S6 Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41

Kornblith, T.Ahles, E.Winer, S.Fleishman, P.Luber, appropriate communication when dealing with death andM.Zevon, R. McQuellon, P.Trief, J.Finkel, J.Spira, JC donation. EDHEP was piloted in The Netherlands andHolland, D.Greenberg, J.Rowland, Doctor-patient Com- has been implemented in 30 countries since 1992.munication Consortium, Rochester, NY, USA Primary Programme evaluation data suggest that participants feelCare Institute, Highland Hospital, 1000 South Avenue, more secure in dealing with bereavement and also theirRochester, NY 14620, USA. ‘barrier’ to requesting donation is reduced.

Method. A research project was started in 1993 toIntroduction. Not much attention has been paid toexamine the effect of attending EDHEP on the compe-involving family members in the process of deliveringtence of doctors and nurses in intensive care to death andbad news. As part of a larger study, we studied thedonation. Two interrelated studies, involving The Nether-comments of cancer patients and their providers on thelands and the United Kingdom, utilized an ‘untreatedpositive and challenging aspects of having family mem-control group design with pretest and posttest’ and abers present during the delivery of a cancer diagnosis andsix-month follow-up.throughout the course of treatment.A knowledge test, an attitude scale, a self-efficacy scaleMethods. The study included 19 focus groups (11 patientand two different instruments for communication skillsand 8 provider groups) at cancer centers around the(paper cases in The Netherlands and simulated-relativesUnited States. A semi-structured focus group guide was

used to facilitate the discussion of receiving a cancer encounters in the United Kingdom) were used to measurediagnosis and to address communication and patient- the effect on competence.provider relationship issues across the continuum of care Results. The results show that in both countries EDHEPfrom pre-diagnosis through diagnosis, postdiagnosis, had a significant effect on self-efficacy (p , .001).treatment and remission or recurrence. Focus groups EDHEP participants’ attitudes changed in The Nether-were audiotape recorded and transcribed verbatim. We lands at post test and was still apparent at follow-updeveloped 33 categories and coded 1001 focus group (p , .01). There was a lasting effect on breaking news ofcomments with a high degree of agreement among the death in the United Kingdom. All EDHEP participantsresearchers. One principle finding was the importance of indicated to have less difficulty with the donation requestincluding family members. after attending the workshop (p , .05). EDHEP particip-Results. Each of the transcripts contained examples of ants indicated they had made more request for organstatements by providers or patients highlighting the donation at follow-up (p , . 05).importance of including family members in the care that Conclusion. It can be concluded that EDHEP is anpatients received. These statements most frequently were effective programme for medical and nursing profession-related to positive aspects of having family members or als to improve their communication skills to developfriends present during the consultation. These included more positive views on donation and to increase theirsupport and additional checks on the content of in- confidence when dealing, with death and donation.formation exchanges during the encounter. Some state- Challenges in communicating about surgical breastments were focused on the challenges of including family biopsy in mammography screening processmember.

Aro AR, Rehnberg N, Absetz P. Health EducationConclusions. Participants generally described the ex-Research Unit, Department of Epidemiology and Health‘periences of including family members as positive,Promotion, National Public Health Institute, Manner-however some challenging aspects of including familyheimintie 166, 00300 Helsinki, Finland.members were noted. Patients and providers can benefit

from the information-gathering and emotional support Introduction. Mammography screening is used for detect-that family members can offer. Providers may also ing early stage breast cancer in order to improve prog-benefit from assessing family dynamics and negotiating nosis. Screening is targeted to age groups of unselectedwith patients and family members to determine the (asymptomatic) women. The study describes needs ofoptimal conditions for inclusion. communication and how these needs were met among

women going through surgical breast biopsy in a screen-European Donor Hospital Education Programmeing programme.(EDHW)–Effects on the competence of intensive careMethods. Subjects were 46 women (22 benign, 24 maligndoctors and nursesfinding) who responded the survey both pre- and post-

Blok, G.A. (a), Dalen, J. van, Morton, J.M., Morley, screening out of 98 invited to breast biopsy. BackgroundM.J.P. (a) University of Maastricht, Dept. of Educ. factors were measured one month before invitation toDevelopment & Research, P.O.Box 616, 6200 MD screening, and experience of the screening process andMaastricht, The Netherlands. biopsy 10 weeks after the referral to biopsy -using bothIntroduction. EDHEP is a one-day workshop for mixed structured and open questions.groups of sixteen doctor and nurses from intensive care. Results. In general the subjects expressed satisfactionIt was designed to address the need for sensitive and with the amount of information received at hospital, and

Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41 S7

most found it reassuring and comprehensible. The malign Results. 283 patients were eligible for the study. 200group wished to get more information than the benign. In patients were included: 105 patients in the experimentalboth groups there were individuals who were troubled by and 95 in the control group. Since the last follow-upthe information, or who suffered from insufficient in- measurements are still being collected, data about theformation. Some women in the benign group were not efficacy of this intervention are not yet available.reassured about the diagnosis. Patients seemed to rely Conclusion. Pending further results, it seems feasible thatrather passively on staff giving information. Most saw providing cancer patients with an audiotape of the initialthe staff as friendly and helpful, but some had ex- consultation is beneficial. The effects of this interventionperienced indifference and lack of empathy, especially will be presented.when receiving the diagnosis. Support from significant

Preparing patients for an aversive medical procedure:others was the most important factor in coping with thetailoring information to individual coping stylescreening process, the second was patient-staff communi-

cation, and the third was aspects of continuity of care.M.J. van Vliet (a), M.H.F. Grypdonck, J.A.M. Winnubst,Conclusions. Mammography screening programme as aF.J. van Zuuren. (a) Institution: University of Utrecht,public health measure touches large groups of women.Department of Nursing Science, Postbus 80036, 3508 TAThis calls for communicating not only about the screenedUtrecht, The Netherlands.condition, but also about consequences of further exami-

nation, operation and bad news. In addition to cancerIntroduction. Preparing patients for aversive medicalpatients also women referred to surgical biopsy endingprocedures and treatments has been thoroughly investi-up with benign finding need information, reassurance andgated in both Nursing Science and Psychology. Thesupport. Empathic attitude, and awareness of continuitypositive effects of concrete objective (sensory) infor-of care without delays, and tailored information at everymation have been repeatedly demonstrated. On the otherstage, seem to be the corner stones of better communica-hand, there is evidence that amount of informationtion about breast biopsy.should be related to coping style, with high monitorsneeding extensive and low monitors limited information.2 EMPOWERMENTThe present experiment investigates whether patientswho are prepared for a gastroscopy in a way which is inThe impact of providing taped consultations andaccordance with their coping style, will experience lesscommunicative behaviors on cancer patients qualityanxiety, less pain, more satisfaction with the informationof life, satisfaction, recall and copingand a more positive experience of the gastroscopy than acontrol group receiving ‘standard’ (that is little andLML Ong (a), MRM Visser, FB Lammes, JCJM de Haes.unstructured) information.(a) Dept. of Medical Psychology, Academic MedicalMethods. In this experiment, patients (n 5 200) who haveCenter, Meibergdreef 15, 1105 AZ Amsterdam-Zuidoost,to undergo a gastroscopy for the first tune, are divided inThe Netherlands.high monitors and low monitors. They are randomly

Introduction. Several studies have suggested that pro- assigned to the experimental group or the control group.viding cancer patients with audiotapes of their clinical High monitors in the experimental group receive exten-interviews can have beneficial effects. Results from a sive information from the researcher about the gastros-pilot study, for instance, have indicated that the majority copy and are shown photographs, whereas low monitorsof patients listened to the tape, together with relatives. in the experimental group only receive basic informationThey also found that the tape contained both ‘forgotten and are not shown photographs. Patients in the controlinformation’, and ‘reassuring information’. The present group receive ‘standard’ information from the nurse.study was designed to test these preliminary results. High monitors in the experimental group are comparedMethod. In a randomised ‘double blind’ study, consecu- with high monitors in the control group, low monitors intive cancer patients (N 5 200) were either provided with the experimental group with low monitors in the controltheir taped consultation or not. Eligible were patients group.who had been referred to the gynaecology or medical Before, during and after the gastroscopy physiologicaloncology outpatient clinic for an initial discussion of and self-reported measures are taken.treatment. Baseline characteristics were assessed prior to Results and conclusions. Data are collected, up tillthis consultation, follow-up measures were assessed at January 1998. At the time of the conference, data willone week- and three months afterwards. Patient outcomes have been analysed and will be ready for presentation.consisted of: quality of life (RSCL and MOS-24), Based on the results of this experiment, guidelines forsatisfaction with communication (PSQ and VSQ), coping nursing practice will be provided. They will allow nurses(Ways of Coping) and recall of information. All con- and physicians to take the patients’ coping style intosultations were analysed using the Roter Interaction consideration when preparing them for a threateningAnalysis System. medical procedure.