The Importance of How: A Comparative Analysis of Patient and Physician’s Perception of Bad News Communication

The aim of this research is to analyze the conversation dynamics in the medical setting between health-provider and patient and to provide a deeper insight into how the spoken and unspoken dialogue is perceived and conceived by both parties. The research arose from the necessity for further understanding of interpersonal dynamics in doctor-patient communication and of the psychological impact that the interaction carries on the dyad. The main intent is to collect and elaborate data that will be used to create a formative program for doctors to interact with patients in an ameliorated way, safeguarding both parties wellness and mental health, preventing burnout for doctors and positively impacting HRQoL (Health Related Quality of Life) for patients. The research is based on data collected from the oncological wards in Ospedale Mauriziano Umberto I and Ospedale Molinette in Turin. The collected data is derived from questionnaires administered to oncological patients undergoing outpatient visits and to the doctors involved, both prior and subsequently to the meeting and from the audio recordings of the latter. The analysis focuses on two types of appointments: those to communicate a first cancer diagnosis and those to inform of disease progression, the choice of focusing on this subset is driven by the greater emotional burden those carry for both the informing and the informed party. This dissertation will focus on emotional challenges faced both by oncological patients and by doctors carrying bad news, we will then dive into the realm of communication, appreciating different styles and forms. We will later talk about Balint’s view on doctor-patient dynamics and the relationship that is consequently created, and how this can be influenced by pre existing factors. We will then analyze data collected through questionnaires administered previously and subsequently to outpatient visits to both health practitioners and patients, in order to highlight similarities and differences in their perception of the interaction and starting from those results elaborate conclusions on the efficacy and effectiveness of communication in oncological settings.