Open Journal of Social Sciences, 2014, 2, 90-96
Published Online November 2014 in SciRes.
How to cite this paper: Hanakova, A., Potmesil, M. and Stejskalova, K. (2014) The Role of Multidisciplinary Teams: A Focus
on Communicating Bad News. Open Journal of Social Sciences, 2, 90-96.
The Role of Multidisciplinary Teams: A
Focus on Communicating Bad News
Adela Hanakova, Milon Potmesil, Katerina Stejskalova
Institute of Special Education Studies, Faculty of Education, Palacky University, Olomouc,
Czech Republic
Email: aja 6@cen tru,
Received Oc tob er 2014
Commu nic ation is one of the key processes of being human, furthermore, being a good communi-
cator can help with building good quality relations hip s between people. Communication may be
used to construct a mental imag e of individuals. The paper focuses on the research and results of a
study concerned with the quality of communication between parents and doctors. From the find-
ings of the study, quality communication can be used in the rapeu tic int erve ntion an d practice,
when bad news has to be conveyed by medical practitioners to clients and/or patients. The target
group for the rese arch was parents of children with hearing impa irment . The authors present re-
sults pointing to a possible remedy of the issue of communicating bad news.
Doctor, Child, Disability, Parents, Communication, Bad News
1. Introduction
When communicating the bad news to clients and/or patients or parents of patients about a hearing impairment,
experts should have sufficient time to meet and talk with the family about the medical situation. Communicating a
diagnosis, in this instance breaking the bad news about the hearing impairment of a child, is the focus of the re-
search conveyed in this paper.
When learning the bad news about a child’s hearing impairment, parents usually have very little information
about hearing defects and/or hearing loss, what opportunities are available to help compensate for the hearing
impairment and other related issues. Taking any step that affects their childs future and coping with a hearing
impairment is for them a long and emotionally arduous process [1] [2]. Initially, therefore, it is the parents who
need help in adjusting their perceptions of hearing impairment and the impact upon their child and family. As
Vyml átilo vá states (in Říčan, Krejčířová, 1997) [3] [30], from the first meeting the parentsfeelings and opinions
must hold equal importance with the child’s diagnosis, as this will affect the future of the child and the family as a
whole as stated Regec (2012) [28]. It is surmised that the way in which professionals work with parents and
communicating the essential diagnostic information is crucial. In addition, parents’ rate information provided by
medical and special education practitioners as the most important sources of information, which was confirmed by
A. Hanakova et al.
research conducted by Potměšil and Pospisil [4]. Wigert et al. [5] and Orioles [6] research studies focus on the
communications by staff of neonatology departments and parents, and define areas of communication skills such
as empathic, informative and communicative behaviours that need to be improved. The studies yielded eleven
parameters that parents considered critical for acceptable communication: Empathy, availability, individual access
to the child, respect for parentsknowledge about the child, leaving room for hope, body language, diligence, care
above and beyond professional duty, responsibility, willingness to listen to questions, and sensitivity to the childs
Further considerations for practitioners to be aware of and to develop are a respect the need for adequate space
when communicating bad news to parents. Michalik states [7]: When communicating the news to the patient or
his family (typically the parents of the child), you must respect two aspects of this rule. The first is the spatial
expression of this need, i.e. simply put, adequate space to provide seamless communication, noise-free and ade-
quately equipped with appropriate furniture (a laboratory full of strange devices and flashing monitors is inap-
propriate). Likewise, corridors in the hospital, the doctorsroom where other colleagues are writing reports, etc.,
are totally inappropriate. A second aspect of the same rule is to create a space for communication in the mind of
the communicator (usually the doctor). The patient must feel (and considering that from that moment feelings will
be remembered more than anything else) that the medical worker wants to pay attention to them, has time for them,
and that communicating this news is not a burden, but that, while maintaining professional distance, the content
being communicated to the recipient contains the necessary amount of empathy.
Behavioural indicators. According to Vymlátilová, (2003) [8] the re are signs indicate when a patient and/or
parent(s) is in crisis concerning diagnosis. These behaviours are depression, vegetative symptoms and a signifi-
cantly reduced ability to process new information. Vymlátilová, (2003) [8] further points out that the speed and
manner in which the family member adapts to the new and difficult situation is significantly affected by the way in
which the diagnosis was communicated to the child's parents in the early stages. According to Potměšilová [9],
another important factor in the communication of bad news is the ability to initiate such dial o gue in an appropriate
manner. Positive physical behaviours identified include: eye contact, expressions of interest by the practitioner, a
friendly demeanour and speaking at eye level to the client in order to reduce the feeling of submissiveness. In
respect of communication conducted by a multi-disciplinary team, members should empl oy a breadth of com-
prehensive care behaviours that incorporate the following [10]:
providing a responsive and honest method of communication
allowing the presence of both parents during the discussion
providing subsequent support for both parents
offering the possibility of the child’s presence
demonstrating the doctors (psychologists, speech therapists and other team members) approach to the child
allowing repeated discussion about the child
involving grandparents and siblings in the discussion
Resistance type behaviours that have been found to occur in stressful situations include the inability to use
positive incentives, in particular the ability to maintain social contacts, to accept offers of help and to communi-
cate about the problem.
Positive behaviours can include assistance, which is often understood in terms of social support, and can be
realised as support from families, friends, partners, wider social networks, and the help of professionals [11].
Vágnerová [12] points out that it is important for any support of this kind to be available and that the affected
individual is able to recognize, accept and use it. The absence of support is both a cause and a consequence of
various psychological problems.
Social environments. The social environment in which a child with hearing disabilities grows up determines
not only the quality and quantity of acquired experience and skills, but also the emotional relationships that are
formed between the child and other family members [13]. A parent’s inability to cope with their childs health
condition and the resulting feelings of personal failure has a negative impact on the child's emotional and cogni-
tive development. Following an objective confirmation of a hearing impairment, parents face several months of
uncertainty about which direction to take to help their child’s hearing deficit, for example, whether to choose a
hearing aid and the use of such technology in the short term, or whether to opt for a cochlear implant, speech
therapy and long-term adjustment [14]. Crossley [15] focuses on the evaluation of communication skills with
parents, physicians and paediatric patients in his research and uses his own tools for authentication as well as for
obtaining feedback for the physician.
A. Hanakova et al.
Martin, Bat-Chava, [16] and Stejskalová [17] emphasize the child’s personality characteristics, which offer a
different perspective on the diagnostic process and conveying bad news. The afore mentioned authors seem to
suggest a subjective evaluation of stressors that act on a child is related to an evaluation of the child’s ability to
cope with adverse life situations, however, children usually have a more limited range of coping strategies than
adults. Furthermore, essential aspects for practitioners to consider are that children have fewe r opportunities to
make decisions about their own lives. Important decisions such as whether to opt for a cochlear implant, for ex-
amp le, are usually made by the parents, and the child's participation in the decision-making process is minimal.
The author Zaidman-Zait [18] states that even the best professional assistance and support cannot influence
parentsexperiences. Psychologists, teachers, speech therapists and other professionals should be aware that even
when they provide the best support, the most comprehensive information and the soundest advice with the highest
degree of empathy, parents are still on their own when resolving problems concerning their child’s best interests.
This might be a cons ideratio n in cases when the family ignores well-intentioned advice offered by professionals.
Thus, it is necessary to strengthen parental feelings of competence when dealing with their child, and also to
strengthen the confidence and competences of siblings of individuals with hearing disabilities [19].
2. Methodology
The current study employed a questionnaire that focused on the process and form of cooperation between par-
ents of children with cochlear implants and professionals who were part of the medical (?) team caring for the
child. Given that the research was multi-dimensional, the respondents, namely the parents of children with co-
chlear implants have been reported in this paper.
Participants. There were forty-nine respondentsparents of children with cochlear implants. All of the par-
ents have normal hearing. In most cases the questionnaires were filled out by the mother (92%). At the time of the
research the oldest child was 14 years old and the youngest was eight months. The gender distribution of the
children with cochlear implants among the respondents was 47% girls and 53% boys.
Instru ment s. The questionnaire comprised Parents rated the teamwork, quality and quantity of information
obtained from experts based on their experience. The parents responded to the statement on a scale of 1 - 5. A
separate section of the questionnaire was devoted to statements to which the parents were asked to respond on a
scale of 1 to 5 (1 = mostly agree, 5 = mostly disagree). Participants could also answer by saying I dont know,
which in many cases had an informative value for us (e.g., Our paediatrician, if necessary, communicates with
other experts and consults with them.).
To evaluate the issue from the parentsperspective, semi-structured interviews were conducted, recorded
and transcribed as a verbatim record. Interviews lasted for approximately 30 minutes. Questions used in
the interviews highlighted and illustrated the current state of cooperation between parents and professionals.
The specific questions designed to obtain data from the interviews primarily focused on the following areas:
The atmosphere in the family, family background.
Characteristics of development (educational process, cooperation with experts, family context, the process of
socialization, personality characteristics).
Characteristics of communication with experts (accuracy, completeness and clarity of the information, advice,
empathy level, overall approach).
Data analysis. As stated by Stejskalová [17]an integral part of the data management phase is data systema-
tizationmaking it easier and faster to work with qualitative data is a prerequisite for subsequent analysis and
interpretatio n.(Hendl in Stejskalová, [17]) presents four techniques for transcribing the text material obtained in
our case by means of the semi-structured interview method: literal transcription, commented transcription, a
summary report and a selective report. Due to the relatively good knowledge of the subject based on the study of
the literature and personal experience, the team of researchers considered the use of the summarizing report tech-
nique as the most relevant for data anal ysi s.
With the participants consent, interviews were conducted in the pleasant environment of a building where a
summer meeting organized by SUKI (Association of Cochlear Implant Users) took place. During the initial phase
of the interviews, respondents were presented with basic information about the meaning and purpose of the re-
search. Informed consent was obtained which particularly related to the handling of sensitive data. In addition, the
progress and content of the interview was outlined and, respondents were informed of their option to refuse to
answer any questions or to end the interview if they found the experience unpleasant in any way. This created a
friendly and relaxed and safe atmosphere. Validity of presented research was supported by consequently organ-
A. Hanakova et al.
ized open discussions with the target group where experiences and statements were confirmed.
3. Results
Given that the research was multidimensional, only a portion of the results are reported that focus on a group of
parents of children with cochlear implants.
Parents rated the quantity of information received from experts (We get enough information from the ex-
perts) with an average mark of 1.92 (standard deviation 0.975). From this general question we can therefore
deduce that parents are generally satisfied with the amount of information received. With regard to the availability
of information, one of the respondents added the following:
R3: ... when I feel that I dont have enough information or if I dont understand something I look for it on the
Internet. Internet forums, where users of cochlear implants and parents of these children share their experiences
and impressions, really help me. Publications with case studies of children with implants would also be helpful.
A small note here relating to the nature of information presented in electronic media: The main source of in-
formation should without doubt be a knowledgeable expert or team of experts, not an electronic source. Never-
theless, psychologists describe the effect of similarity, i.e. the ability to share similar problems and experience the
same situation, and internet forums can be one way to facilitate the process of accepting the bad news of a hearing
impaired child.
The statement We received instruction on how to monitor the development of the childs speech after
cochlear implantsreceived an average rating of 1.84 (standard deviation 1.264). The interviews show that
parents received instruction on how to monitor the childs speech after cochlear implantation in particular from
Tamtam centres of early care and from the CKID.
R2: In Tamtam and the CKID (Centre for Cochlear Implantation in Children) they told us that we need to
follow the development of speech after implantation. In Tamtam they even helped us with the choice of commu-
nication methods for our child.
On a scale of satisfaction the results had an average mark of 3.06 (standard deviation 1.590) demonstrating
that parents are generally dissatisfied with the manner in which they were told about their childs hearing
impairment (the assertion I am satisfied with the way the doctor told us about our childs hearing im-
pairment” ). The respondents reported that the staff's approach was rather formal. Information was presented
openly, but without much emotion. The results are documented in several responses from the interviews.
V: Do you have any major negative experiences you would like to share?”
R6: The first I can think of is my negative experience with how the information that our child has a hearing
impairment was communicated... The doctor first said it was a cold and that we should come back in two months.
At the time I said I wouldnt leave it like that and so I turned to someone else, and Im very glad I did. Losing two
months would have been a big mistake.
Another respondent answered the same question as follows:
R2: I was angry that no one would believe me that my child cant hear. Everyone told me that my child just
doesnt listen, that it was somehow my fault. When it was confirmed that our child has a hearing defect, we were
surprise d by the phoniatrists approachhe seemed unable to empathize with our situation. We had to find out
everything ourselvesfrom acquaintances, via the Internet. It seemed to me that two months was a long time to
wait for a hearing aid, so we had to arrange everything ourselves. We attended speech therapy and Tamtam be-
fore he had a hearing aid. I think it would be best if they gave us a lot of pamphlets about everything we can expect
and we would study everything calmly ourselves. It would be better to tell us: once youve read it all, here is our
phone number, give us a call.
Another respondent (R1) answered the question In your opinion, which area of care should change for the
better?” as follows: We ll, I think that above all the expertsapproach in communicating bad news such as a
hearing impairment should change.Then she added: I cant change what happened to us, but I hope it never
happens to anyone else.
Here we want to emphasize the individual process of accepting bad news about the health of a child. At the same
time, it is not only parents who report an apparent lack of awareness on the part of health professionals in com-
municating with the patient in the sense of a lack of understanding about the characteristics of the phase of shock
and denial of the childs disability. Although this problem may only be local, it nevertheless cannot be ignored due
to its effect on the lives of people with hearing impairments and their families.
A. Hanakova et al.
Overall, the respondents assessed the cooperation with experts at various levels of care and services rather
negatively, both in terms of access and in terms of the information provided. We can also trace the many negative
experiences of parents who describe an inappropriate (arrogant, haughty) approach by experts, which was con-
firmed in the interviews.
The average mark on the scale of satisfaction about the assertion Our paediatrician monitors the perfor-
mance of our childs auditory function throughout childho od was “2.71(standard deviation 1.468).
Worth noting, however, is the evaluation of this assertion by eight respondents, who gave it a mark of “3”, seven
respondents who gave it a mark of “4” and seven other respondents who evaluated this assertion with a mark of
“5”. The question remains as to how the paediatrician's role is perceived in the overall care for a child with co-
chlear implants, not only by parents, but also by the paediatricians themselves.
One of the respondents explained their dissatisfaction as follows:
R3: When I told the paediatrician that I felt that my child cant hear, he told me that I was an overly frightened
mother and that I was watching my child too much.
Another respondent discusses her paediatrician's level of kno wledge :
R4: We did not get any information from the paediatrician; on the contrary, we provided the information to
him. At the level of cooperation with the experts participating in the care of children with cochlear implants and
their families, the results related to the distribution of information, access to experts, levels of empathy and co-
operation at the trans-disciplinary optimization level should reflect comprehensively conceived treatment for
persons with hearing disabilities and improve their quality of life.
4. Discussion
Improving the teamwork skills of professionals who understand the problems of hearing impairment and have
empathy and understanding is recommended. When communicating the bad news about hearing impairment all
experts should have sufficient time to discuss the situation with the family. In this regard, we recommend that
medical facilities train their staff on communicating effectively with families, especially when confirming hearing
impairment. This education should not only include issues of deafness as a scientific and medical focus, but also
the possible aspects of the positive effects of hearing impairment for the child and the whole family.
At the level of cooperation with experts, the characteristics of tra ns-disciplinary collaboration should be reflect-
ed in the optimization of services for clients with cochlear implants and their families. One of the bases is paedi-
atric—neonatology care. In our opinion, the main ideological pillar is care focused on achieving optimal health of
the new-born and cooperation with other experts [20].
The paediatricianneonatologist should ensure that the mother of a child with hearing impairment is educated
in the area of preventing upper respiratory tract infections to which these children are particularly sensitive; they
should also be provided information on other related care for achieving optimal health, especially when preparing
the child for cochlear implantation [21].
The family should have an adequate amount of material to take home and study. These materials should contain
all the available information about the cochlear implantation centre, wound care and organizations to which they
can turn.
One of the questions examined the frequency of visits by experts who are part of a multidisciplinary team for
children with hearing impairments. Parents should evaluate the frequency of visits by each expert separately, with
the possibility of assessing experts that are visited due to other related problems suffered by the child. As we
expected, this produced interesting data such as the item p s ycho ther ap ist . The results showed that only four
parents visited a psychotherapist. Another reason for not using the services of a psychotherapist may be lingering
prejudices and stereotypes among the general public, in our case the parents. The lack of information provided to
parents by experts may also play a role. The results can also be demonstrated by the respondent's answers obtained
from the interview:
V: In your opinion, what area of care should change for the better?”
R1: Help for the familyso that we know how to accept the fact that our child has a hearing impairment and to
work with this information... I think we lack care from the psychotherapist.”
From the statement The psychotherapist provides information on how to care for the child, how to raise
them, how to work with and communicate with them it followed that sixteen parents do not know if the
psychotherapist provides information on communicating with the child. This is probably the result of the fact that
these parents do not visit a psychotherapist. In the context of the effectiveness of the communication of bad news
A. Hanakova et al.
and, based on many studies (e.g. [22] [23] ), it can be generally recommended that psychotherapy services be in-
tegrated as a completely natural part of services across the age spectrum.
5. Conclusions
Our recommendations are directed towards cooperation with experts who are part of a team caring for clients with
hearing impairments and their families. Those are especially health workers, in terms of the issue of communi-
cation with the family, empathy, communicating bad news in an adequate manner, acceptable and clear form. We
recommend that parents be fully involved in the process of treatment, which is the most important component, as
well as have the opportunity to fully monitor and assess the effectiveness of the services provided and to provide
professionals with feedback which correlates with findings reported by Ruzickova (2008) [29].
We place great emphasis on the increasingly acute need for further training of health professionals, but also
people in related professions. In this context, it is in our view necessary to increase the trans-disciplinary level of
care and services. Orioles et al. [6] as well as Wigert [5] illustrate the results of a sample of 270 parents with the
same requirements.
Our study has shown that there is dissatisfaction with how medical staff communicates information to families.
Similarly, Ejaz et al. [24] discuss the communication shortcomings of the majority (65%) of doctors at the hos-
pital in Karachi. We also consider it desirable to support and develop the intensive participation of families in
terms of active cooperation, not only with the medical staff of cochlear implantation centres, but also early in-
tervention centres and special pedagogical centres.
After parents overcome the initial shock, it is necessary to ensure that have continuous access to information
and to strive for comprehensive family support from professionals at all levels of care. The level of communica-
tion with family largely predicts the success of the treatment process [25] . One of them is respect for ethnicity [26],
a fact that is starting to be discovered in numerous professions. Similarly, Farrell [27] draws attention to the pos-
sibility of improving communication as an otherwise effective tool.
Apart from the research work, the authors focused on designing and implementing courses for medical staff.
Based on theoretical and practical experience in communicating bad news, courses were held as part of a project of
the Union of EmployersAssociations of the Czech Republic entitled Effective communication with patients,
relatives and close persons, with a focus on communicating with persons with special needs (the author of this
article was the lecturer). Ongoing courses were intended for healthcare professionals from selected health care
facilities in the Czech Republic. These courses aimed to improve communication with patients with special needs,
their relatives and other close persons, including communication for the prevention and management of aggres-
sion. The course intended for healthcare professionals from non-medical facilities covered the principles of
communication with patients with special needs. In 2010-2012 the course was attended by 280 health profes-
sionals in eight regional capitals of the Czech Republic.
This research was supported by the grant UPOL PdF_2014007 SPP 43414061.
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