Blog: Receiving bad or difficult news: patients and their support networks

At some point in time, we have all had to receive difficult news in one life domain or another.  Depending on personal psychological and physical composition, the experience may hit us first physically, with a sensation such as a sinking of the stomach, a hit in the face, or a clouding or ringing in the ears. This may be followed perhaps by a flood of emotions in various constellations – anger, fear, sadness, anxiety, panic…, and various thoughts – what will happen now? What to do next?

In the health field, giving and receiving bad or difficult news is a particularly poignant topic. Illness, – chronic, terminal, debilitating, life altering – is a life occurrence that rocks peoples’ respective worlds.

Attention in research and discussion is therefore given to how such news can be delivered in the best possible way, from the point of view of both givers and receivers. Below are the voiced opinions of doctors and nurses, and patients and their support networks, on this topic.

What is needed to deliver difficult news in health care in the best possible way? Opinions of the people involved

Doctors and Nurses

  • Address emotions
  • Address external factors that influence the effect of the news beyond the patient-professional relationship: family, systemic and institutional factors, and cultural factors
  • Health professionals must thus consider their individual relationships with the patient, the patient’s family, the institutional and systemic environment, and any relevant cultural aspects

Patients/Support Networks

What patients want from health professionals:

  • Clear explanation,  including status of illness, symptoms, and what to expect in the future
  • Empathetic way of delivering the message
  • Emotional support during the interaction
  • Understanding what is important to the individual patient
  • Having their concerns listened to
  • Assurance that pain can be controlled

Patient and family experiences:

  • Patients are more satisfied when health professionals spend time delivering bad news
  • Families of critically ill patients seek information and want to be clearly informed
  • Patients and families have experienced both supportive and unsupportive interactions, depending on health professional communication skills
  • Clear communication and information from health professionals can help reduce stress and anxiety

Interestingly, the viewpoints of all people involved seem to have a large degree of overlap. So why is the topic still so hard? One straightforward explanation is that we as people are different. We don’t fit cookie cutter images and cannot be treated perfectly with one recipe for all. But how then can this be improved?

Taking more general tips, while being sensitive to individual differences, may be the most flexible and useful guide. Below are some examples of such tips from both health professionals and patients.

Doctors and Nurses

Suggestions for what is necessary:

  • Effective communication with patients and their families
  • Prepare and set the stage for delivering bad news
  • Minimize as much negativity associated with the illness as possible
  • Help patients and families make appropriate treatment decisions

Patients/Support Networks

Some acts that can help fulfill patient desires:

  • Tell patients to prepare mentally
  • Telling patients of their expected life expectancy (if applicable)
  • Help patients sustain hope
  • Respond empathically to patients’/families’ feelings
  • Inform clearly and suggest realistic goals
  • Listen to what patients and families expect/want/hope
  • Help make and  carry out a plan

Giving and receiving bad news will always be a difficult topic, but listening to what patients and their families need and want, and health professionals being as sensitive and empathetic as possible, can at least assist those on the journey to effectively traverse a challenging path.

References

Abbaszadeh, A., & Ehsani, S. R. (2014). Nurses’ perspectives on breaking bad news to patients and their families: a qualitative content analysis. Journal of medical ethics and history of medicine, 7.

Aoun, S. M., Breen, L. J., Howting, D., Edis, R., Oliver, D., Henderson, R., … & Birks, C. (2016). Receiving the news of a diagnosis of motor neuron disease: What does it take to make it better?. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 17(3-4), 168-178.

Bousquet, G., Orri, M., Winterman, S., Brugière, C., Verneuil, L., & Revah-Levy, A. (2015). Breaking bad news in oncology: a metasynthesis. Journal of Clinical Oncology, 33(22), 2437-2443.

Parker, P. A., Baile, W. F., de Moor, C., Lenzi, R., Kudelka, A. P., & Cohen, L. (2001). Breaking bad news about cancer: patients’ preferences for communication. Journal of clinical oncology, 19(7), 2049-2056.

Umezawa, S., Fujimori, M., Matsushima, E., Kinoshita, H., & Uchitomi, Y. (2015). Preferences of advanced cancer patients for communication on anticancer treatment cessation and the transition to palliative care. Cancer, 121(23), 4240-4249.

Wong, P., Liamputtong, P., Koch, S., & Rawson, H. (2015). Families’ experiences of their and Critical Care Nursing, 31(1), 51-63.