Breaking Bad News among Cancer Physicians

Abstract

Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life.
Objective: The aim of this study was to explore the physicians' perceptions and perspectives of breaking bad news to cancer patients.
Methods: A cross-sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the Middle East was conducted from August to September 2016.
Results: Sixty-eight percent responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24% stated that the patient alone should be involved in the discussion.
Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

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© 2017 Journal of Health Specialties | Published by Wolters Kluwer ‑ Medknow
66
Original Article
IntRoductIon
Bad news is dened as ‘Any news that adversely and severely
affects an individual’s view of his or her future.’[1] Providing
serious case disclosure to anyone needs expertise, experience
and compassion.
Breaking bad news is never an easy or comfortable task for
physicians. However, disclosure of bad news is inevitable in
medical institutions and is a vital part of the duties of doctors
and other healthcare professionals.
Breaking bad news needs skills and strategies where a
physician should be able to disclose bad news to patient and
family while addressing their concerns accordingly. However,
subtle differences in the content manner or behaviour during
disclosure change the interpretation of the patient or family
and affect their understanding and attitudes of dealing with
the news. It has also been shown that a patients’ outlook on
their disease depends much on the delivery of the bad news.[2]
Considering such matters makes most people feel anxious and
afraid to do the task. On the contrary, there are professionals,
specically doctors and other healthcare providers, who have
the distinct skills and condence of breaking bad news with
ease and comfort without provoking anyone. There are also
some who may not be that honed of doing the task, but they
are committing themselves with all willingness to learn the
techniques needed.
Cancer is a serious illness and oncologists, usually, break
the bad news to cancer patients and their families. Most
cancer patients desire that their oncology doctors extend
their compassion and understanding in order to help them
understand their situation more without the great fear of the
worst case scenarios. Honesty, compassion, care and optimism
Breaking Bad News among Cancer Physicians
Sami Ayed Alshammary1, Abdullah Bany Hamdan1, Jesusa Christine Tamani1, Abdullah Alshuhil1, Savithiri Ratnapalan2, Musa Alharbi1
1Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia, 2Department of Pediatrics, Dalla Lana School of Public Health, Toronto, Ontario, Canada
Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and
understood, and prognosis must be well‑discussed in the most gentle and comfortable manner. It is important that the disclosure is performed
in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life.
Objective: The aim of this study was to explore the physicians’ perceptions and perspectives of breaking bad news to cancer patients.
Methods: A cross‑sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the
Middle East was conducted from August to September 2016.
Results: Sixty‑eight percent responded to the survey. Eighty‑four percent were comfortable with breaking bad news, and 70% had training
in breaking bad news. Eighty‑six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents
stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that
they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if
the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24%
stated that the patient alone should be involved in the discussion.
Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity
of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school
must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.
Keywords: Attitude, breaking bad news, comprehensive cancer centre, perception, psychosocial distress, survey
Address for correspondence: Dr. Sami Ayed Alshammary,
King Fahad Medical City, Riyadh, Saudi Arabia.
E‑mail: drsamiayed@gmail.com
Abstract
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DOI:
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How to cite this article: Alshammary SA, Hamdan AB, Tamani JC,
Alshuhil A, Ratnapalan S, Alharbi M. Breaking bad news among cancer
physicians. J Health Spec 2017;5:66‑72.
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Alshammary, et al.: Break it gently
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Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
are considered some of the attributes that oncologists must
possess.[3]
Cancer patients want to be well‑informed and updated about the
progress of their case and prefer to have disclosures with their
doctor in a private setting.[4] However, there are times that the
cancer patients request some of their relatives to be with them
during discussions with their oncologists. It is imperative to
inform these patients personally the details of their condition in
the manner that they are most comfortable. Their convenience
and comfort in disclosing bad news are of the utmost priority.[4,5]
Cancer patients do not only aspire to nd very competent and
well‑versed physicians in order to facilitate the treatment of
their condition; they are also seeking to nd a doctor who is
compassionate enough to communicate with them in the most
efcient and comprehensive manner.[4,5] Thus, there must be
guidelines and a system to follow when breaking bad news.[6]
These should highly consider the patients’ welfare and comfort
as well as their level of understanding.
Breaking bad news is a serious and very challenging task
for physicians and may become very stressful for all parties
concerned, including doctors and patients.[7] However, a
structured procedure for disclosure with proper practice have
been associated with positive and meaningful outcome.[8]
Anecdotally, some cancer patients in Saudi Arabia do not
know their diagnosis. At present, there is less information
and education regarding disclosure patterns or disclosure
training offered to oncologists and other physicians involved
in breaking bad news in the Middle East. The purpose of this
research is to identify the comprehensive cancer centre (CCC)
physicians’ perspectives and practices about breaking bad news
to cancer patients in Saudi Arabia.
Related literature
There have been accounts in the history of medicine, during
the earlier era, that Hippocrates recommended hiding any
information that would cause despair to patients and may
worsen situations. This scenario is in concurrence with the
rst ethical code in medicine (1847) that states that doctors
should not disclose bad news to the patients as this has a
greater possibility of shortening their life span. Furthermore,
in numerous Asian cultures, and in the Middle East, it is
perceived as unnecessary to inform the patients about a
cancer diagnosis directly; they believe there is a better way of
doing it. Consequently, it has become a collected worldwide
approach to keep the patient unaware of their condition in
order to prevent any harm. However, there have been no
validated psychological accounts of the notion that receiving
unfavourable information is consistently harmful.
There have also been several studies in various communities
which show that a high number of patients prefer to know
directly if they have cancer, get a realistic estimate of survival
as well as the available therapies that they could avail and their
corresponding benets and adverse effects. Receiving accurate
information regarding their case is what most of the patients
prefer in order for them to generate specic decisions that may
have a great impact on their quality of life and plans.[9] In a
survey given as part of the study conducted by MD Anderson,
it was revealed that physicians’ expertise, discussion of options,
clarity and honesty in providing the information were the
attributes most preferred by the patients on disclosing bad
news. The survey revealed a lesser percentage with regard
to physicians’ communication skills, especially in giving
comforting words. Patients also prefer to discuss bad news
with their family doctors rather than the oncologists. Therefore,
oncologists should invite the presence of the family physicians
during the discussion of bad news to patients.
In a research conducted regarding breaking bad news in
relevance to caregivers’ perspective, it was revealed that an
effective strategy was to rst relay encouraging words to
patients before exposing the bad news which can contribute
to feelings of hopelessness. Thus, caregivers must bear in
full consideration how to promote a sense of identication
to patients before striking hopelessness. However, most of
the caregivers were not qualied on the concern related to
breaking bad news. This nding was generated after a 35‑item
questionnaire was distributed to doctors, nurses and patients.
The data showed that caregivers and patients both gave similar
importance to the presence of family members during the ‘bad
news’ interview. Moreover, patients gave more attention than
caregivers during disclosure of bad news and diagnosis, their
possible treatment, and its adverse effects. There was also a
common agreement on the issue concerning the fact that the
patient, and not the caregiver, should be the one to select the
amount of information to be delivered.[10]
One of the most challenging instances in the clinical practice
are when relatives interfere and demand not to let the patient
know the current condition. In a study conducted, 66.7% of its
respondents preferred not to let the patient know about their
real health status in order to prevent intense negative emotions
such as downfall and heartbrokenness.[11]
In Italy, there was a survey about disclosure practices and cultural
narratives. The results revealed that only 44% of the responding
physicians preferred to inform the patients of the cancer diagnosis
and their respective prognosis if the patients themselves wanted
to; even if the family members opposed.[12] In another physician
survey, it was revealed that the majority of its responders felt
the need of having guidelines for breaking bad news to patients.
It showed that in practice, only 25% of them gave diagnosis
disclosure to their patients. Moreover, 44.8% believe that patients
with cancer should always be informed of their condition,
whereas 46.6% believed that patients should be told the truth
but should be limited to some cases only.[13] Meanwhile, in this
study, approximately 29.4% of the respondents felt that it would
be better if they would undergo training in doing disclosures to
acquire the necessary skills needed.
A six‑step protocol (termed SPIKES) aims to give an effective
method of bad news disclosure to cancer patients. SPIKES
stands for: Setting, perception, invitation, knowledge,
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Alshammary, et al.: Break it gently
68 Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
CCC includes 94 in‑patient beds and approximately 1,500
out‑patient visits per month.
A cross‑sectional study was carried out to physicians (n = 75)
who are currently working in a university teaching hospital in the
Middle East. The study population comprised of all (oncology,
haematology, paediatric, radiation and palliative) physicians
working in CCC. Those who were not directly in contact with
patients, for instance, forensic and doctors’ full time working in
hospital administration were excluded from the study.
Before beginning the study, a self‑administered questionnaire
was distributed with the aim of the study explained to the
participants; of course, a nonymity was maintained. The Ethical
Committee of the Institutional Research Centre granted their
approval for the study protocol.
The questionnaire was composed of two sections [Appendix 1].
The rst section obtained demographic details, including age,
gender, clinical position, speciality, qualications and year
of graduation, whereas the second part tried to elicit the
respondents’ opinions and practices about breaking bad news
which included 17 items.
Statistical analysis procedure
All categorical variables: age group, speciality, job title, etc.,
were presented as numbers and percentages. Chi‑square/Fisher’s
exact test was used according to whether the cell expected
frequency was smaller than 5 and furthermore to determine
the signicant relationship between trained professionals
breaking bad news and survey responses as well as other
categorical variables. The value of P < 0.05 was considered
statistically signicant. All data were entered and analysed
through statistical package IBM Corp. 1989, 2013. IBM SPSS
Statistics, Version 22.0.
emotion and strategy (summary). On nalising the subject for
disclosure, there should be constant communication between
all the people concerned (setting up the interview). The
disclosing physician should understand that the main focus
of the disclosure is the patient. There must be an assessment
of the patient's perception, his/her invitation to the amount
of details desired, giving knowledge and information to the
patient while addressing the patient's emotion with emphatic
responses and devising a strategy for future management in
collaboration with the patient. Finally, closing the disclosure
by summarising the discussion to avoid misinformation.[1]
During the annual meeting of the American Society of Clinical
Oncology on 1998, an informal survey was conducted using
select delegates. The results showed that 60% of the total
respondents disclosed bad news to cancer patients 5‑20 times
in a month while 14% did disclosure for 20 times only. On
the other hand, 55% believed that the most difcult task in
breaking bad news was maintaining honestly without taking
away hope, whereas 25% considered that the most difcult
part of the process was dealing with the emotional reactions of
the patients. There were only 10% who conrmed that they had
undergone training in bad news disclosure to cancer patients
while around half of them have rated their communication
skills as poor or fair.
Breaking bad news is commonly perceived to affect patients’
self‑control concerning emotions, condence, professionalism
and trust. This idea was generated after an interview was
conducted with some Swedish physicians who have been in
the medical eld for >21 years. Nearly 30% of them conrmed
that they had not received any formal training in doing
disclosures. There were 87% who believed that breaking bad
news is indeed a difcult task. Despite this condition, 90% of
them afrmed that they had performed disclosures to patients
for >5 times, during the year prior to the period the interview
was conducted.[14]
Nowadays, majority of the medical schools in the Western
areas are integrating communication skills training in their
undergraduate and postgraduate curriculum as part of their
academic activities in order to mold their students as they
become doctors to also be skilled communicators as well. In
contrary to the old belief that communication skills would
be enhanced as they practice their profession in the eld,
tutorials, lectures, textbooks and other aides (CD‑ROMS,
websites) are some of the established didactic means of
delivering principles of communications skills. These may be
enhanced through their experiences in the medical institutions.
Since communication plays as vital skills, in each physician,
workshops related to this are always included in most annual
meetings of numerous cancer societies.[15]
metHods
Study design
A quantitative survey was performed in CCC at King Fahad
Medical City (KFMC) from June to August 2016. At present,
Table 1: Demographic data
Category n (%)
Age group (years)
25‑35 19 (37.3)
36‑45 24 (47.1)
46‑55 7 (13.7)
>56 1 (2.0)
Gender
Male 42 (82.4)
Female 9 (17.6)
Speciality
Oncology 16 (31.4)
Haematology 14 (27.5)
Radiation oncology 5 (9.8)
Palliative care 10 (19.6)
Paediatric haematology oncology 6 (11.8)
Job title
Resident 7 (13.7)
Assistant 21 (41.2)
Fellow 8 (15.7)
Associate 1 (2.0)
Consultant 14 (27.5)
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Alshammary, et al.: Break it gently
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Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
Results
Overall, 68% (n = 51/75) of physicians responded to the survey.
As shown in Table 1, age of the majority of the doctors working
in the cancer center was between 36 and 45 years old. There
was only one senior consultant that belonged to 56 years old
and beyond, and only 9 (17.6%) of these respondents were
female physicians, while 42 (82.4%) were males.
High response was received from the Haematology and
Oncology specialties 31% (n = 16) of respondents were
from the Oncology Department, and 27.5% (n = 14) were
haematology respondents. Majority of the respondents were
assistant consultants 41% (n = 21) [Table 1].
Table 2 illustrates the statistical interpretation of the responses
of physicians related to breaking bad news. Nearly 84% (n = 43)
of the physicians stated that they were comfortable enough
while breaking bad news. This is not a surprise since 70.6%
of them conrmed that they received training. More than half
of the responders (51%) stated that the presence of both the
patient and his/her family was necessary for breaking bad news.
Eighty‑six percent of responders said that patients should be told
about their cancer. Furthermore, 15 (29.4%) of the respondents
stated that they would still disclose the diagnosis to patients even
if it would be against the preference of the patient's relatives of
not saying so. In contrary, 31 (60.8%) of them preferred only to
tell the details to the patients if they are asked to. Meanwhile,
34 (66.7%) chose to disagree with the point that patients should
be told about the diagnoses only with the relatives's consent.
Ninety‑four percent stated that information regarding the
patient's case could be given over multiple visits. In this
manner, there will be a more comprehensive and more efcient
acceptance to the information conveyed. More than half of
them do not agree that breaking bad news will take away the
patient’s hope and lessens his/her survival.
With regard to the impact of breaking bad news, about 30% of
the respondents who felt that they would benet further if they
would undergo training about managing disclosures.
Thirty‑nine (76.5%) of respondents believed that patients were
keen on knowing about their disease. Only 21 (41.2%) of the
respondents agreed that they felt depressed after disclosing bad
news to patients. A similar number of 21 (41.2%) did not report
having any particular feeling on doing such. Interestingly,
43 (84.3%) considered giving false hope to patients was more
stressful than disclosure of diagnosis.
Table 3 shows the relationship between respondents who were
trained and not trained for breaking bad news. 47.2% (n = 17)
of the respondents who trained for breaking bad news belonged
to the age group of 35–45 years, 30.6% (n = 11) belonged to
the age group of 25–35 years, while those who were not trained
belonged to the age groups between 25 and 45 years old.
Majority of the respondents were male, out of which
86.1% (n = 31) were trained, while 73.3% (n = 11) were
Table 2: Questions and responses pertaining to breaking
bad news to cancer patients responses (total=51)
Questions Respondents
(%)
Do you feel comfortable in discussing with
patient/relatives issues concerning cancer
diagnosis, prognosis and life expectancy?
Yes 43 (84.3)
No 5 (9.8)
Not sure 3 (5.9)
Have you been trained for breaking bad news?
Yes 36 (70.6)
No 15 (29.4)
Not sure 0
For whom should the bad news be delivered
Family 13 (25.5)
Patient 12 (23.5)
Both family and patient 26 (51.0)
Do you feel patient should be told everything
about their cancer?
Yes 44 (86.3)
No 4 (7.8)
Not sure 3 (5.9)
If the relatives want to conceal the diagnosis what
you do?
Agree to relative and avoid difcult questions 4 (7.8)
Tell them to take the patient to a doctor who
agrees to whatever the relatives say
1 (2.0)
Tell them that if the patient asks them they will
tell the truth, but if the patient doesn’t ask you
won’t tell
31 (60.8)
Disagree to relatives and tell the diagnoses and
prognosis to the patient
15 (29.4)
Do you feel relatives should be told rst about the
diagnoses and patients only later if they consent?
Yes 13 (25.5)
No 34 (66.7)
Not sure 4 (7.8)
If yes, do you think patient should be told?
Everything in single visit 3 (5.9)
Partial information in each visit 48 (94.1)
Do you feel telling all to patients take away their
hope and their survival lessens?
Yes 13 (25.5)
No 26 (51.0)
Not sure 12 (23.5)
Do you think patients don’t want to know about
the diagnosis and prognosis?
Yes 5 (9.8)
No 39 (76.5)
Not sure 7 (13.7)
Do you feel depressed after breaking bad news to
the patient/relatives?
Yes 21 (41.2)
No 21 (41.2)
Not sure 9 (17.6)
Do you feel which is more stressful?
Explaining bad prognosis 8 (15.7)
Giving false hope to terminal patients 43 (84.3)
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Alshammary, et al.: Break it gently
70 Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
not. Among the physicians who underwent breaking bad
news training, 36.1% (n = 13) came from the Department
of Haematology, 25% (n = 9) came from Palliative,
22.2% (n = 8) came from Oncology, 13.9% (n = 5) from
Paediatric and 2.8% (n = 1) was from Radiation Oncology.
From the respondents list who were trained, 36.1% (n = 13)
were consultants, 30.6% (n = 11) were Assistant Consultants,
19.4% (n = 7) were Fellows, 11.1% (n = 4) were Residents
and 2.8% (n = 1) was an Associate.
dIscussIon
In this study’s context, breaking bad news is dened as any
information given to patients, which could adversely and
seriously affect their view and perspective of their future.
Disclosures are indeed very challenging to physicians dealing
with cancer patients as these often cause stress. Breaking bad
news has been a dilemma in all generations of people in the
medical eld.
The leap with the rates of the comfort among the patients during
breaking bad news is quite higher than the rest of the previous
studies. This could be due to the fact that KFMC is a tertiary
medical hospital which has exposed the participants in this
study to the most relevant factors of patients such as advanced
routinely encountered instances in daily clinical practice. This
can also be reected by the 41.2% of the participants who felt
depression in an unspecied level after they have been into
bad news disclosures. Politely explaining the diagnosis and
prognosis to a sick patient is never easy which may indulge
them to shift tempers and feel dissatisfaction in the end.
In the previous eras, the doctors were the ones who decided
the fate of their sick patients. It is in contrary to the majority
of the concerned patients who are more eager to know about
their condition and their health status. Furthermore, they even
want to get involved in the decision‑making, wherein 76.5%
of the respondents conrmed that their patients were eager to
know about their illness. Moreover, this also concurs with the
international guidelines that patients should be aware of their
disease. However, the manner of disclosure must not be at one
interview setting. The information about a patient's disease must
be informed in a gradual manner to prevent patient's emotional
downfall and promote more comprehension.
It is common to the populace’s perception that cancer, as a
diagnosis, is directly relevant to death.[16,17] In this context,
the responsibility lies on the treating physicians. He/She must
be able to assess the patients’ capability to accept information
in order for them to act accordingly or else, he/she will just
be striking them unnecessarily or re‑assure them falsely.
Inuenced by modern culture, it has been an accepted practice
nowadays to disclose details to patients with cancer which have
been evident in most western areas.
The effective strategy is to rst relay encouraging words to
patients before exposing the bad news which contributes
to feelings of hopelessness.[18] In this study, majority of the
physicians believed that sick patients gave importance to the
presence of family members during the ‘bad news’ interview.
In previous studies, it was the patient who determines the
amount of information needed to disclose.[19,20] Furthermore,
the disclosure of patients’ clinical information should best rely
on the patients’ preference.[21,22] He/She has the right not to let
his/her relatives know the details of his/her condition, and this
is a vital ethical principle that all doctors must bear in mind.[10]
However, in this communication, the doctor must be at his/her
modest condition for him/her to appear as very approachable and
not provoking at all. Assertively, he/she needs to explain to the
patient’s relatives in the most comprehensive manner the ethical
purpose of keeping information from the patient as it may lead to
some effects such as confusion and loss of condence. He/She
must also give an assurance that he/she would be able to set the
discussion with the patient with high sensitivity while limiting
the information as to what the patient prefers to share.[23,24]
One of the previous studies showed that 66.7% of its
respondents preferred not to let the patient know their very real
health condition to prevent intense negative emotions such as
downfall and heartbrokenness.[11] Meanwhile, 51% among all
of the respondents in the current study concur with the idea
that the undesirable breaking of bad news regarding a patient’s
diagnosis was related to the limitation of life expectancy with
unfavourable diagnosis disclosure. In comparison with our
study, the result showed that 39 (76.5%) versus 44 (86.3%)
among the respondents preferred to tell all the information,
Table 3: Relationship between respondents who were and
were not trained for breaking bad news
Have you been
trained for breaking
bad news?
P
Yes (%) No (%)
Age group (years)
25‑35 11 (30.6) 8 (53.3) 0.186
36‑45 17 (47.2) 7 (46.7)
46‑55 7 (19.4) 0
>56 1 (2.8) 0
Gender
Male 31 (86.1) 11 (73.3) 0.275
Female 5 (13.9) 4 (26.7)
Speciality
Oncology 8 (22.2) 8 (53.3) 0.005*
Haematology 13 (36.1) 1 (6.7)
Radiation oncology 1 (2.8) 4 (26.7)
Palliative care 9 (25.0) 1 (6.7)
Paediatric haematology oncology 5 (13.9) 1 (6.7)
Job title
Resident 4 (11.1) 3 (20.0) 0.066
Assistant 11 (30.6) 10 (66.7)
Fellow 7 (19.4) 1 (6.7)
Associate 1 (2.8) 0
Consultant 13 (36.1) 1 (6.7)
*There is signicant Relationship between respondents who were and were
not trained for the breaking bad news pertaining to physicians specialty
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Alshammary, et al.: Break it gently
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Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
whereas 31 (60.8%) indicated that they would not volunteer
themselves to relay the information; however, they would do
such as the need requires.
KFMC is a busy hospital setting and it is indeed tough to
implement the idea of disclosing bad news to patients even
if the family members do not agree that the physician would
tell it all in full details. There are times that doctors would
cater others’ suggestions on how to disclose bad news in order
to make quicker decisions and maximise the time for other
aligned activities.
conclusIon
Our physicians working in the cancer centre believe that
patients are keen on knowing their medical conditions, their
diagnosis as well as their prognosis. Although most doctors
working in the cancer centre felt that they are just comfortable
in breaking the bad news to patients, there are statements that
show that physicians felt depressed after disclosure and need
on‑going training and support. The social context in the Middle
East where there are an extended family set‑up and family
support during illness, the relatives’ attitudes and beliefs versus
patients’ wishes remain a tricky area.
It is, therefore, a vital need to incorporate breaking of bad news
in medical school curriculum focusing more on legal issues
in cancer patients. In connection to the various beliefs and
practices observed, it is recommended that breaking bad news
education should be part of the residency medicine curriculum,
especially in the oncology, haematology, paediatric oncology
and radiation oncology elds. Availability of guidelines from
some professional organisations (i.e., Saudi Association of
Palliative Care or Saudi Oncologists society) in this would go
a long way in resolving some of these issues to a large extent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
RefeRences
1. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP.
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Alshammary, et al.: Break it gently
72 Journal of Health Specialties ¦ Volume 5 ¦ Issue 2 ¦ April‑June 2017
APPendIx 1
A
Age :□ 25-35 Yrs. □ 36-45Yrs □ 46-55Yrs □ Above 56 Yrs.
B
Gender :
□
Male
□
Female
C
Specialty :
□
Oncology
□
Hematology
□
Radiation Oncology
□
Palliative Care
□
Pediatric Hematology Oncology
D
Job Title :
□
Resident □ Assistant
□
Fellow
□
Associate
□
Consultant
E
Year of Graduation :
F
Year of Oncology Experience :
No.
1
Doyoufeelcomfortableindiscussingwith
patient/relativesissuesconcerningcancer
□

YES
□
No
□
NotSure
2
Haveyoubeentrainedforbreakingbadnews?
□

YES
□
No
□
NotSure
3 For whom to deliver breaking bad news
□
Family
□
Patient
4
Doyoufeelpatientshouldbetoldeverything
abouttheircancer?
□

YES
□
No
□
NotSure
7
Doyoufeelrelativesshouldbetoldfirstaboutthe
diagnosesandpatientsonlylateriftheyconsent?
□

YES
□
No
□
NotSure
8
Doyoufeeltellingalltopatientstakeawaytheir
hopeandtheirsurvivallessens?
□

YES
□
No
□
NotSure
9
Doyouthinkpatientsdon'twanttoknowabout
thediagnosisandprognosis?
□

YES
□
No
□
NotSure
10
Doyoufeeldepressedafterbreakingbadnewsto
thepatient/relatives?
□

YES
□
No
□
NotSure
11
Doyoufeelwhichismorestressful?
□
Explaining bad prognosis
□
Giving false hope to terminal patients
6
Iftherelativeswanttoconcealthediagnosiswhat
youdo?
□
Agree to the relatives and lie to patient
□
Agree to relative and avoid difficult questions
□
Tell them to take the patient to a doctor who agrees to whatever the relatives say
□
Tell them that if the patient asks them they will tell the truth, but if the patient doesn't ask
you won't tell
□
Disagree to relatives and tell the diagnoses and prognosis to the patient
Breakin
g
Bad News Amon
g
Cancer Physicians
Questionnaire
5
Ifyes,doyouthinkpatientshouldbetold?
□
Everything in single visit
□
Partial information in each visit
A.Demo
g
raphic Details
B.Opinions and Practices
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