How to Break Bad News to Patients: A Guide for Medical Professionals
Key Takeaways
In a physician’s career, breaking bad news to patients is one of the most challenging duties. The discomfort and unease associated with a grim piece of news can be is unsettling. Even though there is no avoiding the inevitable, it is one of the toughest parts of a doctor’s life. While medical school cannot really prepare doctors for such an incident, experience, empathy and frankness can definitely help. Here are some ways to do this while maintaining professionalism.
Deliver bad news with care and understanding
In order to compassionately and effectually deliver bad news, Rabow and McPhee [1] have developed a practical and comprehensive model. Their study highlights the use of a simple mnemonic ABCDE technique. Read on to know how to execute this technique. However, keep in mind that while in most generic cases these recommendations will serve the purpose, certain situations may hinder doctors from carrying out some of these suggestions.
A–Advance Preparation
A little planning goes a long way when delivering grave news. To start, doctors need to familiarize themselves with the basic clinical information and study the patient’s reports. Next, plan the diagnosis and treatment options ahead of time. Some doctors may prefer to rehearse how they will deliver the information too. This is also the time to plan for adequate privacy when speaking to the patient. For instance, doctors can switch off their mobiles or ask staff not to allow interruptions midway.
B–Build A Therapeutic Environment/Relationship
Creating an environment that exudes warmth will be helpful as the next step. Remember, assurance is what the patient and his/her family deserve at this stage. Physicians can use touch where appropriate but avoid it if the patient is sensitive. Being assertive and letting the patient and their family know what is expected from their medical team and during the course of their treatment will offer solace.
C–Communicate Well
The amount and intensity of information a doctor can pass on to their patient depends on the rapport they share. Physicians must choose their words with compassion and exhibit openness if the patient is prepared for it. Keeping a conscious tab on negative words to ease the patient’s discomfort can help. Being expressive and simplifying information is also beneficial to the patient. It may be a good idea to abridge the session when sharing critical news and cite follow-up plans at the conclusion of the visit.
D–Deal With Patient And Family Reactions
When breaking bad news, be prepared to respond to emotional reactions. Be mindful of cognitive coping techniques that the patient may display like denial, blame or disbelief before acceptance. Keeping an eye on the patient’s body language and their evolving coping mechanism now and in subsequent visits will further help the doctor gauge red flags like suicidal tendencies. This can help in taking the appropriate action.
E–Encourage and Validate Emotions
Doctors need be realistic when assuring patients about their course of treatment. Offer hope and encouragement but do so while being accurate and rational. Discuss the patient’s options at the outset and arrange follow-up meetings for decision-making. Inquire about the patient's emotional and spiritual needs and talk to them about their financial strength. This will help them know the support system they have or need to put into place. If need be, physicians can involve other clinic staff, such as those who offer support services, or ask the patient to bring their primary caregiver to the next consultation.
Other techniques to deliver grave news to patients
Alongside this proven technique, doctors may read Robert Buckman’s [2] landmark 1992 book, How to Break Bad News: A Guide for Health Care Professionals. This book draws from numerous examples to set a guideline for delivering bad news in person, how much information to share and the ways to make the patient comfortable.
It is also easy to follow the SPIKES protocol to break bad news: S, setting up the interview; P, assessing the patient's perception; I, obtaining the patient's invitation; K, giving knowledge and information to the patient; E, addressing the patient's emotions with empathic responses; and S, strategy and summary. [3] Formulated by Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP, this 6-step protocol is a culmination of many research formulations and is illustrated through numerous articles and videos that describe each step.
Other aspects to consider when delivering bad news include the ambience and the message [4]. A physician should choose the right place to deliver the news. This will help make the patient more comfortable and allows them to process the information in private. In terms of timing, bad news should be delivered when it is convenient to the patient. Obviously, the doctor should have ample time in hand when having this conversation. Most importantly, delivering such news in person is important and ideally, it should be done in the presence of a support network, a person or people who the patient is at ease with and can take comfort from.
With these recommendations, doctors can shoulder grim news with practicality, sensitivity and empathy. Care and understanding coupled with a researched psychological approach as described above can help do this right.
Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.
