"I'm sorry to tell you ..." physicians' reports of breaking bad news.

Department of Psychology, Bucknell University, Lewisburg, Pennsylvania 17837, USA.
Journal of Behavioral Medicine (Impact Factor: 3.1). 05/2001; 24(2):205-17. DOI: 10.1023/A:1010766732373
Source: PubMed

ABSTRACT In this investigation the authors assessed what physicians do when planning for and delivering bad news to patients. Seventy-three physicians responded to a series of statements about the behaviors, thoughts, and feelings they might have had while preparing for and delivering bad medically-related news. Data were also obtained about how well they thought the transaction had gone, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. Physicians reported that these transactions were only moderately stressful, with 18.1% and 18.7% indicating that preparation stress or delivery stress, respectively, were above the midpoint on the scale. Slightly over 42% of the sample indicated that the stress they experienced lasted from several hours to three or more days. Thirty-six delivery-related statements were typical (with endorsement rates of at least 80% in a given direction) for at least one of the two recall groups.

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    Journal of Creativity in Mental Health 07/2013; 8(3):265-277. DOI:10.1080/15401383.2013.821926
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    ABSTRACT: PREFACE BY Professor Raphael Mechoulam Breast cancer is a brutal disease. About 8-9% of all women get breast cancer and it is by far the most prevalent female cancer. According to the World Health Organization breast cancer accounts for 16% of all types of cancer deaths globally. Total deaths of cancer amount to 7,600,000, whereas total breast cancer deaths are 460,000. The incidence rates of breast cancer are increasing and the reasons for this increase are not clear. Although research over the last few decades has discovered many of the mechanisms of breast cancer, we are still far away from fully understanding its devious routes. We have however learned that breast cancer is the result of several different disease pathways, each of which has to be blocked by different pharmacological agents. Numerous drugs are now available and they save millions of lives. But we know now that there is not a single drug that can be compatible for all patients. What do we know of these mechanisms? In brief, there is a subtype (named Luminal A) which is associated with the female hormone estrogen. It develops relatively slowly and the prognosis to treat this breast cancer subtype is generally good. In contrast, a second, related subtype (named Luminal B) is similar to Luminal A tumors. It is also associated with estrogen but it develops faster and the prognosis is by far not as good when compared to the Luminal A type. A third subtype (HER-2) depends on specific genes known as HER2 genes and it has an overall poor prognosis. The forth subtype is not associated with the female hormones or with the HER2 genes; it grows fast and it has a poor prognosis. The treatment of these different types of breast cancer requires different approaches. Hence the first step of modern cancer treatment today needs the establishment of the subtype by investigating the genes of the patient involved and only then should the appropriate treatment be undertaken. In this field of medicine science is indeed opening the door to more personal, individualized therapy. Indeed breast cancer associated with female hormones is treated with tamoxifen which blocks the receptor of the female hormone progesterone and specific anti-HER2 treatments result in improvements in the clinical outcome of patients with HER2- positive breast cancer. For instance Trastuzumab is efficient in early and advanced HER2 breast cancer treatment. This personal, individualized therapy will expand rapidly and maybe, just may be, the grim statistics will improve. However a major problem in cancer therapy is the rapidly formed resistance of the cancer cells to anti-cancer drugs. Cancer cells learn very fast how to get rid of the cancer drug entering the cell. They also learn very fast how to metabolize – and thus neutralize - the drug. The fight against cancer now proceeds on this front too. A very recent observation is that cannabidiol – a constituent of the plant Cannabis sativa – can block the mechanism through which the cancer cell gets rid of the anti-cancer drug. Unexpectedly, recently it was also shown that cannabidiol affects not only proliferation of cancer cells , but also interferes with two other crucial steps of breast cancer cell progression, namely invasion of other tissues and metastasization – transportation to far away organs. May be cannabidiol will lead us to novel anti-cancer drugs acting on several of the cancer mechanisms. At present however neither cannabidiol nor related drugs have been tested in human patients. In the present, excellent book Dr Zornitza Ganeva looks mostly at other aspects of the dreadful disease – the psychological effects of breast cancer on the patient: the initial shock, the slow realization of possible death, the ways to minimize the anxiety and the depression. She thoroughly discusses the existing literature on psycho-oncology and has succeeded in admirably summarizing and presenting it. This book should be seen not only as an academic book, but should also reach – and help – patients. Professor Raphael Mechoulam Head, Division of Science, Israel Academy of Sciences.
    12/2014; Елестра ЕООД., ISBN: 978-954-90789-7-8