Discussing serious news
- Stephanie M Harman, MD, FACP
Stephanie M Harman, MD, FACP
- Clinical Associate Professor
- Stanford University School of Medicine
- Robert M Arnold, MD
Robert M Arnold, MD
- Editor-in-Chief — Palliative Care
- Section Editor — General Principles of Palliative Care
- Chief, Section of Palliative Care and Medical Ethics
- University of Pittsburgh School of Medicine
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…"  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" . 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 . 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” .
PATIENTS' PREFERENCES WHEN RECEIVING SERIOUS NEWS
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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- PATIENTS' PREFERENCES WHEN RECEIVING SERIOUS NEWS
- CLINICIANS' PREFERENCES WHEN COMMUNICATING SERIOUS NEWS
- Views of patients and families on how clinicians communicate serious news
- IMPACT OF COMMUNICATING SERIOUS NEWS ON PATIENTS AND CLINICIANS
- INFLUENCE ON CLINICAL OUTCOMES
- Can communication skills be taught and learned?
- APPROACHES TO BREAKING SERIOUS NEWS: EXISTING MODELS AND KEY ELEMENTS
- Preparation and setting
- Asking the patient/family what they understand or perceive
- Sharing the serious news itself
- Attending to emotions as they arise
- Planning and discussing next steps
- Approach to patients with intellectual disabilities