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Complementary and alternative medicine (CAM) disclosure to health care providers: A qualitative insight from Malaysian thalassemia patients

Ismail WI, Ahmad Hassali MA, Farooqui M, Saleem F, Roslan MNF

Complement Ther Clin Pract, 2018 Nov;33:71-76.
PMID: 30396630 DOI: 10.1016/j.ctcp.2018.06.004

BACKGROUND AND PURPOSE: This study investigated the disclosure of complementary and alternative medicine (CAM) use to health care providers by Malaysian thalassemia patients.
METHODS: The semi-structured interviews were audio taped, transcribed verbatim, and translated into English.
RESULTS: Thematic analysis identified four themes: 1) reason for CAM disclosure, 2) attempt to disclose CAM, 3) withdrawal from CAM disclosure, and 4) non-disclosure of CAM use. The reason for patients' disclosure of CAM use to healthcare providers is because they wanted to find information about CAM and were afraid of the interaction between the conventional medicine and CAM. Patients also disclosed the use of CAM because they were not satisfied with the conventional medicine that had caused them harm.
CONCLUSION: Effective communication between patients and health care providers is important, especially for patients who are undergoing conventional thalassemia treatment, for fear that there is an interaction between conventional treatment and CAM use.

Matched MeSH terms: Physician-Patient Relations*
Fulltext Cancer: to tell or not to tell?

Sng KH

Singapore Med J, 1994 Feb;35(1):115.
PMID: 8009271
Matched MeSH terms: Physician-Patient Relations*
Fulltext Communication practices for delivering health behaviour change conversations in primary care: a systematic review and thematic synthesis

Albury C, Hall A, Syed A, Ziebland S, Stokoe E, Roberts N, et al.

BMC Fam Pract, 2019 08 03;20(1):111.
PMID: 31376830 DOI: 10.1186/s12875-019-0992-x

BACKGROUND: Clinical guidelines exhort clinicians to encourage patients to improve their health behaviours. However, most offer little support on how to have these conversations in practice. Clinicians fear that health behaviour change talk will create interactional difficulties and discomfort for both clinician and patient. This review aims to identify how healthcare professionals can best communicate with patients about health behaviour change (HBC).
METHODS: We included studies which used conversation analysis or discourse analysis to study recorded interactions between healthcare professionals and patients. We followed an aggregative thematic synthesis approach. This involved line-by-line coding of the results and discussion sections of included studies, and the inductive development and hierarchical grouping of descriptive themes. Top-level themes were organised to reflect their conversational positioning.
RESULTS: Of the 17,562 studies identified through systematic searching, ten papers were included. Analysis resulted in 10 top-level descriptive themes grouped into three domains: initiating; carrying out; and closing health behaviour change talk. Of three methods of initiation, two facilitated further discussion, and one was associated with outright resistance. Of two methods of conducting behaviour change talk, one was associated with only minimal patient responses. One way of closing was identified, and patients did not seem to respond to this positively. Results demonstrated a series of specific conversational practices which clinicians use when talking about HBC, and how patients respond to these. Our results largely complemented clinical guidelines, providing further detail on how they can best be delivered in practice. However, one recommended practice - linking a patient's health concerns and their health behaviours - was shown to receive variable responses and to often generate resistance displays.
CONCLUSIONS: Health behaviour change talk is smoothly initiated, conducted, and terminated by clinicians and this rarely causes interactional difficulty. However, initiating conversations by linking a person's current health concern with their health behaviour can lead to resistance to advice, while other strategies such as capitalising on patient initiated discussions, or collaborating through question-answer sequences, may be well received.

Matched MeSH terms: Physician-Patient Relations*
Perception of Patients, Physicians, and Chaperones Regarding the Use of Chaperones During Patient Examinations for Plastic Surgery: A Systematic Review

Ou KQ, Wong ZN, Wong ZY

Plast Aesthet Nurs (Phila), 2024 04 19;44(2):140-146.
PMID: 38639973 DOI: 10.1097/PSN.0000000000000560

In this systematic review, we searched electronic databases for literature addressing physician use of chaperones during examinations of patients undergoing plastic surgery from the perspective of the patient, physician, and chaperone from inception of the database until April 2023. After screening 939 articles, we included seven studies in a systematic review. We conducted an inductive thematic analysis of four domains (physician perspective, patient perspective, chaperone perspective, and chaperone documentation). The results of the analysis showed that surgeons who are experienced, are men, or have received education related to using chaperones are more likely to provide chaperones during patient examinations for medicolegal protection and patient comfort. A small percentage of surgeons have faced accusations from patients of inappropriate behavior. Most of these incidents have occurred without a chaperone present. Patients who have long associations with a particular plastic surgery practice are less likely to want a chaperone. When physicians examine nonsensitive areas, most patients prefer having no chaperone. However, young patients and patients undergoing reconstructive procedures are more likely to request chaperones. Patients prefer having family members or friends serve as chaperones. Notably, despite the presence of a chaperone, we found that documentation of the presence of a chaperone was inadequate. Using a chaperone helps establish trust and ensure patient comfort. Further research, including qualitative studies and multinational approaches, is warranted to gain deeper insights and develop comprehensive guidelines for chaperone use that empowers both patients and health care providers.

Matched MeSH terms: Physician-Patient Relations*
Fulltext Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018

Tay KT, Ng S, Hee JM, Chia EWY, Vythilingam D, Ong YT, et al.

J Med Educ Curric Dev, 2020 10 16;7:2382120520955159.
PMID: 33150208 DOI: 10.1177/2382120520955159

Background: Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.
Methods: Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles.
Results: 3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism.
Conclusions: Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.

Matched MeSH terms: Physician-Patient Relations
Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia

Mohd Mydin FH, Othman S

J Interpers Violence, 2020 11;35(23-24):6041-6066.
PMID: 29294874 DOI: 10.1177/0886260517726411

This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.

Matched MeSH terms: Physician-Patient Relations
Fulltext Stopping doctor-patient communication gap: the ten essential methods

Khalib, A.L., Farid, A.R.

Malaysian Journal of Community Health, 2010;16(1):48-53.
MyJurnal

Background: An effective doctor-patient communication has increasingly being recognized as an important factor in patient care. All means should be oriented towards narrowing communication gap. The essential methods must be searched and doctor must be able to conduct communication session in more pleasing manner.
Methodology: This is a systematic review on observations made on doctor-patient relationship on various setting and supported by feedbacks from many scholars who are involved in research, teaching and also papers and studies on the said subject.
Results: It is been realized that effective communication is not easily done if its process not well complemented and the gap is left widening. From all possible communication gaps recognized and listed, at least ten have identified to be the most essential methods to be prioritized while counseling or consulting a patient.
Conclusion: Effective communication between patient and doctor is the essential prerequisite of good medical practice and especially important for accurate diagnosis and effective treatment. Its mutual benefit can only be observed if all efforts are centered towards managing the communication gap.

Matched MeSH terms: Physician-Patient Relations
Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia

AlFaris E, Irfan F, Abouammoh N, Zakaria N, Ahmed AM, Kasule O, et al.

BMC Med Ethics, 2023 Jun 07;24(1):39.
PMID: 37287002 DOI: 10.1186/s12910-023-00918-9

INTRODUCTION: Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients' perspective.
METHODS: Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software.
RESULTS: Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not.
DISCUSSION/CONCLUSIONS: The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.

Matched MeSH terms: Physician-Patient Relations
Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models

Lau I, Wong YH, Yeong CH, Abdul Aziz YF, Md Sari NA, Hashim SA, et al.

Quant Imaging Med Surg, 2019 Jan;9(1):107-114.
PMID: 30788252 DOI: 10.21037/qims.2019.01.02

Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.

Matched MeSH terms: Physician-Patient Relations
Breaking News of Cancer Diagnosis: A Qualitative Study on the Experiences and Emotional Needs of Patients With Cancer in a Multiethnic Asian Setting

Wong LP, Kong YC, Bhoo-Pathy NT, Subramaniam S, Bustamam RS, Taib NA, et al.

JCO Oncol Pract, 2021 04;17(4):e548-e555.
PMID: 32986532 DOI: 10.1200/JOP.20.00002

PURPOSE: The breaking of news of a cancer diagnosis is an important milestone in a patient's cancer journey. We explored the emotional experiences of patients with cancer during the breaking of news of a cancer diagnosis and the arising needs in a multiethnic Asian setting with limited supportive cancer care services.
METHODS: Twenty focus group discussions were conducted with 102 Asian patients with cancer from diverse sociodemographic backgrounds. Thematic analysis was performed.
RESULTS: While most participants, especially younger patients with young children, experienced intense emotional distress upon receiving a cancer diagnosis, those with a family history of cancer were relatively calm and resigned. Nonetheless, the prior negative experience with cancer in the family made affected participants with a family history less eager to seek cancer treatment and less hopeful for a cure. Although a majority viewed the presence of family members during the breaking of bad news as important, a minority opted to face it alone to lessen the emotional impact on their family members. Difficulties disclosing the news of a cancer diagnosis to loved ones also emerged as an important need. Sensitive and empathetic patient-physician communication during the breaking of news of a cancer diagnosis was stressed as paramount.
CONCLUSION: A patient-centered communication approach needs to be developed to reduce the emotional distress to patients and their families after the breaking of bad news of a cancer diagnosis. This is expected to positively affect the patients' subsequent coping skills and attitudes toward cancer, which may improve adherence to cancer therapy.

Matched MeSH terms: Physician-Patient Relations
Fulltext Non-verbal cues: an inevitable assessing skills in doctor-patient relationship

Khalib, A.L., Madihah, A.B.

Malaysian Journal of Community Health, 2010;16(1):33-37.
MyJurnal

Introduction: Non-verbal cues are untold words that carry a significant meaning. As a doctor, this remark needs to be perceived correctly. It is an inevitable communication knowledge and skills ought to be mastered in any doctorpatient relationship, particularly when making patient’s assessment.
Methodology: This was a systematic communication assessment of a real observations on doctor-patient relationship in various setting. It was supported by feedbacks from many scholars who were involved in research and teaching and also reviews, papers and studies on the said subject.
Results: It has been realized that non-verbal communication was equally important and necessary to complement the verbal one. From all non-verbal cues we have recognized and listed, we have identified at least ten to be the most vital areas to be observed while counseling or consulting a patient.
Conclusion: Non-verbal cues were always present to support doctor in making a final conclusion about his/her patient’s state. If doctor was patience enough, he or she could has a complete profile of his/her patient and this would lead to the improvement in a person’s life. Having an observant attitude and being able to nose around appropriately were skills that have to be learnt, experienced and applied as these might make an effective doctor-patient communication.

Matched MeSH terms: Physician-Patient Relations
Fulltext Should doctors apologize and disclose medical errors?

Aimi Nadia Mohd Yusof

Medical Health Reviews, 2009;2009(2):5-16.
MyJurnal

No vaccination is available to provide doctors with the immunity from errors and mistakes. Humans make mistakes everyday and eventually doctors will make mistakes or errors during their practice. Therefore, knowing how to handle the mistakes is crucial in improving patient safety and management. Disclosure of errors can be argued to play a significant role in respecting the patients’ rights and interest. We need to know that in a doctor-patient relationship, trust and vulnerability exist. If errors occur and doctors try to keep patients away from the truth, patients may no longer maintain their trust and this could lead to a negative turn in the relationship. Moreover, if errors are disclosed, doctors then may face a legal and ethical dilemma on whether to apologize for the errors made. This issue of apology has created debates among health professionals and lawyers in searching for the best answer. Apology can be a powerful tool to reconcile relationships but at the same time can also be a tool of deception.

Matched MeSH terms: Physician-Patient Relations
Fulltext Professional conduct of clinical teachers: perspectives of medical students

Harlina H. Siraj, Salam, A., Juriza, I., Zaleha A. Mahdy, Nabishah, M.

Education in Medicine Journal, 2014;6(3):13-19.
MyJurnal

Introduction: Appropriate professional conduct of clinical teacher is vital in their medicine practice. In UKM medical centre Malaysia, personal and professional development (PPD) of future medical professionals is greatly emphasized. The objective of this study was to determine the medical students' perception about the professional conduct of their clinical teachers at UKM medical centre. Methods: It was an online questionnaire survey conducted among the clinical students enquiring about the professional conduct of their clinical teachers. There were five statements and one open ended question which described students' preference about PPD teaching- learning method, expectation on PPD session, need of teachers training and experience about the excellent and inappropriate professional conduct of clinical teachers. The open ended question described what students had observed regarding the 'doctor-patient relationship' medical ethics and 'student-teacher relationship. A total of 77 questionnaires were returned after complete evaluation. The data were compiled and analysed using SPSS version 20 and the answers to the open ended questions were transcribed. Result: Role modelling was the preferred teaching-learning method for PPD as stated by 38% respondents; subsequent preferred methods were small group (30%), role play (24%), large group (7%) and reflective writing (1%). Majority (67.5%) respondents indicated that professional conduct of their clinical teachers was frequent enough as they had expected while 29.9% claimed that professional conduct was infrequently emphasized. Excellent professional conduct of clinical teachers was witnessed by 73% respondents while 27% indicated that they had never seen excellent conduct. When asked about inappropriate professional behaviours by clinical teachers, 53% indicated to have witnessed. Qualitative data also revealed both positive and negative experiences as reflected in open comments. According to 70% respondents clinical teachers required training to apply PPD in their daily practices. Conclusion: Professional conduct of clinical teachers as perceived by the students was excellent and frequents enough with experience of inappropriate behaviour too. Role modeling was the preferred teaching method while attention needed on reflective assignment. Educators must emphasize on role modelling in their daily practices and curriculum planners should give due importance on training needs of clinical teachers to apply PPD in their daily practices.

Matched MeSH terms: Physician-Patient Relations
Fulltext Autonomy to refuse: please doctor, I want to fast, I don't want my medications

Kumurasamy V, Ahmad Fairuz M, Taib F, Mat Pa MN, Mohd Nazri S, Norzila Z, et al.

Education in Medicine Journal, 2014;6(1):66-69.
MyJurnal

This paper discusses the ethical issues of patient autonomy based on a case of a patient who refused medication during Ramadhan fasting period. Issues on patient autonomy include the right of a patient to refuse medication, informed decision making, the importance of effective communication and the physician roles and responsibilities are discussed. In conclusion, patient autonomy must be respected and valued. However, the need of effective communication in facilitating informed decision making to improve doctor-patient relationship, should not be overlooked and compromised.

Matched MeSH terms: Physician-Patient Relations
Fulltext Optimizing the multidimensional aspects of the patient-physician relationship in the management of inflammatory bowel disease

Chew D, Zhiqin W, Ibrahim N, Ali RAR

Intest Res, 2018 10;16(4):509-521.
PMID: 30369231 DOI: 10.5217/ir.2018.00074

The patient-physician relationship has a pivotal impact on the inflammatory bowel disease (IBD) outcomes. However, there are many challenges in the patient-physician relationship; lag time in diagnosis which results in frustration and an anchoring bias against the treating gastroenterologist, the widespread availability of medical information on the internet has resulted in patients having their own ideas of treatment, which may be incongruent from the treating physicians' goals resulting in patient physician discordance. Because IBD is an incurable disease, the goal of treatment is to sustain remission. To achieve this, patients may have to go through several lines of treatment. The period of receiving stepping up, top down or even accelerated stepping up medications may result in a lot of frustration and anxiety for the patient and may compromise the patient-physician relationship. IBD patients are also prone to psychological distress that further compromises the patient-physician relationship. Despite numerous published data regarding the medical and surgical treatment options available for IBD, there is a lack of data regarding methods to improve the therapeutic patient-physician relationship. In this review article, we aim to encapsulate the challenges faced in the patient-physician relationship and ways to overcome in for an improved outcome in IBD.

Matched MeSH terms: Physician-Patient Relations
A Multinational Study of Patient Preferences for How Decisions Are Made in Their Care

Pines R, Sheeran N, Jones L, Pearson A, Pamoso AH, Jin YB, et al.

Med Care Res Rev, 2023 Apr;80(2):205-215.
PMID: 35815591 DOI: 10.1177/10775587221108749

Inadequate consideration has been given to patient preferences for patient-centered care (PCC) across countries or cultures in our increasingly global society. We examined what 1,698 participants from the United States, Hong Kong, Philippines, and Australia described as important when making health care decisions. Analysis of frequencies following directed content coding of open-ended questions revealed differences in patients' preferences for doctor behaviors and decision-making considerations across countries. Being well informed by their doctor emerged as most important in decision-making, especially in Hong Kong. Participants in Australia and the United States wanted their doctor to meet their emotional needs. The safety and efficacy of treatments were the most common consideration, especially for Hong Kong. Findings suggest that doctors should focus on information exchange and identifying patient concerns about efficacy, lifestyle impact, cost, and recovery speed. Rather than assuming patients prefer shared decision-making, doctors must assess patient's decision control preferences.

Matched MeSH terms: Physician-Patient Relations
Development and validation of a medication non-adherence scale for Malaysian hypertensive patients: a mixed-methods study

Yew SQ, Tan KA, Nazan AINM, Manaf RA

Environ Health Prev Med, 2023;28:75.
PMID: 38057094 DOI: 10.1265/ehpm.23-00223

BACKGROUND: Non-adherence to anti-hypertensive medications can lead to hypertension-related complications. One of the most effective preventive measures to mitigate these complications is to understand the underlying determinants of medication non-adherence using various scales. Unfortunately, existing scales for measuring non-adherence to anti-hypertensive medications have certain limitations, such as insufficient consideration of validity, dimensionality, and cultural adaptation. In response, the current study aimed to develop and validate a measure of non-adherence to anti-hypertensive medications-known as the Malaysian Anti-hypertensive Agent Non-Adherence Scale (MAANS)-for use in local hypertensive patients.
METHODS: A two-phase mixed-methods approach was used. Phase 1 involved qualitative interviews with hypertensive patients from two health clinics in Kuala Lumpur, Malaysia. The themes extracted from these interviews were used to generate items for the MAANS. In Phase 2, data from 213 participants were analysed using exploratory factor analysis (EFA) to establish the scale's factor structure, thereby created the modified version of the MAANS. Confirmatory factor analysis (CFA) was then conducted on a separate dataset of 205 participants to confirm the factor structure, resulted in the final version of the MAANS. The reliability of the final MAANS version was assessed using Cronbach's alpha coefficient. The MAANS scores were used to predict subscales of the Malay version of the WHO Quality-of-Life (QOL) BREF, demonstrating the scale's predictive validity.
RESULTS: Ten qualitative interviews yielded 73 items. The EFA produced a modified MAANS with 21 items grouped into five factors. However, the CFA retained three factors in the final scale: Perceived Non-Susceptibility, Poor Doctor-Patient Relationship, and Unhealthy Lifestyle. The final 14-item, 3-factor MAANS demonstrated moderate reliability (Cronbach's alpha coefficient = 0.64) and exhibited partial predictive validity, with the Poor Doctor-Patient Relationship and Unhealthy Lifestyle subscales significantly predicting Social QOL and Environmental QOL.
CONCLUSION: The MAANS is a reliable, valid, and multidimensional scale specifically developed to evaluate non-adherence to anti-hypertensive medications in local clinical settings with the potential to further the advancement of research and practice in sociomedical and preventive medicine.

Matched MeSH terms: Physician-Patient Relations
Fulltext Medical professionalism from a socio-cultural perspective: evaluating medical residents communicative attitudes during the medical encounter in malaysia

Ganasegeran K, Al-Dubai SA

J Postgrad Med, 2014 Jan-Mar;60(1):12-5.
PMID: 24625933 DOI: 10.4103/0022-3859.128799

The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care.

Matched MeSH terms: Physician-Patient Relations*
Fulltext The pre-employment medical--ethical dilemmas for GPs

Thuraisingham C, Nalliah S

Aust Fam Physician, 2013 Apr;42(4):249-51.
PMID: 23550254

In many workplaces, employment is conditional on a successful pre-employment medical examination. This examination is usually conducted by a general practitioner on the employers' panel of approved clinics or by an in-house company doctor.

Matched MeSH terms: Physician-Patient Relations/ethics
Preferences of Malaysian cancer patients in communication of bad news

Eng TC, Yaakup H, Shah SA, Jaffar A, Omar K

Asian Pac J Cancer Prev, 2012;13(6):2749-52.
PMID: 22938453

BACKGROUND: Breaking bad news to cancer patients is a delicate and challenging task for most doctors. Better understanding of patients' preferences in breaking bad news can guide doctors in performing this task.
OBJECTIVES: This study aimed to describe the preferences of Malaysian cancer patients regarding the communication of bad news.
METHODOLOGY: This was a cross-sectional study conducted in the Oncology clinic of a tertiary teaching hospital. Two hundred adult cancer patients were recruited via purposive quota sampling. They were required to complete the Malay language version of the Measure of Patients' Preferences (MPP-BM) with minimal researcher assistance. Their responses were analysed using descriptive statistics. Association between demographic characteristics and domain scores were tested using non-parametric statistical tests.
RESULTS: Nine items were rated by the patients as essential: "Doctor is honest about the severity of my condition", "Doctor describing my treatment options in detail", "Doctor telling me best treatment options", Doctor letting me know all of the different treatment options", "Doctor being up to date on research on my type of cancer", "Doctor telling me news directly", "Being given detailed info about results of medical tests", "Being told in person", and "Having doctor offer hope about my condition". All these items had median scores of 5/5 (IQR:4-5). The median scores for the three domains were: "Content and Facilitation" 74/85, "Emotional Support" 23/30 and "Structural and Informational Support" 31/40. Ethnicity was found to be significantly associated with scores for "Content and Facilitation" and "Emotional Support". Educational status was significantly associated with scores for "Structural and Informational Support".
CONCLUSION: Malaysian cancer patients appreciate the ability of the doctor to provide adequate information using good communication skills during the process of breaking bad news. Provision of emotional support, structural support and informational support were also highly appreciated.

Matched MeSH terms: Physician-Patient Relations*

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