Delivering Difficult News in Psychiatric Settings

Abstract

Communication research and investigations into the delivery of bad news are uncommon in psychiatry versus other medical specialties. The question of delivering "bad" diagnostic news in psychiatry has been focused on dementia rather than actual psychiatric disorders and their sequelae. Common problems are that psychiatrists avoid dealing with patients' emotional reactions to bad news and that they avoid providing a clear diagnosis for fear that patients or carers will be distressed. This article aims to provide an overview of key elements of the "breaking bad news" literature, teasing out factors that are relevant to psychiatric practice. Topics explored include: definitions; clinical considerations for delivering difficult news within medical and psychiatric settings; protocols and guidelines; evidence about patient information needs and communication preferences; research into actual delivery of such news; and areas for future education and research.

A Qualitative Exploration of Service Users’ Information Needs and Preferences When Receiving a Serious Mental Health Diagnosis

“…As diagnosis can be a challenging time for individuals (Cleary et al 2010a), their families (Greenwood et al 2000) and clinicians (Cleary et al 2010b) calls have been made to improve clinician competencies and confidence when initially discussing a diagnosis by providing training (Cleary et al 2010b;Gerrity et al 1999;Jha et al 2001;Luderer and Bocker 1993;Milton and Mullan in press;Scardovi et al 2003;Shergill et al 1998;Wong et al 2007) and developing protocols (Cleary et al 2009;Milton and Mullan in press). To address this need, a step-wise model of breaking news borrowed from oncology has been advocated [SPIKES protocol;See (Baile et al 2000;Cleary et al 2010a) and Table 2], and a model specifically tailored to discussing a schizophrenia diagnosis has been developed [See (Levin et al 2011) and Table 2].…”

“…None of these models have been empirically tested in mental health, nor have they incorporated viewpoints service users. Broadening the consultation process, as was done in the development of oncology-related consensus guideline (Clayton et al 2007), has been recommended (Cleary et al 2009). …”

Communication skills in the training of psychiatrists: A systematic review of current approaches

“…Euphemistic terminology for severe conditions (e.g. 'psychosis' for schizophrenia) is frequently used but does not enhance patient understanding (Cleary et al, 2009). Clinicians indicate insufficient communication skills for these types of conversations (Levin et al, 2011).…”

Communication of a mental health diagnosis: a systematic synthesis and narrative review

“…From a macro perspective, the annual incidence of MHD remains high; UK rates for a depression diagnosis are 14 per every 1000 (Rait et al, 2009), and 32 per 100 000 for bipolar and psychotic-related disorders (Kirkbride et al, 2012). Despite this high incidence and impact, there remains a limited understanding of how best to communicate diagnostic news (Cleary et al, 2009).…”

“…All have been narrative literature reviews (Atkinson, 1989;Cleary et al, 2009;Lequesne & Hersh, 2004;Mitchell, 2007;Rose & Thornicroft, 2010) that lacked systematic synthesis. In addition, some focused on communication of news for subtypes of mental health issues (Atkinson, 1989;Lequesne & Hersh, 2004) or concentrated chiefly on making comparisons with the oncology field (Mitchell, 2007).…”