The goals of communicating bad news in health care: do physicians and patients agree?

Abstract

Background Communicating bad news serves different goals in health care, and the extent to which physicians and patients agree on the goals of these conversations may influence their process and outcomes. However, we know little about what goals physicians and patients perceive as important and how the perceptions of physicians and patients compare.

Entrega de malas noticias en la práctica clínica

“…La percepción del profesional de la salud de cuáles son los objetivos importantes para el paciente también influencian el cómo se entrega la noticia 1 . Una pobre comunicación puede frustrar el objetivo de entender las expectativas de tratamiento del paciente o involucrar al mismo en la planificación del tratamiento.…”

“…Los profesionales de la salud deben rutinariamente comunicar malas noticias, como resultados anormales de exámenes, malos pronósticos, resultados adversos de los tratamientos, entre otros 1 . A pesar de lo habitual de esta práctica, es considerada una tarea complicada 2 y poco confortable 1 .…”

Editorial

“…The next two articles focus on the communication between health professionals and patients. Particular attention has been paid to the way that clinicians deliver ‘bad news’ relating to a diagnosis or prognosis, and Sweeny, Shepperd and Han explore the different perception of the underlying goals physicians and patients in California expressed in relation to such communication . Based on surveys of a random sample of physicians and a snowball sample of patients, Sweeny concludes that while there is significant alignment in perceived goals of delivering bad news, there were differences in the relative priority of physicians and patients; persuading patients to follow physician recommendations was rated higher by patients than physicians.…”

‘Just gripping my heart and squeezing’: Naming and explaining the emotional experience of receiving bad news in the paediatric oncology setting

“…The findings of this study support the interpretation of these behaviours as beneficial processes within the bad or significant news context.Although the remaining descriptors were connected by the participants to issues arising from the news itself, some were based on particular thoughts and beliefs that, while not caused by the actions of clinicians, might be eased over time through appropriate intervention(43,45). These included feelings of fear in the anticipation of pain during the palliative stages, and feelings of powerlessness and hopelessness in the acknowledgement of the finality of their situation(46)(47)(48).There may be specific characteristics of this participant population that influenced the distribution of perceived origins found in this study, or resulted in only positive feelings being reported in connection to the deliverer, and delivery, of this news. For example, the clinical team and the clinicians who broke the news were all well known to the participants and, while the parents were narrating feelings related to the moment of the interaction, the way in which they explained them suggested that their established familiarity with the clinician may have played a part in the parent s experiences both at the moment of the interaction and during the recall of these experiences for the research interview.…”