Bad News for the Patient and the Family? the Worst Part of Being a Health Care Professional

Abstract

In Spain, there is a general tendency to conceal the prognosis from a terminally ill patient. We conducted grounded-theory-based, phenomenologi-cal, qualitative research on this using a final sample of 42 in-depth interviews with doctors and nurses from different fields. We found that most health professionals believe that although patients don't ask questions, they know what is happening to them. Many professionals feel bad when communicating bad news. In hospitals, doctors take responsibility for doing so. The attitudes of professionals are influenced by their sense of responsibility and commitment to the principle of patient autonomy, as well as to the level of their agreement with the cultural context. The tacit agreement of silence makes communication impossible: the patient does not ask questions, the health professional does not want to be interrogated, and family members don't talk about the disease and want health professionals to follow their example. This situation is detrimental to patients and their families and leads to suffering, low levels of satisfaction, and feelings of guilt and helplessness. Health care professionals must acquire the means and the skills for communicating bad news.

Newborn Screening for Metabolic Disorders

“…Giving bad news is one of the most challenging forms of clinical communication. 31-34 This exploratory study suggests that there is room to improve the communication of NBS results. As newborn screening programs continue to expand, closer collaboration with primary care providers will be warranted, as they will increasingly be called on to give news about conditions with which they may be unfamiliar.…”

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

“…A majority of the caregivers were found to be overloaded [212], [213] and did not have any economic help or enough information of the resources available [213], [214], [215]. Two concepts with negative connotations relating to the patient’s family were identified: the ‘conspiracy of silence’ [216], [217], [218], the partial or non-disclosure which is frequently attributed to family members; and, ‘claudicación familiar’ (family surrender), when patients die in hospital and not at home (the ideal place of death according to health professionals) [219].…”

“…Intermediate positions were also found; the majority of doctors stated that they would inform the patient only in certain circumstances or if requested by the patient [206], [207], [208], [209], [228], [229], [230], [231], [232]. The two main obstacles to giving bad news were found to be acceptance of the wishes of the family, hence tolerating the ‘conspiracy of silence’ imposed by the relatives, and feeling uncomfortable to give bad news [217].…”

End-of-life care across Southern Europe: A critical review of cultural similarities and differences between Italy, Spain and Portugal

“…Two main obstacles to the communication of bad news were identified in Spanish health professionals' discourse on disclosure: acceptance of the wishes of the family, hence tolerating the 'conspiracy of silence imposed by the relatives', and feeling uncomfortable and unprepared to give bad news. Doctors in hospitals were found to be more comfortable communicating bad news than doctors in primary healthcare settings and nurses, who often consider the communication of bad news to be doctors' responsibility [84].…”