"I'm Sorry to Tell You..." Physicians' Reports of Breaking Bad News

ArticleinJournal of Behavioral Medicine 24(2):205-17 · May 2001with19 Reads
Impact Factor: 3.10 · DOI: 10.1023/A:1010766732373 · Source: PubMed

In this investigation the authors assessed what physicians do when planning for and delivering bad news to patients. Seventy-three physicians responded to a series of statements about the behaviors, thoughts, and feelings they might have had while preparing for and delivering bad medically-related news. Data were also obtained about how well they thought the transaction had gone, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. Physicians reported that these transactions were only moderately stressful, with 18.1% and 18.7% indicating that preparation stress or delivery stress, respectively, were above the midpoint on the scale. Slightly over 42% of the sample indicated that the stress they experienced lasted from several hours to three or more days. Thirty-six delivery-related statements were typical (with endorsement rates of at least 80% in a given direction) for at least one of the two recall groups.

    • "Not surprisingly, doctor's self-reports indicate that they find BBN stressful [11] [12], particularly when they feel a sense of responsibility for the news, [13] or fear the patient/family emotional reactions to the news [14]. Doctors also report that they sometimes have difficulty separating their own emotions from the clinical situation [15] [16]. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to investigate the relationship between doctors' bad news delivery style and their experience of physiological stress during simulated bad news consultations. 31 doctors participated in two simulated breaking bad news (BBN) consultations. Delivery style was categorized as either blunt, forecasting or stalling (i.e. avoidant), based on the time to deliver the bad news and qualitative analysis of the interaction content and doctor's language style. Doctors' heart rate (HR) and skin conductance (SC) were recorded in consecutive 30s epochs. Doctors experienced a significant decrease in HR (F(1,36)=44.9, p<.0001) and SC (F(1,48)=5.6, p<.001) between the pre- and post-news delivery phases of the consultation. Between-group comparisons for the three delivery styles did not identify any significant differences in HR (F(2,36)=2.2, p>.05) or SC (F(2,48)=.66, p>.05). Doctors experience heightened stress in the pre-news delivery phase of breaking bad news interactions. Delaying the delivery of bad news exposes doctors to a longer period of increased stress.This suggests that medical students and doctors should be taught to deliver bad news without delay, to help mitigate their response to this stressful encounter. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Full-text · Article · Aug 2015 · Patient Education and Counseling
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    • "Second, much research on patient-centered communication in cancer care has focused on clinicians and paid much less attention to the patient's role in the encounter. For example, numerous studies have focused on clinicians' challenges and strategies when breaking bad news12131415, delivering diagnostic and prognostic information [16,17], recognizing and responding to patient's emotions [18,19], discussing risks and benefits associated with screening and treatment decisions [20,21], and facilitating shared decision-making [22,23]. However, to achieve patient-centered care, patients also have responsibilities to be actively engaged [4]. "
    [Show abstract] [Hide abstract] ABSTRACT: To test a pathway through which a tailored, pain management education-coaching intervention could contribute to better cancer pain control through the effects of patients' communication about pain on physician prescribing of pain medication. Secondary analysis of data from a randomized controlled trial that tested the effects of a tailored education-coaching intervention on pain control for patients with advanced cancer. The current analysis focused on a subset of the patients (n = 135) who agreed to have their consultations audio-recorded. Patients' active communication about pain (e.g., expressing questions, concerns, and preferences about pain-related issues) was coded from audio-recordings. Change in pain medication was measured by patient self-report. Improvement in pain control was scored as the difference between baseline pain score and pain reported at 6 weeks. Patients' pain-related communication was a significant predictor of patient-reported changes in physician prescribing of pain medication (p < .0001) and mediated the effect of baseline pain on medication change. Other predictors of change in pain medication were age (younger) and having participated in the intervention (as opposed to usual care). Of the patients reporting adjustment in pain medications, 49% experienced better pain control compared with only 27% of patients reporting no change in pain management (p < .02). Cancer patients who ask questions, express concerns, and state preferences about pain-related matters can prompt physicians to change their pain management regimen, which in turn may lead to better pain control. Future research should model pathways through which clinician-patient communication can lead to better cancer outcomes. Copyright © 2014 John Wiley & Sons, Ltd.
    No preview · Article · Oct 2014 · Psycho-Oncology
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    • "Studies evaluating the psychological effects of prenatal diagnosis have described in detail the effect of receiving a diagnosis during pregnancy or after the birth [4], and the types of emotions experienced by women [7] [8] as well as by both parents [9] [10]. They have examined the ways in which the diagnosis is given by medical staff [11] [12] and in turn received by the parents [13] [14]. Further, they have evaluated the possible coping strategies [2] and the consequences over time of a pregnancy termination after the diagnosis [15]. "
    [Show abstract] [Hide abstract] ABSTRACT: The study's aim was to evaluate how information related to a prenatal diagnosis of fetal malformation could modify parenthood experience descriptions during pregnancy and after the child's birth. A longitudinal case-control clinical study was conducted. Data on parenthood experience descriptions collected using a validated semantic differential technique during pregnancy and after the child's birth were compared between seven couples of parents receiving a prenatal diagnosis of fetal malformation and seven couples without any fetal diagnosis. Our results show that during pregnancy parents in the clinical group describe themselves as more fragile, passive, and timid [p=0.007] than those in the control group. On the other hand, after the child's birth, there are no significant differences between groups. Data are discussed with reference to better knowledge of the psychological dynamics involved in becoming a parent and to rational planning of support for parents receiving a diagnosis of fetal malformation.
    Full-text · Article · Feb 2014 · Journal of Pediatric Surgery
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