Breaking Bad News and Discussing DeathBreaking bad news and discussing death
Section snippets
Case Study
Shirley Smith, a 43-year-old elementary school teacher, sees her physician, Dr. Williams, because she has been feeling tired. In addition to a careful history and physical examination, the physician suggests some blood tests. The next day, Dr. Williams receives laboratory results that show probable leukemia. He knows that he needs to contact Shirley, but he feels uncomfortable and sad about what he has to tell her. He calls Shirley at work. The school office transfers Dr. Williams' call to the
Literature Review
“Death the Healer, scorn thou not, I pray,
To come to me: of cureless ills thou art
The one physician.
Pain lays not its touch
Upon a corpse.”
Æschylus. 525–456 B.C.
Each of us has a common sense understanding of what bad news is. However, Æxsschylus reminds us that “bad news” is contextual; even death stirs multiple emotions–sadness, tragedy, and, at times, comfort and relief. Folkman and Lazarus14 define bad news as that which engenders a feeling of no hope or threatens a person's physical or
A Clinical Approach to Giving Bad News
“A physician's own humanity may at times be the most powerful healing instrument.”15 Consider the following case example.
Summary
The ability to discuss bad news with a patient and family is a clinical skill that is essential to providing effective end-of-life care. Patients and families value direct, nontechnical explanations that are given by a physician with compassion and kindness. Patients and families value time to talk, express their feelings, and ask questions. Patients need the physician's humanity as much as the physician's technical expertise. As Loxterkamp30 stated, “…patients often demand just our presence.
References (42)
- et al.
Patient participation in the cancer consultation: Evaluation of a question prompt sheet
J Clin Oncol
(1994) Giving sad and bad news
Lancet
(1993)Intercultural differences and communication of the end of life
Prim Care
(2001)- et al.
Cultural considerations of death and dying in the United States
Clin Geriatr
(1996) - et al.
Information needs in terminal illness
Soc Sci Med
(1999) - et al.
Communicating medical bad news: Parents' experiences and preferences
J Pediatr
(1992) - et al.
Delivering bad news
- et al.
Ethnicity and attitudes toward patient autonomy
JAMA
(1995) - et al.
The addition of an audiocassette recording of a consultation to written recommendations for patients with advanced cancer: A randomized controlled trial
Cancer
(1999) How to Break Bad News: A Guide for Health Care Professionals
(1992)
Communication and decision-making in seriously ill patients: Findings of the SUPPORT Project
J Am Geriatr Soc
Why don't patients and physicians talk about end-of-life care?
Arch Intern Med
Letters to patients: Improving communication in cancer care
Lancet
Effects of information on recently diagnosed cancer patients and spouses' satisfaction with care
Cancer Nurs
General information tapes inhibit recall of the cancer consultation
J Clin Oncol
Cancer by another name: A randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients
J Clin Oncol
How should doctors communicate the diagnosis of cancer to patients?
Ann Med
An analysis of coping in a middle-aged community sample
J Health Soc Behav
The rehumanization of death: The ethical responsibility of physicians to dying patients
JAMA
Breaking bad news: Consensus guidelines for medical practitioners
J Clin Oncol
Breaking bad news: 1. Current best advice for clinicians
Behav Med
Cited by (41)
End-of-life and goals of care discussions with cancer patients in the coronavirus pandemic
2021, Palliative and Supportive CareBeing the Best Bearer of Bad Tidings
2007, Review of General PsychologyInterventions for interpersonal communication about end of life care between health practitioners and affected people
2022, Cochrane Database of Systematic ReviewsPublic Health Perspective of Primary Palliative Care: A Review through the Lenses of General Practitioners
2022, Indian Journal of Palliative CareBreaking bad news in the emergency department: A comparative analysis among residents, patients and family members' perceptions
2018, European Journal of Emergency MedicineNeeds of cancer patients in palliative care during medical visits: Qualitative study
2017, Canadian Family Physician
Address reprint requests to, Bruce Ambuel, PhD, Department of Family and Community Medicine, Medical College of Wisconsin, Waukesha Family Practice Residency, 210 NW Barstow, Room #201, Waukesha, WI 53188