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Discussing serious news

Stephanie M Harman, MD, FACP
Robert M Arnold, MD
Section Editor
Susan D Block, MD
Deputy Editor
Diane MF Savarese, MD


Discussing serious news, or breaking "bad news" is a common communication task in clinical care. Virtually every clinical specialty requires doctors at some stage to be the bearers of sad, bad, or difficult news. From telling an adolescent that she has mononucleosis, or a woman that she is not in labor, or an athlete about a knee injury, to talking about a life-limiting illness, the ability to deliver "bad news" compassionately is a core skill for all primary care and subspecialty clinicians.    

This topic will cover how we define "bad news", review the evidence that exists regarding patients' and families' preferences about getting such news, summarize clinicians' preferences and skills in disclosure, and review existing strategies for this communication task. Specific issues related to communication about prognosis in advanced, serious illness and estimating survival in individuals with advanced cancer are covered elsewhere, as are discussions on conveying the diagnosis of fetal demise and communication with families in the event of the death of a child. (See "Communication of prognosis in palliative care" and "Survival estimates in advanced terminal cancer" and "Fetal death and stillbirth: Maternal care", section on 'Conveying the diagnosis of fetal demise' and "Assessment of the pediatric patient for potential organ donation", section on 'Family communication' and "Sudden unexpected infant death including SIDS: Initial management", section on 'Family communication and support' and "Pediatric palliative care", section on 'Communication and building relationships'.)


"Bad news" has been defined as "any information likely to alter drastically a patient's view of his or her future…" [1] or that "…results in a cognitive, behavioral, or emotional deficit in the person receiving the news that persists for some time after the news is received" [2]. Inherent in defining what constitutes "bad news" is that it depends heavily on the patient's beliefs and perceptions. As an example, a hospitalized patient may be relieved by a diagnosis of liver abscess because he or she previously believed that the diagnosis was cancer. On the other hand, the diagnosis of diabetes may be viewed as horrific news if an individual believes that this means that they, perhaps like a parent, will need an amputation.

In this topic review, the term "serious news" will be used rather than "bad news". This preference is based upon a qualitative study in which patients listened to these conversations and gave feedback about what they liked and disliked [3]. Patients did not like clinicians judging whether the news was bad, and highlighted the value of framing the news as something to work through and manage with the guidance of the clinician, rather than labeling it as "unfortunate or bad". Another alternative term for “breaking bad news” is “sharing life altering information” [4].


In considering how to conduct these conversations, it is important to consider the preferences of patients and families regarding what information is disclosed, how the information is delivered, and who delivers it.


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Literature review current through: Sep 2016. | This topic last updated: Jan 11, 2016.
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