Breaking bad news to cancer patients in times of COVID-19

Abstract

Breaking bad news is a mandatory provision in the professional life of nearly every physician. One of its most frequent occasions is the diagnosis of malignancy. Responding to the recipients’ emotions is a critical issue in the delivery of unsettling information, and has an impact on the patient’s trust in the treating physician, adjustment to illness and ultimately treatment. Since the World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020, several measures of social distancing and isolation have been introduced to our clinical setting. In the wake of these restrictions, it is important to reexamine existing communication guidelines to determine their applicability to face-to-face counseling in the context of social distancing, as well as to new communication technologies, such as telemedicine. We address these issues and discuss strategies to convey bad news the most empathetic and comprehensible way possible.

From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19

“…The innovation and usefulness of these results consist of the fact that it seems to be the first time that the buffering effect of the two aforementioned communicative elements is proved in relation to COVID-19-related negative feelings. Consequently, physicians could take into account these communicative functions when interacting with patients since they seem to "shield" their psychological well-being [71][72][73]. Furthermore, it is important to highlight that on the basis of this and previous results [57,132,133,135], it may be possible to structure communication skills training for health personnel working with oncological patients.…”

“…For example, they reported being scared of COVID-19 contagion as well as any of its possible repercussions on cancer treatment (i.e., delays in therapies) [45,47,50]. However, a good doctor-patient communication based on PCC seems to contribute to the reduction in distress and to the improvement of oncological patients' psychological well-being [58,72,74].…”

“…Clinician-patient communication presenting both empathy and clarity of language seems to calm oncological patients' fears and to reduce both their anxiety symptoms and their feeling of hopelessness [58,62,[71][72][73][74].…”

“…Still, the research focused on the impact of doctor-patient communication on oncological patients' negative feelings at the time of COVID-19 is scant [34,72,75], and no study has previously investigated the relationships between fear of COVID-19 and feelings of hopelessness in this patient population.…”

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

“…On the other hand, mediated interactions, either by phone or video, potentially lessen clinicians’ capacity to respond sufficiently to patients’ uncertainty and difficult feelings. For example, while the pandemic-induced transition to telehealth has been relatively well received 17 , 70 , many clinicians and patients are concerned that telehealth visits can be a hindrance to effective clinician-patient communication 21 , 22 , 71 . Accordingly, cancer patients present mixed views of the utility of telehealth, as some hope it will remain an option for some cancer care services [70] , whereas others hope to return to pre-pandemic, in-person cancer care [72] .…”