news,and the model itself contributes to the indigenization of the model.This improvement and revision can also provide more stable academic support for the communication practice of Chinese doctors in breaking bad news.