Breaking Bad News: The Patient's Viewpoint

Abstract

The objective of this study was to ascertain how patients judge the acceptability of physicians' communication of bad news. Two hundred forty-five adults, who had in the past received bad medical news, indicated the acceptability of physicians' conduct in 48 vignettes of giving bad news to patients. Vignettes were all combinations of five factors: level of bad news (infection with hepatitis C, cirrhosis of the liver, or liver cancer); request or not to the patient to come with spouse or partner; attempt or not by the physician to find out the patient's expectations about the test results; presence or absence of emotional supportiveness; and provision or not of complete and understandable information. In addition, nine physicians rated the same vignettes. Quality of information and emotional supportiveness explained more than 95% of the variance in patients' acceptability judgments, while the degree of badness of the news had no impact. In addition, for patients, low emotional supportiveness could not be fully compensated by high quality of information, nor the inverse. Physicians, in contrast, responded as if such compensations were possible. Physicians must appreciate that patients expect high levels of both empathy and information quality, no matter how bad the news.

Personal fear of death affects the proper process of breaking bad news

“…Physicians need to accept that patients expect high levels of both empathy and information quality, no matter how bad the news is [13]. Kübler-Ross pointed out that patients usually know the bad news about upcoming death, regardless of whether they are informed by the physician.…”

Communication in a medical setting: can standards be improved?

“…Emphasis on the expected functional state and quality of life as well as emotional support have been shown to be the real need of patient and family [13-15]. Sastre et al [16]. assert that support cannot be fully compensated by high quality of information, which is the contrary to the thesis popular among physicians for whom such a compensation is possible.…”

Breaking Bad News in a Southeast European Population: A Survey among Cancer Patients in Albania

“…12,13,15,16 The quality and completeness of information coupled with the physician's emotional support were considered important factors in breaking bad news appropriately in another study in France. 17 Alternatively, the process of a patient's understanding of the bad news is complex. Morse concluded that being told bad news is only one part of the patient's knowing.…”