Sensitive Communication Strategies for Delivering Bad News to Patients
Professionals in healthcare are present at critical moments in the lives of their patients. These relationships with patients along with their families mean that healthcare providers, or HCPs, often share important news. This may involve rejoicing with patients who are given good reports, as well as consoling those for whom the story may take a turn for the worse. Delivering bad news is one of the toughest challenges providers face in their careers.
Without a doubt, imparting bad news is stressful for HCPs, and this can contribute to burnout. However, the way such information is conveyed can impact the patient’s perceptions, treatment decisions, and outcomes. Unfortunately, few HCPs have received formal training in the delivery of bad news. A 2019 study of faculty and residents in Guilan University of Medical Sciences in Iran found that while 91% of physicians surveyed believe communicating bad news is an important skill, less than half had received training on carrying this out.
Learning to break the bad news is a skill that is developed over time. There are several models to help guide conversations involving giving information that may be upsetting to patients. But first let’s consider what constitutes bad news.
The impact of bad news
Strictly defined, bad news refers to information that will negatively change the patient’s view of the future. Bad news results in responses that are cognitive, behavioral, and emotional. HCPs often equate a terminal diagnosis as bad news, but the patient’s perception of the information determines if the news is bad. Examples include a newly diagnosed diabetic that views the diagnosis as life-altering for the future, or an injury that may lead to significant change — such as a season-ending orthopedic injury for an athlete.
Bad news impacts both the giver and the receiver of the information. As much as patients do not want to receive troubling news, HCPs do not want to give it. The emotion and stress of communicating and receiving the information affect both the patient and the HCP.
Patient impacts
How bad news is delivered to a patient affects the trajectory of their illness. A 2017 study found that the behavior of the HCP delivering bad news played a role in patient decisions regarding continuing or quitting medical treatment. Patients’ understanding of the information presented, their satisfaction with medical care, positive outlook, and psychological adjustment are all influenced by how the HCP delivers bad news.
HCP impacts
Providers experience stress when faced with the prospect of delivering bad news to a patient. Often this stress extends beyond the initial conversation and disclosure of the information. Unfortunately, the stress of these situations does not lessen with experience, and remains a constant stressor throughout the HCP’s career. As a result, HCPs may withhold information or overestimate survival rates when discussing situations with patients.
Specific fears that influence the HCPs discussions of bad news include the following:
Fear of the patient’s emotional reaction
Fears that the news will result in the patient feeling hopeless and depressed, possibly shortening their life span
Expressing their own emotion during the process
Being blamed for the bad news
Fear of negative reviews from the patient
Ways to break the news
HCPs have legal and ethical obligations to disclose as much information as patients want regarding diagnosis and treatment. The truth can not be withheld from patients, even if that may have negative effects.
Delivering troubling or upsetting news is a complex communication process that requires advanced skills across the following areas:
Dealing with patient expectations for a cure
Dealing with stress created by the patient
Involving the patient in decision-making
Potential involvement of multiple family members
Responding to patients’ emotional cues and reactions
The dilemma of how to offer hope when the situation is bleak
There are several models available to guide HCPs in the practice of delivering bad news, which have been well studied and can guide discussions with patients during these difficult conversations, including the ABCDE model, the BREAKS model, and the SPIKES model. They have a few strategic approaches in common that lead to effective communication:
Establish rapport with the patient. Ensure a comfortable, unhurried, private environment for sensitive conversations. Use open-ended questions taking discussion cues from the patient.
Determine the patient’s previous knowledge and desire for details. Ask the patient what their current level of understanding is. Assess the amount of information the patient wishes. Some patients want great detail, while others do not.
Avoid medical jargon and euphemisms. Give information in short, simple sentences. Explain information in plain and understandable terms. Take frequent breaks to assess the patient’s level of comprehension and clarify any points.
Support the patient’s emotions. Observe and identify patient responses while acknowledging the reason for the feelings. Allow the patient time to express emotion, while reassuring them you understand where their reactions are coming from.
Allow for questions, summarizing, and determining next steps. Ensure adequate time to let there be questions and to clarify or elaborate on any required information. A written summary and treatment plan are beneficial for patients who may not remember details during the stress of the disclosure. Set a clear plan for the future.
The bottom line
Giving bad news to a patient will remain a stressor throughout the careers of HCPs. However, with thoughtful communication strategies and techniques, providers can raise their level of self-efficacy and prevent burnout. Communicating in an empathetic and kind manner respects patients and positively impacts the trajectory of their illness, allowing for the continuation of a meaningful relationship.
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