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ABSTRACT BACKGROUND There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure. OBJECTIVE To determine if volunteers’ reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility. DESIGN Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose, delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility (full, none). PARTICIPANTS Adult volunteer sample from the general community in Baltimore. MEASUREMENTS Viewer evaluations of physicians in the videos using standardized scales. RESULTS Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility. Perceived apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender, race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures. Inclination to sue was reduced non-significantly. CONCLUSIONS Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

Governments need to think twice before they suppress messages related to COVID-19. Governments need to think twice before they suppress messages related to COVID-19.

Abstract Background Prognostic disclosure enables shared decision-making by keeping patients informed about their health and involved in treatment choices. Prognostic uncertainty is prominent in metastatic breast cancer (mBC) and is a known barrier to prognostic disclosure, yet knowledge about prognostic disclosure in mBC has not been systematically mapped. Objective This scoping review aimed to explore the literature on prognostic disclosure in mBC and highlight research gaps. Methods We followed Arksey and O’Malley’s expanded framework. Electronic databases MEDLINE (via PubMED), Scopus, PsychINFO and CINAHL were systematically searched for peer-reviewed, published journal articles. Results are reported following the PRISMA-ScR guidelines. Results The search yielded 1715 articles; ten met the inclusion criteria. Qualitative analysis identified 9 themes: Balancing Truth and Hope; Persistent Gaps Between Patient Informational Needs and Physician Responses; Using the Internet to Find Prognostic Information; the Role of Religious Beliefs; Challenges in Understanding Prognostic Information; Use of Empathy; Health Literacy and Satisfaction with Communication; Potential Harms; Structured Multidisciplinary Disclosure Interventions. Our findings suggest that the needs and preferences of patients with mBC regarding prognostic disclosure are influenced by emotional, psychological, religious, and existential factors, and change during the disease trajectory. Conclusions Balancing truth and hope in prognostic disclosure with patients with mBC requires nuanced, emotionally attuned approaches. Clinicians could revisit patients’ preferences at disease milestones or decision points. Research is needed to explore patient characteristics predicting prognostic preferences, to facilitate individualized communication, and to elucidate the impact of targeted treatments, immunotherapy, and the associated prognostic uncertainties on prognostic disclosure in mBC.

Bogus remedies, myths and fake news about COVID-19 can cost lives. Here’s how some scientists are fighting back. Bogus remedies, myths and fake news about COVID-19 can cost lives. Here’s how some scientists are fighting back. A poster warning against the spread of 'fake news' online

ObjectiveBreaking bad news about life-threatening and possibly terminal conditions is a crucial part of paediatric care for children in this situation. Little is known about how the parents of children with life-threatening conditions experience communication of bad news. The objective of this study is to analyse parents’ experiences (barriers and facilitators) of communication of bad news.DesignA qualitative study consisting of a constant comparative analysis of in-depth interviews conducted with parents.SettingThe Netherlands.ParticipantsSixty-four parents—bereaved and non-bereaved—of 44 children (aged 1–12 years, 61% deceased) with a life-threatening condition.InterventionsNone.ResultsBased on parents’ experiences, the following 10 barriers to the communication of bad news were identified: (1) a lack of (timely) communication, (2) physicians’ failure to ask parents for input, (3) parents feel unprepared during and after the conversation, (4) a lack of clarity about future treatment, (5) physicians’ failure to voice uncertainties, (6) physicians’ failure to schedule follow-up conversations, (7) presence of too many or unknown healthcare professionals, (8) parental concerns in breaking bad news to children, (9) managing indications of bad news in non-conversational contexts, and (10) parents’ misunderstanding of medical terminology.ConclusionsThis study shows healthcare professionals how parents experience barriers in bad news conversations. This mainly concerns practical aspects of communication. The results provide practical pointers on how the communication of bad news can be improved to better suit the needs of parents. From the parents’ perspective, the timing of conversations in which they were informed that their child might not survive was far too late. Sometimes, no such conversations ever took place.

For philosophers like me, post-truth also goes against the grain. But in the wake of the US presidential election and the seemingly endless campaigns preceding it, author Ralph Keyes's 2004 declaration that we have arrived in a post-truth era seems distressingly plausible.

Biobanks and archived data sets collecting samples and data have become crucial engines of genetic and genomic research. Unresolved, however, is what responsibilities biobanks should shoulder to manage incidental findings and individual research results of potential health, reproductive, or personal importance to individual contributors (using “biobank” here to refer both to collections of samples and collections of data). This article reports recommendations from a 2-year project funded by the National Institutes of Health. We analyze the responsibilities involved in managing the return of incidental findings and individual research results in a biobank research system (primary research or collection sites, the biobank itself, and secondary research sites). We suggest that biobanks shoulder significant responsibility for seeing that the biobank research system addresses the return question explicitly. When reidentification of individual contributors is possible, the biobank should work to enable the biobank research system to discharge four core responsibilities to (1) clarify the criteria for evaluating findings and the roster of returnable findings, (2) analyze a particular finding in relation to this, (3) reidentify the individual contributor, and (4) recontact the contributor to offer the finding. We suggest that findings that are analytically valid, reveal an established and substantial risk of a serious health condition, and are clinically actionable should generally be offered to consenting contributors. This article specifies 10 concrete recommendations, addressing new biobanks as well as those already in existence. Genet Med 2012:14(4):361–384

As whole-exome sequencing (WES) and whole-genome sequencing (WGS) move into routine clinical practice, it is timely to review data that might inform the debate regarding secondary findings (SF) and the development of policies that maximize participant benefit. We systematically searched for qualitative and quantitative studies that explored stakeholder views on SF in WES/WGS. Framework analysis was undertaken to identify major themes. Forty-four articles reporting the views of 11,566 stakeholders were included. Stakeholders were broadly supportive of returning “actionable” findings, but definitions of actionability varied. Stakeholder views on SF disclosure exist along a spectrum: potential WES/WGS recipients’ views were largely influenced by a sense of rights, whereas views of genomics professionals were informed by a sense of professional responsibility. Experience with genetic illness and testing resulted in greater caution about SF, suggesting that truly informed decisions require an understanding of the implications and limitations of WES/WGS and possible findings. This review suggests that bidirectional interaction during consent might best facilitate informed decision making about SF and that dynamic forms of consent, allowing for changing preferences, should be considered. Research exploring views from wider perspectives and from recipients who have received SF is critical if evidence-based policies are to be achieved. Genet Med19 3, 283–293.