"I wish I had better news."
Delivering bad news is never easy, but learning how to do so is essential for all clinicians. Knowing how to present information can help you to make the process more bearable for patients. The American Medical Association’s Institute for Ethics program offers a module, “Communicating Bad News,” that provides a practical approach. It indicates that breaking bad news in a compassionate yet direct way can help the patient and family set realistic goals. And, although some of the advice may seem obvious, it may also be the sort of thing that is easily overlooked. The first step is to prepare yourself: Before meeting with the patient, think about what you want to say, and make sure that you have all of the information you need. Be sure there is enough time, rather than trying to schedule it between other appointments. If possible, ask your staff to hold calls and pages until the appointment is over.
You may feel more comfortable by first finding out what the patient knows about his or her condition. You might ask questions such as, “How would you describe your medical situation?” and “Have you been worried about your illness or symptoms?”
Next, you might spend a few moments finding out how much the patient really wants to know. Depending on their cultural background, personal history, or medical status, people may have different expectations and preferences for what they should be told. You might ask the patient if he or she wants to hear the prognosis, for example, or if they would prefer not to know.
If the family asks that the patient not be told, you might ask them why they are making this request. Legally, of course, you are obligated to tell the patient; however, you may negotiate some elements with the family. If you cannot resolve it, an ethics consult may be helpful.
The Language of Bad News: Phrases That Help
These phrases can help you to be straightforward yet compassionate. Delivering Bad News
“I’m afraid the news is not good. The biopsy showed you have colon cancer.”
”Unfortunately, there is no question about the results. You have emphysema.”
”The report is back, and it’s not as we had hoped. It confirms that you have the early stages of Parkinson’s disease.” Responding to Patient Reactions
”I imagine this is difficult news...”
”Does this news frighten you?"
”I wish the news were different.”
”Is there anyone you’d like me to call?”
”I’ll try to help you.”
”I’ll help you tell your children.” Dealing with Prognosis
”What are you expecting to happen?”
”What would you like to have happen?”
”How specific would you like me to be?”
”What are your fears about what might happen?” Adapted from Communicating Bad News, EPEC Project, The Robert Wood Johnson Foundation, 1999. |
When you are ready to share the bad news, try to be as straightforward as possible, without speaking in a monotone or delivering a monologue. Communications experts suggest that you not start by saying, “I’m sorry…”; instead, try saying, “I feel badly to have to tell you…” You can end your conversation with an apology for the patient’s condition.
Of course, people will respond differently to bad news; shock, anger, sorrow, despair, denial, blame, disbelief, and guilt all are common reactions. In some cases, people may simply have to leave the office. Emotional outbursts may make you very uncomfortable. Try to give the patient and family time—and privacy—to react.
A good way to end this discussion is to establish a plan for next steps. This may include gathering more information, ordering more tests, or preparing advance directives. Reassure the patient and family that you are not going to abandon them, regardless of referrals to other health care providers. Let them know how they can reach you—and be sure to respond when they call.
Referring Patients to Clinical Trials Carefully conducted clinical trials are the primary way to find out if a promising treatment is safe and effective. Patients who participate in clinical research can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. Clinicians have an important role in providing continuing care for patients who participate in clinical trials. Most trials provide only short-term treatments related to a specific illness or condition. They do not provide extended or complete primary health care. By working with the research team, you can ensure that other medications or treatment needed by your patient will not conflict with the protocol. For information about federally and privately supported clinical research, contact: National Institutes of Health
www.ClinicalTrials.gov |
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