Delivering bad news by physicians – Polish reality check

Abstract

Introduction. Disclosing unfavorable information is a very important moment in both diagnostic and therapeutic processes. It is also a highly stress‑inducing factor, both among patients and physicians. During our research we tried to establish how exactly bad news is communicated to patients and the amount of stress that Polish physicians are under in such situations.Material and Methods. Quantitative research was conducted in a university clinical hospital. With the use of an anonymous questionnaire, physicians (n = 100) from oncology, internal diseases, cardiac surgery, gynecology, obstetrics, and urology clinics were asked about the sources and the intensity of stress involved in BBN (Breaking Bad News). Similarly, patients (n = 378) of said clinics were asked to evaluate the relationships they had with their doctors. Results. Most (66.7%) clinicians declared they always conveyed unfavorable information to their patients fully and in detail. Exactly 50.0% admitted they were experiencing high or very high level of stress while doing so. They were mostly (56.1%) anxious about depriving their patients of hope and (38.5%) feared they were letting their patients down. 37.3% of clinicians were afraid of emotional response. Significantly fewer physicians (43%) than patients (84.6%) were of the opinion that all of the medical orders must be followed to the letter.Conclusions. Results suggest that BBN was a stressful experience for physicians. It was mostly related to the fear of disrupting the patient's well‑being. Low level of effective communication was caused by the insufficiency of BBN skills. Social and cultural aspects also played a role.

Delivering bad news: patient's perspective and opinions

“… 16 , 17 These results support the findings gathered in our earlier studies in which a larger number of patients than doctors expressed their need for partnership and open communication in clinical relationships that will enable them to participate in the process of decision-making as regards their further medical therapy and to fully realize the patient’s right to access all the information about their health. 8 …”

“…Our earlier studies indicated that there are two main factors that escalate doctors’ stress level in the process of DBN. 8 , 9 The first of these factors is the education gap in terms of soft skills, which is present in the process of education of medical university students in Poland. The second factor is paternalistic viewpoint among doctors.…”

<p>Preferred Medium of Receiving Diagnostic News Depending on Patients’ Perception of Their Health Status (Healthy or Sick)</p>

“…Some previous studies by other researchers indicated that there are two integral factors that increase doctors' stress in the process of dispersing BDN which are deficits in education in terms of the soft skills required and the paternalistic approach of medical doctors. 9,10 Our research indicated some patients would like to receive their diagnostic news from medium other than medical doctors, although the statistics varied depending on their perceived health status (sick or healthy). Another question that arises from our research is how equipped these other media are in delivering BDN.…”

Future doctors’ priorities and approach to breaking bad news

“…Dwoma głównymi czynnikami zwiększającymi poziom stresu wśród lekarzy w czasie przekazywania złych informacji są brak zdobycia tzw. umiejętności miękkich w czasie studiów oraz utrzymujący się nadal paternalistyczny stosunek lekarzy do pacjentów [19,20]. Wykazano, iż uczestnictwo w Areopagu Etycznym istotnie wpłynęło na przewidywania dotyczące nasilenia niektórych odczuć, które mogą towarzyszyć przekazywaniu trudnej informacji pacjentowi: zmniejszyły się m.in.…”