Amineh A.S. Al-Tamimi, Ph.D. and Mohammad Bushnaq
Dear Editor:
In recent years, our ethics committee received many reports related to conflicts between oncologists and their patients or patient’s families over breaking bad news. Some patients were traumatized by the ‘‘unkind way’’ they learned about their condition from their physician. They said the oncologist was ‘‘really aggressive’’ and ‘‘uncompassionate,’’ or that he used words like ‘‘hopeless,’’ or ‘‘nothing I can do.’’ On the other hand, other patients complained that they faced another kind of oncologist, who did not tell them the news at all but rather gave ‘‘false hope.’’
Since 2000, we have been working to improve the palliative care at the King Hussein Cancer Center (KHCC) in Amman, Jordan, a referral center for all of Jordan and the region. We have successfully adapted approaches to the breaking of bad news advocated in the west to our Arab culture.1 As a result of that success, we were asked to conduct workshops for 80 physicians from surgery, pediatrics, and radiation oncology departments at KHCC to help them develop their skills in dealing with different types of patients and negotiating goals of care.
The workshop was mandatory for all physicians including consultants, fellows, and residents and it was accredited for continuing medical education (CME) credit. A workshop was given for each department individually. Two sessions were given in the workshop, each session lasting for 50 minutes.
Fundamental communication skills, doctor–patient relationship, breaking bad news, the concept of do not resuscitate (DNR), and dealing with difficult families were the main domains that were discussed. Role-playing, discussion and interaction were the main educational methods used during the workshop, to give participants chance to share their experiences and thoughts in an open environment. Ninety percent of the physicians reported they participated in asking questions and participated in the discussion. Eightyseven percent endorsed the communication workshop as effective in demonstrating needed knowledge. Eighty-four percent agreed that the workshop learning objectives were clearly stated and the information was presented in an easy and understandable way that achieved the learning objectives.
To assess the effect of skills learned from communication skills workshop on participant behavior, participant were asked to give their feedback after 6 months by answering two
questions:
1. Did the workshop help you to change your practice?
2. Did you notice a positive change in your practice after attending ‘‘communication skills and breaking bad news’’ course?
Sadly, because of rapid turnover in physicians, only 19 participants who still work in the center could participate. All of them answered that the workshop helped them change their practice positively. The ethics committee has not noted any more complaints like those that stimulated the request for training.
We conclude that ‘‘Western style’’ experiential training that contradicts very traditional approaches to doctor–patient communication in a traditional Arab country is effective. Furthermore, the course was taught by ‘‘young’’ physicians practicing in the new field of palliative medicine, another aspect that is not traditional in the Arab world. In Jordan, overall salaries for physicians are low compared to other countries in the Arab world. Consequently, there is a considerable ‘‘brain drain’’ of physicians, nurses, and other trained health professionals to these other countries. While that is a challenge to the provision of health care in Jordan, it does raise the possibility that there will be rapid spread of these ideas into these other countries that have not developed more effective approaches to doctor-patient communication.
Reference
Bushnaq M: Palliative care in Jordan: Culturally sensitive practice.
J Pall Med 2008;11:1292–1293.
Address correspondence to:
Amineh S.S. Al-Tamimi, Ph.D.
King Hussein Cancer Center
Dr. Mohammad Bushnaq
General Manager
Dr. Mohammad Bushnaq is an internist with international fellowship in Palliative Care and Pain Management from USA. He is the Chairman of Jordan Palliative Care Society.
He worked at King Hussein Cancer Center, and he is currently associate instructor at Hashimate University. He is a temporary advisor for WHO, regional office for palliative care and pain management.
He has a long experience in pain management, wellness, burnout and self care. He participated by presentations and scientific papers at local and international levels.
Jordan - Amman - Al-Madenah Al-Munawarah Street –Al-Andalus building (273) - office (108)
Phone/ fax: 009626 5679099
Mobile: 00962 79 6924688
00962 79 567700
Email: info@drbushnaq.com
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