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Breaking Bad News: A Review of the Literature
Abstract
To review the literature on breaking bad news while highlighting its limitations and describing a theoretical model from which the bad news process can be understood and studied.
Sources were obtained through the MEDLINE database, using "bad news" as the primary descriptor and limiting the sources to English-language articles published since 1985. STUDY SELECTION AND EXTRACTION: All articles dealing specifically with bad news were examined. These works included letters, opinions, reviews, and empirical studies. Recommendations from these articles were examined, sorted into discrete categories, and summarized.
The 13 most consistently mentioned recommendations (eg, delivering the news at the patient's pace, conveying some hope, and giving the news with empathy) were examined.
Although much has been written on the topic of breaking bad news, the literature is in need of empirical work. Research should begin with the simple question of whether how the news is conveyed accounts for variance in adjustment before moving to more specific questions about which aspects of conveying bad news are most beneficial. It is suggested that the bad news process can be understood from the transactional approach to stress and coping.
... Bad news is defined as any news that drastically and negatively alters the patient's view of his or her future [15][16][17]. Breaking bad news in a compassionate way is an essential component of the doctor-patient relationship [18][19][20]. Nonetheless, most undergraduate and graduate medical programs lack formative or summative assessments for breaking bad news, leaving many physicians unprepared to handle such conversations with patients [18,19]. ...
... Nonetheless, most undergraduate and graduate medical programs lack formative or summative assessments for breaking bad news, leaving many physicians unprepared to handle such conversations with patients [18,19]. Even experienced clinicians report that having to break bad news is a source of significant stress [4,[17][18][19][20]. Additionally, trainees enter residency programs with different levels of experience, as formal instruction during medical school for breaking bad news is highly variable [20]. ...
... Additionally, trainees enter residency programs with different levels of experience, as formal instruction during medical school for breaking bad news is highly variable [20]. Because most trainees lack previous hands-on experience, an intern's first clinical experience of delivering bad news typically occurs during residency [17,19]. This lack of practice and experience is less than ideal for patients and their families. ...
Background
The transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol.
Methods
The IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be “easy” and “intermediate” in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cases in sessions held in November 2013 and May 2014. Standardized patients completed an assessment checklist to evaluate each resident’s performance in breaking bad news based on their use of the SPIKES protocol and IMA tool. Residents answered post-encounter questions about their training and comfort in breaking bad news. The association between SPIKES and IMA scores was investigated by simple linear regression models and Spearman rank correlations.
Results
There were 136 eligible medical residents: 108 (79.4%) participated in the first session and 97 (71.3%) participated in the second session, with 96 (70.6%) residents participating in both sessions. Overall, we were able to identify residents that performed at both extremes of the assessment criteria using the integrated milestone assessment (IMA) and the SPIKES protocol. Interestingly, residents rated themselves below “comfortable” on average.
Conclusion
We developed an integrated milestone assessment (IMA) that was better than the SPIKES protocol at assessing the skill of breaking bad news. This collaborative assessment tool can be used as supplement tool in the era of milestone transformation. We aim assess our tool in other specialties and institutions, as well as assess other shared milestones across specialties.
... The definition of bad news is information that points towards the consideration of an unfavorable outcome [11,12]. In obstetrics, bad news can be the precursor to adverse effects on the health of the mother or the fetus, defying hopes and expectations [13][14][15][16]. Many emotions, potentially negative ones, are experienced during the transmission of bad news, both from the pregnant women and from the medical staff [11,[13][14][15][16]. ...
... In obstetrics, bad news can be the precursor to adverse effects on the health of the mother or the fetus, defying hopes and expectations [13][14][15][16]. Many emotions, potentially negative ones, are experienced during the transmission of bad news, both from the pregnant women and from the medical staff [11,[13][14][15][16]. The discovery of a fetal anomaly or fetal dysplasia on ultrasound is most commonly an unexpected, particularly stressful, and sometimes emotionally devastating event for pregnant women. ...
Introduction: Breaking bad news is one of the most difficult responsibilities in medical practice. Although medical staff in clinical practice often encounter situations that necessitate the announcement of unpleasant news, there is a lack of training regarding their communication with patients and their families. Effective interaction between medical staff and pregnant women constitutes a crucial component of breaking down unpleasant news. This research aimed to investigate the knowledge and attitude of health professionals, particularly obstetricians, and midwives, regarding the announcement of bad news during prenatal screening.
Methods: The study was conducted between September 2017 and April 2018. One hundred professional obstetricians and midwives involved in fetal and prenatal medicine in Greece were part of the study. The study consisted of two parts: the first covered the emotional state of healthcare professionals during the announcement of unpleasant news, and the second covered the appropriate way to inform unpleasant results during prenatal testing.
Results: In this study, only 41% of the participants considered that they felt comfortable discussing issues related to the diagnosis of an unpleasant result during prenatal testing with the pregnant woman/patient, or her relatives, and 85% accepted that they had experienced feelings of sadness, anxiety, or guilt when announcing unpleasant results. Furthermore, 87% of the participants believed that the non-verbal communication component (eye contact, body language) plays an important role in breaking bad news. Finally, 65% considered that prolonged monitoring of the ultrasound screen during prenatal screening does not increase the anxiety of pregnant women when carried out for a better medical opinion.
Conclusions: Delivering bad news during prenatal screening creates stress for the parents. As far as the ethical, cultural, psychological, and legal complicity of healthcare professionals is concerned, communicating unpleasant news has been a subject of discussion by many experts. It is important to understand the concerns of women regarding the risks of counseling.
... Three quarters of patients want more information and support at diagnosis and half feel uncomfortable talking about psychosocial issues [83]. Consultants may benefit from consultation skills training to maintain focus on the patient during interpreted sessions, to break bad news sensitively [84,85], including via telemedicine [86], and to meet different informational and emotional needs during diagnosis [87]. Patient needs include information about the purpose of concomitant therapies (such as chemo-preventives), mental health support and the practical issues of living with IBD, including requesting reasonable adjustments from employers and concessions under disability legislation. ...
Objective
An improved understanding of the causes and experience of diagnostic delay in Inflammatory Bowel Disease (IBD).
Methods
Framework analysis of semi-structured interviews with 20 adults with IBD.
Results
Participants’ prior knowledge of normal bowel function/IBD was limited. Symptoms were sometimes misattributed to mild/transient conditions or normalised until intolerable. Family pressures, work, education, mistrust of doctors, fear and embarrassment could exacerbate delays. Poor availability of face-to-face appointments deterred people from seeing a GP. Patients feared that by the time they got to see their GP, their symptoms would have resolved. Patients instead self-managed symptoms, but often regretted not seeking help earlier. Limited time in consultations, language barriers, embarrassment, and delays in test results subsequently delayed specialist referrals. GPs misattributed symptoms to other conditions due to atypical or non-specific presentations, leading to reduced trust in health systems. Patients complained of poor communication, delays in accessing test results, appointments, and onward referrals–all associated with clinical deterioration. GPs were sometimes unable to ‘fast-track’ patients into specialist care. Consultations and endoscopies were often difficult experiences for patients, especially for non-English speakers who are also less likely to receive information on mental health support and the practicalities of living with IBD.
Conclusions
The framework analysis demonstrates delay in the diagnosis of IBD at each stage of the patient journey.
Recommendations
Greater awareness of IBD amongst the general population would facilitate presentation to healthcare services through symptom recognition by individuals and community advice. Greater awareness in primary care would help ensure IBD is included in differential diagnosis. In secondary care, greater attention to the wider needs of patients is needed–beyond diagnosis and treatment. All clinicians should consider atypical presentations and the fluctuating nature of IBD. Diagnostic overshadowing is a significant risk–where other diagnoses are already in play the risk of delay is considerable.
A comunicação de más notícias na prática médica é um processo desafiador que envolve compreender a subjetividade do paciente e adotar uma conduta apropriada. Esta revisão de literatura destaca a importância da empatia, individualização, clareza e suporte emocional na comunicação de más notícias. A formação médica adequada e o suporte contínuo são essenciais para capacitar os profissionais de saúde nesse processo. Ao aprimorar a comunicação de más notícias, é possível minimizar o sofrimento do paciente e promover um cuidado mais humano e centrado no paciente.
Patients with advanced cancer increasingly receive end-of-life care from a variety of health care professionals, physicians and nurses. These professionals need to be able to assess the original diagnosis and the appropriateness of patient referral, set a treatment or palliation program, and recognise and plan for the clinical problems associated with specific primary tumors. This is the first comprehensive source of information available at a level between specialist oncology texts and nursing texts. Two eminent physicians from one of the world's foremost cancer centers have drawn together a remarkable team to provide a handbook which covers the full range of problems the healthcare workforce caring for these patients will encounter. This highly accessible text covers general principles in oncology, the primary tumors one by one, and management of specific symptoms and syndromes. It will be invaluable to primary care physicians, surgeons, nurses, therapists and trainees.
Patients with advanced cancer increasingly receive end-of-life care from a variety of health care professionals, physicians and nurses. These professionals need to be able to assess the original diagnosis and the appropriateness of patient referral, set a treatment or palliation program, and recognise and plan for the clinical problems associated with specific primary tumors. This is the first comprehensive source of information available at a level between specialist oncology texts and nursing texts. Two eminent physicians from one of the world's foremost cancer centers have drawn together a remarkable team to provide a handbook which covers the full range of problems the healthcare workforce caring for these patients will encounter. This highly accessible text covers general principles in oncology, the primary tumors one by one, and management of specific symptoms and syndromes. It will be invaluable to primary care physicians, surgeons, nurses, therapists and trainees.
Patients with advanced cancer increasingly receive end-of-life care from a variety of health care professionals, physicians and nurses. These professionals need to be able to assess the original diagnosis and the appropriateness of patient referral, set a treatment or palliation program, and recognise and plan for the clinical problems associated with specific primary tumors. This is the first comprehensive source of information available at a level between specialist oncology texts and nursing texts. Two eminent physicians from one of the world's foremost cancer centers have drawn together a remarkable team to provide a handbook which covers the full range of problems the healthcare workforce caring for these patients will encounter. This highly accessible text covers general principles in oncology, the primary tumors one by one, and management of specific symptoms and syndromes. It will be invaluable to primary care physicians, surgeons, nurses, therapists and trainees.
Patients with advanced cancer increasingly receive end-of-life care from a variety of health care professionals, physicians and nurses. These professionals need to be able to assess the original diagnosis and the appropriateness of patient referral, set a treatment or palliation program, and recognise and plan for the clinical problems associated with specific primary tumors. This is the first comprehensive source of information available at a level between specialist oncology texts and nursing texts. Two eminent physicians from one of the world's foremost cancer centers have drawn together a remarkable team to provide a handbook which covers the full range of problems the healthcare workforce caring for these patients will encounter. This highly accessible text covers general principles in oncology, the primary tumors one by one, and management of specific symptoms and syndromes. It will be invaluable to primary care physicians, surgeons, nurses, therapists and trainees.
ResearchGate has not been able to resolve any references for this publication.