A randomized, controlled trial of physician postures when breaking bad news to cancer patients

Abstract

Medical training teaches physicians to sit when breaking bad news, though there have been no controlled studies to support this advice. We aimed to establish cancer patients' preference for physician posture when physicians break bad news using a randomized controlled crossover trial in a department of palliative care at a large US cancer center. Referred patients were blind to the hypothesis and watched video sequences of a sitting or standing physician breaking bad news to a cancer patient and 168 of 173 participants (88 female) completed the study. Sitting physicians were preferred and viewed as significantly more compassionate than standing physicians (P < 0.0001) but other physician attributes and behaviours were generally rated as of equal or more importance than posture. In summary, cancer patients, especially females, prefer physicians to sit when breaking bad news and rate physicians who adopt this posture as more compassionate. However, sitting posture alone is unlikely to compensate for poor communication skills and lack of other respectful gestures during a consultation.

Which Treatment Is Better? Ascertaining Patient Preferences With Crossover Randomized Controlled Trials

“…We investigated the effect of physician posture when breaking bad news on patients’ perception of their compassion (33), using a crossover RCT design. One hundred seventy-three cancer patients were randomly assigned to watch two nine-minute videos in different order.…”

Deciding what information is necessary: do patients with advanced cancer want to know all the details?

“…The vast majority of oncology patients prefer face-to-face communication, 9 and randomized controlled trials of physicians' posture whilst breaking bad news have shown patients prefer physicians to sit rather than stand, and perceive those that do so as more compassionate. 92,93 Patients with advanced cancer perceive physician behaviors such as making eye contact (if culturally appropriate) and not taking phone calls to convey a sense of being present and not hurried. This is felt to be more important than the actual amount of time spent.…”

End-of-life diagnosis, communication, and the search for “Infectin,” “Clottin,” and “Heart Arrestin”

“…Recent research suggests that physical signs such as pulselessness of the radial artery, respiration with mandibular movement, decreased urine output, Cheyne-Stokes breathing, and death rattle are more associated with a high likelihood of death within 3 days. 4 Sitting during the medical visit 5 and examining the patient 6 are perceived by patients as highly positive and compassionate aspects of care and will help alleviate some of the distress associated with uncertainty.…”