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    Breaking bad news about cancer : the experiences of patients, patients' family/whānau members and healthcare professionals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2020) Matthews, Tamyra
    Breaking bad news is a reality of medical practice in oncology, and can be a challenging task for those receiving and delivering the news. For patients and their family members, ‘bad news’ is understandably accompanied by strong emotions and ongoing implications for their lives as they adjust to the news. For healthcare professionals (HCPs), there are numerous variables to consider and balance when having these difficult conversations, as well as managing the personal impact. The current study aims to explore the subjective experiences of patients, patients’ family/whānau members, and HCPs when bad news was delivered to patients about their cancer within the surgical departments of MidCentral District Health Board. The study is designed to allow multiple perspectives to be gathered and compared, and recommendations for practice to be made that align with the goals of those involved in the project’s inception, as well as attend to the underrepresentation of family members’ perspectives and New Zealand-based data in the literature. To achieve this, the current study utilised a qualitative approach with the epistemological and methodological basis informed by interpretative phenomenological analysis. The study also included a consumer perspective with the involvement of the Otaki advisory group to guide how the study was conducted and provide feedback on the study outcomes. Data was collected through semi-structured interviews with 10 patients, 6 family/whānau members, 5 surgeons, and 6 nurses. Interviews were analysed in two ways: by participant group (i.e., patients, family members, and HCPs) and by ‘linked case’ (i.e., direct comparisons of the perspectives of all those involved in the same patient’s case of breaking bad news). The findings are presented as a series of superordinate and subordinate themes. The group-based analysis highlighted that patients understood their bad news experiences through the lens of their health beliefs and expectations of care, the relational and support needs they, and others, had during and following the encounter, and the ongoing shifts in perspective and priorities they experienced. Family members identified the patient as the focus of care, but also acknowledged their need for support in order to cope. HCPs recognised that breaking bad news was challenging based on the variation between instances of breaking bad news and patients’ needs, organisational constraints they had to work under, and the personal toll this task could take. The linked case-based analysis demonstrated that the receivers of bad news have a range of emotional and informational needs and that HCPs and family members fulfil important roles in accurately meeting patients’ needs. Four conclusions can be drawn from the study as a whole about the process of breaking bad news. Firstly, there is variability in the situations, delivery approaches and needs of those involved in breaking bad news, requiring a flexible and tailored approach. Secondly, establishing an interpersonal connection between the deliverer and receiver of bad news is a central part of the process. Thirdly, breaking bad news is a challenge for all and receiving support in order to cope, is paramount. Lastly, there is a shared responsibility across healthcare organisations, training providers, HCP teams, and individual HCPs to make this process go as well as possible for all those involved. The current research makes an important contribution to understanding that, without doubt, breaking bad news is a complex process for those delivering and receiving the news, and improvements in this area require careful consideration, prioritising and resourcing as part of delivering effective cancer care.
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    Communicating health information to Pacific women : a thesis presented in partial fulfilment to the requirements for the degree of Masters of Business Studies in Communications Management at Massey University
    (Massey University, 1997) Jameson, Anna Margaret
    The ability to acquire and use information is an essential component in the process of obtaining knowledge. It is an interesting phenomenon that people do not always access information that is beneficial for them (Chatman, 1991). As New Zealand becomes increasingly multicultural the need to communicate health messages in a culturally appropriate and effective way is expanding in importance. This study examined the nature of current methods used by Pacific women to access cervical screening information. It also explored the barriers to obtaining that information and how the participants believed communication about cervical screening should take place to reach Pacific women in a culturally appropriate way. Results are analysed in the light of the knowledge gap hypothesis. This hypothesis places emphasis on socioeconomic factors as being predictors of knowledge. Twenty Pacific women living in Palmerston North were selected for the study using the snowball sampling technique. The participants varied in age from 20 to over 50 years and their education ranged from primary to tertiary level. The third key variable was length of time in New Zealand. This ranged from three months to 33 years. Semi-structured indepth interviews of approximately two hours duration were completed. These were recorded and transcribed with the permission of the participants. Transcripts were analysed using the technique of content analysis. The study found that knowledge gaps were related to the "subject matter". The topic of cervical screening was perceived to be very sensitive because of the taboo nature of discussing topics related to sex and the sexual organs. Sensitivity appeared to be related to age and length of time in New Zealand but not to education. Socioeconomic factors did not appear to be closely linked to levels of understanding by Pacific women about cervical screening. Interest in the topic and the motivation to acquire information were more indicative of knowledge gaps. Three key barriers to successful communication were identified: cultural background, lack of confidentiality and embarrassment. Of these, cultural background was perceived by the participants to have the most significant influence on their ability to access information. Face-to-face communication was the preferred method for obtaining both health information and cervical screening information. Print, radio or visual media communications were not considered effective due to the sensitivity of the subject and the indirect nature of the media. Written communication was advocated by the participants to supplement face-to-face communication when initially finding out about cervical screening. The study suggested that holding face-to-face meetings with a health professional present, was the most effective way of reaching Pacific women. The lack of research in the area of communicating with Pacific women about health information places greater emphasis on the importance of the findings of this study. It also highlights the need to develop a subsequent body of research to ensure communication is effective, appropriate and not misdirected.