Nurses’ Experiences of Breaking Bad News in Oncology Settings With Adolescents and Young People

Abstract

ABSTRACT Background: Oncology nurses communicate with adolescents and young adults (AYAs) at the end of life to break bad news, communicate important information, or gain insight into the patient’s condition, anxiety, fear, or pain. However, oncology nurses face many barriers to communicating with AYAs to break bad news at the end of life, so identifying these barriers is an essential step in overcoming them. What barriers do oncology nurses face when communicating with AYAs to break bad news at the end of life? Aim: To conduct a systematic review examining barriers oncology nurses face when communicating with AYAs to break bad news at the end of life. Methods: A systematic review question was developed, a search strategy was defined, and inclusion and exclusion criteria were applied to the search results. Afterwards, a quality assessment of the included studies was conducted, and data extraction was conducted according to JBI standards and protocol. The meta-aggregative approach was applied, and the extracted data were grouped into prominent themes. Results: The search and selection strategy resulted in 2,080 studies to which the inclusion and exclusion criteria were applied. After filtering the studies, 20 remained. Four met the high-quality assessment criteria and were included in the thematic analysis and meta-aggregative process. The analysis and synthesis process resulted in the emergence of five main themes related to the barriers faced by oncology nurses in breaking bad news to AYAs at the end of life: 1) communication skills and experiences of oncology nurses, 2) individual barriers, 3) professional barriers, 4) institutional barriers, and 5) societal barriers to breaking bad news. Conclusions: Oncology nurses face many barriers related to their lack of competence and effective communication skills. These barriers may be professional or related to the lack of protocols for breaking bad news and communicating with AYA oncology patients. They may also be due to institutional barriers resulting from inadequate resources, time, and nurses. In addition, the relationships between nurses and multidisciplinary teams, the overlap of tasks, and the lack of clarity of roles in the process of breaking bad news constitute barriers to the success of the communication process, in addition to the linguistic and cultural diversity between nurses, patients, and their families, which constitute major challenges in the communication process.