Are We Prepared to Give Bad News? An International Survey Analysis

Almaguer, Andrea; Garcia, Ismael; Arnaud, D; Mendez, Yamely; Surani, Salim; Marik, Paul E.; Einav, Sharon; Varon, Joseph

doi:10.1016/j.chest.2017.08.869

Cited by 3 publications

(5 citation statements)

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“…Key findings indicate that physicians generally felt unprepared and untrained for the task and were unclear about best practices and cultural norms regarding communication styles. Their feelings of unpreparedness and lack of skills have been consistently found in previous studies (Almaguer et al., 2017; Ferraz Gonçalves et al., 2017; Mostafavian & Shaye, 2018; Van Keer et al., 2019).…”

Section: Discussionsupporting

confidence: 73%

“…Bad news for patients can be any information that produces negative expectations about their future (Buckman, 1984). Although receiving bad news about personal health is a major stressor and can provoke anxiety among patients (Fallowfield & Jenkins, 2004;Zwingmann et al, 2017), health care professionals who give the bad news also report feeling a high level of stress (Ptacek et al, 2001;Shaw et al, 2013) and underprepared for the responsibility (Almaguer et al, 2017;Ferraz Gonc¸alves et al, 2017).…”

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confidence: 99%

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Oncologists’ Experience of Delivering Bad News in Korea

Kim

Choi

et al. 2020

Omega (Westport)

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This study explored oncologists’ experiences of delivering bad news to patients with cancer and their families. Nine oncologists recruited from three superior hospitals in Korea completed in-depth interviews. The results of thematic analyses identified four themes: precursors to bad news delivery, why it is difficult to deliver bad news, when it is more difficult to deliver bad news, and strategies of delivering bad news. The participants felt unprepared for the task and stressed because breaking bad news goes against their responsibility to do no harm and their professional objective to promote healing. Although they were unclear about best practices regarding communication styles, they individualized their communication style to meet the needs of their patients, who have an array of cultural, social, and spiritual backgrounds. Understanding oncologists’ perceptions of bad news delivery can inform culturally appropriate interventions for alleviating their stress and improving patient–physician relationships in communication of bad news.

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Section: Discussionsupporting

confidence: 73%

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confidence: 99%

Oncologists’ Experience of Delivering Bad News in Korea

Kim

Choi

et al. 2020

Omega (Westport)

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“…Despite the challenging nature of breaking bad news, a recent international survey of more than 10,000 healthcare professionals, including doctors, showed that only about a third had received formal training on breaking bad news [ 10 ]. It is, therefore, not surprising that doctors often feel they lack the necessary skills [ 11 ] and feel underprepared for the responsibility of breaking bad news [ 12 , 13 ]. Moreover, studies have shown that breaking bad news can be a stressful task with stress reactions lasting beyond the actual consultation and potentially contributing to symptoms of burnout [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Neurologists’ lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis

et al. 2023

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Background Receiving the diagnosis of a motor neurodegenerative condition (MNDC) can be a life-changing experience. Although several studies of individuals’ experiences have indicated dissatisfaction with aspects of how an MNDC diagnosis was communicated, few studies have addressed doctors’ experiences of breaking bad news for these conditions, especially from a qualitative perspective. This study explored UK neurologists’ lived experience of delivering an MNDC diagnosis. Methods Interpretative phenomenological analysis was used as the overarching method. Eight consultant neurologists working with patients with MNDCs took part in individual, semi-structured interviews. Results Two themes were constructed from the data: ‘Meeting patients’ emotional and information needs at diagnosis: a balancing act between disease, patient and organization-related factors’, and ‘Empathy makes the job harder: the emotional impact and uncovered vulnerabilities associated with breaking bad news’. Breaking the news of an MNDC diagnosis was challenging for participants, both in terms of achieving a patient-centred approach and in terms of dealing with their own emotions during the process. Conclusions Based on the study’s findings an attempt to explain sub-optimal diagnostic experiences documented in patient studies was made and how organizational changes can support neurologists with this demanding clinical task was discussed.

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“…The role-play sessions allowed for a thorough examination and analysis of the medical students' communication patterns in communicating with patients. Six patterns were identified: (1) greatly emphasising patients' emotional needs; (2) showing insufficient care about patients' emotional needs; (3) prioritising the preferred treatment plan instead of respecting the needs of patients' families; (4) acknowledging dying patients' physical discomfort and respecting their treatment preferences; (5) directly disclosing bad news to patients; and (6) addressing patients' familial requirements.…”

Section: Communication Patterns For Delivering Bad News In the Chinese Contextmentioning

confidence: 99%

“…These include making appropriate responses to patients' emotional reactions, engaging patients in the decisionmaking process, managing stress arising from patients' expectations, communicating with family members, and dealing with the difficulty of giving hope in a bleak situation [1]. Due to this complexity, doctors frequently report emotional intensity, communication difficulty and being underprepared for the responsibility when breaking bad news [2][3][4]. Their fear towards bad news delivery include being criticized, the unknown and untaught, managing patients' reactions, not knowing all the answers, illness and death, which may result in emotional disengagement from patients [5,6].…”

Section: Introductionmentioning

confidence: 99%

A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach

Pun

2021

BMC Med Educ

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Background Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. Methods Fifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. Results Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members. Conclusions When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.

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Are We Prepared to Give Bad News? An International Survey Analysis

Cited by 3 publications

References 0 publications

Oncologists’ Experience of Delivering Bad News in Korea

Oncologists’ Experience of Delivering Bad News in Korea

Neurologists’ lived experiences of communicating the diagnosis of a motor neurodegenerative condition: an interpretative phenomenological analysis

A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach

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