Breaking Bad News for Patients with Gastro-Intestinal Malignancy: Experience at Ibn Sina Teaching Hospital

Background: Integrity, beneficence, non-maleficence and Justice are the pillars of the professional behaviour. Confidentiality is a serious issue governed by the law. However, in developing countries, patients’ relatives urge to know the diagnosis and often request the doctor not to mention the word cancer or malignancy to their patient.Objectives: To evaluate the communication skills for breaking bad news to Sudanese patients suffering of gastrointestinal cancer and to find out the patients’ responses on that matter.Materials and Methods: This is a hospital based non-randomized  prospective study, carried out at Ibn Sina Specialized Hospital in the period August through December 2011. The study involved113 patients of whom there were 56 males.Results: Doctors had talked about the disease to 75% of the patients  whereas the rest were told by either the psychologists and/or their  relatives. Only 25% of the patients were told the truth, the rest were told to have mass or lump without explaining its nature. Patients’ responses were as follows: 41.6% were felt terrified, 23.9% were shocked and became  anxious, while 33.6% were stable, but 0.9% became angry and frustrated. No patient was told about the prognosis and the chances of cure.Conclusion: Sympathy over-ride empathy in communicating bad news to Sudanese patients suffering of cancer. Patient education and training in breaking the bad news is needed.Key words: Communication skills, breaking bad news, truth telling, Sudan

The impact of gender on difficulty of classical open cholecystectomy

Background: Cholecystectomy demands attention, and expectation of abnormal anatomy in the veins, arteries or ducts. Prediction of difficult cholecystectomy does not only helpin patient counseling but also helps the surgeon to prepare better for the technical difficulties that may be encountered1-3.The aim: To find out whether there is impact of gender on the difficulty of surgery during open cholecystectomy.Patients and methods: This is a prospective hospital based study. Patients who presented to Ibn Sina Hospital for open cholecystectomy during the period from April 2011 to April 2012 were included in this study. Special emphasis was put on gender, the operative time, difficulty of surgeryand complications of open cholecystectomy. A pre-tested questionnaire was filled during interview of patients and operating surgeons.Results: A total 327 operations were included in the study. Of them there were 34(64.2%) males and 99(36.1%) females presented early i.e. after the first diagnosis was made. The mean operative time was 44.6 min for males and 43.57 min for females. Difficult surgery was described in 6(11.3%) of male and 23(8.4%) females.Conclusion: There was no significant statistical difference in the operative time, difficulty of operation and complication rate between males and females.Key words: Open cholecystectomy, difficulty, gender