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    Comunicação de más notícias no centro de terapia intensiva: inquérito com médicos de hospitais de grande porte na cidade de são paulo
    (Universidade Federal de São Paulo (UNIFESP), 2018-09-14) Gibello, Juliana [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; Parsons, Henrique Afonseca; http://lattes.cnpq.br/9798707175891242; http://lattes.cnpq.br/9593692806458673; Universidade Federal de São Paulo (UNIFESP)
    Caring for seriously ill patients and talking to family members about difficult situations and decisions is routine practice for physicians at Intensive Care Units (ICUs). Communicating bad news in this context is considered one of the most difficult tasks for physicians who may not have had sufficient training to develop such skills. Objective: The objective of this study was to evaluate the perception of ICU physicians about the process of communicating bad news for patients and their families, identifying the degree of selfreported comfort and confidence and what factors may facilitate or hinder such process. Methods: A survey was conducted through a selfadministered questionnaire with ICU physicians and residents of three tertiary hospitals in the city of São Paulo: Hospital Israelita Albert Einstein, Hospital São Paulo UNIFESP and Hospital Municipal Vila Santa Catarina (SBIAE). Results: The 103 ICU physicians who participated (response rate 72.5%) reported that they did not have training or courses to develop communication skills, although they affirm that it is a frequent practice. Conclusions: Facilitators of the process of communication of bad news were: emotional support from the family, patient and family trusting the doctor and patient’s wishes to participate in the decisions. Hindering factors identified were:: discussions on poor prognosis, lack of communication skills (considering that they had little training on the subject), lack of family members (or presence of numerous members) during hospitalization, , fears of the doctors themselves, the possible emotional reactions consequent to the communication, and conflicting and divergent information being communicated by several doctors at the same admission. Doctors also reported that discussing withdrawal from lifesustaining treatment is more difficult than talking about initiating them. Another point mentioned by the intensivists was to feel more comfortable when treatment decisions happen together with patient, family, and doctor, which shows a possible change in the paternalistic positioning learned in their formation to that of a shared decision making setup. In addition, they believe that Palliative Care at the Intensive Care Unit has an impact on their future as a physician.