Más notícias em obstetrícia e ginecologia: Devemos falar sobre isso

Ribeiro, Luísa Silva de Carvalho; D’Abreu, Bárbara Flecha; Santiago, Aline Evangelista; Cândido, Eduardo Batista; Romão, Gustavo Salata; Sá, Marcos Felipe Silva de; Silva Filho, Agnaldo Lopes da

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev Bras Ginecol Obstet. 44 (6) • 2022 • https://doi.org/10.1055/s-0042-1742316 copiar

Más notícias em obstetrícia e ginecologia: Devemos falar sobre isso

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Dar más notícias é comum em obstetrícia e ginecologia. Porém, é difícil e poucos médicos recebem treinamento sobre como lidar com essa situação. Esta revisão narrativa tem como objetivo reunir, analisar e sintetizar parte do conhecimento sobre a área, com foco na obstetrícia. Dentre os 16 artigos selecionados, dois são estudos de intervenção randomizados e controlados, e a maioria dos estudos refere-se à obstetrícia. Os resultados encontrados ressaltaram que simulação, feedback/entrevistas, palestras e protocolos podem melhorar o desempenho dos médicos na comunicação de más notícias. Para os pacientes, o contexto e como as informações são transmitidas parecem ter maior impacto do que o conteúdo das notícias. Os obstetras e ginecologistas poderiam se beneficiar de cursos e protocolos específicos, dadas as particularidades da especialidade. Faltam evidências sobre a forma mais eficaz de realizar esse treinamento. Encontrar formas validadas de quantificar e classificar os resultados dos estudos na área, permitindo uma análise objetiva dos resultados, é um dos maiores desafios neste tema.

comunicação; más notícias; obstetrícia; ginecologia; educação médica

Author and year of publication	Area	Comments
Setubal et al. 2018⁷7 Setubal MSV, Antonio MÂRGM, Amaral EM, Boulet J. Improving perinatology residents’ skills in breaking bad news: a randomized intervention study. Rev Bras Ginecol Obstet. 2018;40(03): 137–146. Doi: 10.1055/s-0037-1621741 https://doi.org/10.1055/s-0037-1621741...	Obstetrics	Randomized controlled intervention study. Case simulation of perinatal loss: a resident physician should inform the occurrence to a simulated patient (the parent), followed by instant feedback from the actor, and both moments are filmed. The participants were then randomly allocated to the intervention group (video review + training using the SPIKES protocol) or the control group (without training). A similar simulation was then performed and analyzed, with the actor blind to the intervention.
Karkowsky et al. (2016)⁸8 Karkowsky CE, Landsberger EJ, Bernstein PS, Dayal A, Goffman D, Madden RC, et al. Breaking Bad News in obstetrics: a randomized trial of simulation followed by debriefing or lecture. J Matern Fetal Neonatal Med. 2016;29(22):3717–3723. Doi: 10.3109/ 14767058.2016.1141888 https://doi.org/10.3109/ 14767058.2016.1...	Obstetrics	Randomized controlled intervention study. Doctors underwent simulation of reporting a fetal death and care plan for the case, followed by immediate performance evaluation from the actor, the examiner, and themselves. After, they were divided randomly into two intervention groups: 1) a lecture about breaking bad news; 2) a debriefing session with the examiner. A new simulation was then performed, with different actors and examiners, blind to the intervention type, followed by further analysis. Six months after training, the researchers would contact the participants to assess the level of knowledge retention.
Guerra et al. (2011)⁹9 Guerra FA, Mirlesse V, Baião AE. Breaking bad news during prenatal care: a challenge to be tackled. Ciênc Saúde Coletiva. 2011;16(05): 2361–2367. Doi: 10.1590/S1413-81232011000500002 https://doi.org/10.1590/S1413-8123201100...	Fetal medicine	Opinion article
Lim et al. (2011)¹⁰10 Lim CE, Cheng NC. Clinician’s role of psychological support in helping parents and families with pregnancy loss. J Aust Tradit-Med Soc. 2011;17(04):215–217	Obstetrics	Opinion article
Nuzum et al. (2017)¹¹11 Nuzum D, Meaney S, O’Donohue K. Communication skills in Obstetrics: what can we learn from bereaved parents? Ir Med J. 2017;110(02):512	Obstetrics	An in-depth qualitative study based on interviews with grieving parents about their memories and insights regarding the moment they received a fetal death diagnosis.
Greiner and Conklin (2015)¹²12 Greiner AL, Conklin J. Breaking bad news to a pregnant woman with a fetal abnormality on ultrasound. Obstet Gynecol Surv. 2015;70(01):39–44. Doi: 10.1097/OGX.0000000000000149 https://doi.org/10.1097/OGX.000000000000...	Obstetrics ultrasonography	Narrative review
Romm (2002)¹³13 Romm J. Breaking bad news in obstetrics and gynecology: educational conference for resident physicians. Arch Women Ment Health. 2002;5(04):177–179. Doi: 10.1007/s00737-002-0145-3 https://doi.org/10.1007/s00737-002-0145-...	Gynecology and obstetrics	This article presents doctors’ and patients’ perceptions about the impact in communication skills produced by lectures given by patients to doctors, reporting their experiences in receiving bad news.
Leone et al. (2017)¹⁴14 Leone D, Menichetti J, Barusi L, et al. Breaking bad news in assisted reproductive technology: a proposal for guidelines. Reprod Health. 2017;14(01):87. Doi: 10.1186/s12978-017-0350-1 https://doi.org/10.1186/s12978-017-0350-...	Reproductive medicine	Doctors formed discussion groups to share their own experiences in communicating bad news and discuss the SPIKES protocol’s applicability in the reproductive medicine area.
Lalos (1999)¹⁵15 Lalos A. Breaking bad news concerning fertility. Hum Reprod. 1999;14(03):581–585. Doi: 10.1093/humrep/14.3.581 https://doi.org/10.1093/humrep/14.3.581...	Reproductive medicine	Opinion article
Kuroki et al. (2013)¹⁶16 Kuroki LM, Zhao Q, Jeffe DB, Powell MA, Hagemann AR, Thaker PH, et al. Disclosing a diagnosis of cancer: considerations specific to gynecologic oncology patients. Obstet Gynecol. 2013;122(05): 1033–1039. Doi: 10.1097/AOG.0b013e3182a9bf42 https://doi.org/10.1097/AOG.0b013e3182a9...	Gynecologic oncology	Survey about patients’ satisfaction regarding several aspects presented or not when they received bad news.
Zanetti-Dällenbach et al. (2006)¹⁷17 Zanetti-Dällenbach R, Tschudin S, Lapaire O, Holzgreve W, Wight E, Bitzer J. Psychological management of pregnancy-related breast cancer. Breast. 2006;15(Suppl 2):S53–S59. Doi: 10.1016/ S0960-9776(07)70019-X https://doi.org/10.1016/ S0960-9776(07)7...	Mastology/ Obstetrics	Case study
Alkazaleh et al. (2003)¹⁸18 Alkazaleh F, Thomas M, Grebenyuk J, Glaude L, Savage D, Johannesen J, et al. What women want: women’s preferences of caregiver behavior when prenatal sonography findings are abnormal. Ultrasound Obstet Gynecol. 2004;23(01):56–62. Doi: 10.1002/uog.906 https://doi.org/10.1002/uog.906...	Obstetrics ultrasonography	Survey about patients’ perception of the moment they received bad news and their preferences for such a situation.
Cockburn and Walters (1999)¹⁹19 Cockburn J, Walters WA. Communication between doctors and patients. Curr Obstet Gynaecol. 1999;9(01):34–40. Doi: 10.1016/ S0957-5847(99)90071-9 https://doi.org/10.1016/ S0957-5847(99)9...	Gynecology and obstetrics	Narrative review
Karkowsky and Chazotte (2013)²⁰20 Karkowsky CE, Chazotte C. Simulation: improving communication with patients. Semin Perinatol. 2013;37(03):157–160. Doi: 10.1053/j.semperi.2013.02.006 https://doi.org/10.1053/j.semperi.2013.0...	Gynecology and obstetrics	Narrative review
Setubal et al. (2017)²¹21 Setubal MSV, Gonçalves AV, Rocha SR, Amaral EM. Breaking bad news training program based on video reviews and SPIKES strategy: what do perinatology residents think about it? Rev Bras Ginecol Obstet. 2017;39(10):552–559. Doi: 10.1055/s-0037-1604490 https://doi.org/10.1055/s-0037-1604490...	Obstetrics	Physicians’ (participants) perception of the training on communicating bad news reported by Setubal et al. (2018).⁷7 Setubal MSV, Antonio MÂRGM, Amaral EM, Boulet J. Improving perinatology residents’ skills in breaking bad news: a randomized intervention study. Rev Bras Ginecol Obstet. 2018;40(03): 137–146. Doi: 10.1055/s-0037-1621741 https://doi.org/10.1055/s-0037-1621741...
Johnson et al. (2019)²²22 Johnson J, Arezina J, McGuinness A, Culpan AM, Hall L. Breaking bad and difficult news in obstetric ultrasound and sonographer burnout: Is training helpful? Ultrasound. 2019;27(01):55–63. Doi: 10.1177/1742271X18816535 https://doi.org/10.1177/1742271X18816535...	Obstetrics ultrasonography	Analysis of a questionnaire applied to sonographers about training in breaking bad news, burnout syndrome, and psychological well-being.

Breaking bad news in Ob-gyn
DOs
Follow the SPIKES protocol, adapting it to ob-gyn reality.
Study and practice “communicating bad news” as any other medical professional should.
Try to guarantee the patient’s privacy and an environment free of interruptions when breaking bad news.
The communication must be patient-centered.
Express empathy and hope.
Review the information with the patient and offer written material about it.
In obstetrics, consider both the parents and the fetus as the patient. Work with a multidisciplinary team whenever possible.
DON’Ts
Avoid expressions like “I know what you are going through” or “I know how you feel,” unless you have gone through a similar situation.
Avoid excessively technical language.
Do not provide statical data unless you are requested to do so.
Do not omit, minimize, or delay the information, if the patient desires to hear it.
Do not communicate bad news through impersonal means, such as voice/text messages.

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[1] Address for correspondence Aline Evangelista Santiago, PhD, Av. Professor Mário Rubens Guimarães Montenegro, s/nº, CEP 18618-687, Botucatu, SP, Brazil (e-mail: alinevajf@gmail.com).