Communicating Bad News in Healthcare Professions

Original Editor - Habimana Sixbert Top Contributors - Habimana Sixbert, Candace Goh and Ines Musabyemariya

Introduction[edit | edit source]

Bad news is defined as “any information that adversely and negatively affects the patients’ view of future”[1].  Breaking bad news is a sensitive, complex yet important communication skill that all healthcare professionals must be able to execute well and avoid a drastic effect on the patient experience. There are many benefits of communicating sad news, not only for the patient, but also for the medical team managing the patient. This empowers and informs the patient and allows them to plan ahead.

It is thought that many health professionals aren’t well skilled or haven’t learned the best, most compassionate techniques for delivering bad news to patients. They may assume that that particular skill is more necessary for other health professionals like an oncologist, palliative and end-of-life care etc. Yet, health professionals in almost every specialty will one day find themselves in a position of giving an unpleasant diagnosis or prognosis.

Why is it really necessary?[edit | edit source]

Breaking bad news has psychological effects on both patient and a professional[2]. Studies have shown that there is a need and interest for patients to know the truth about their conditions[3].If they feel that their health professional is not honest, it makes them more anxious and damages their trust which may increase risk situations, such as the probability of suicide or harm to others[4][5]. The reasons that prevents the professionals from telling the truth about a bad news include fear of being blamed, unexpected evoking reactions by the patients and their family, and expressing piteous emotions and questions[6][7]. In stead of the benefits of being truthful, if bad news is not delivered appropriately, it will have negative consequences. It is therefore relevant to tell the truth which has several benefits, such as strengthening the professional-patient relationship, less complains against him/her and better decision making for the treatment process[8]

Approaches To Break Bad News[edit | edit source]

Being a health professional can be exhilarating and fulfilling when you are able to help patients recover from life threatening illnesses. But there are going to be times when you will need to tell a patient some negative information about their prognosis. Are you prepared to be the bearer of bad news? No one likes to be the bearer of bad news but in health care, it’s part of the job. Fortunately, there are ways to equip yourself to do your best in this difficult situation and get through it.

  • What to consider

Clear and empathic communication is particularly important when breaking bad news. The following are key things to be taken into consideration as they may be among possible barriers to effectively breaking bad news(BBN) as well:

  1. Culture: healthcare professionals work with persons from different background. Patients’ cultural background is often very different from that of the health facility where they seek healthcare services. Therefore, there is a need to use a client-centered approach when providing such services. This includes providing culturally sensitive care. As these differences may create certain challenges, health workers should consider client's culture, as well as their own.
  2. Professional attitudes (Body language): Non-verbal behavior or body language such as gestures, facial expressions, movements and tone of voice can convey receptivity, interest, comprehension, hostility, disinterest, anxiety or discomfort. Interestingly, in cases where verbal and non-verbal messages contradict each other, non-verbal communication tends to outweigh the verbal message. This means that non-verbal communication is an integral, but often overlooked part of the medical interview. Empathy is expressed by being warm, friendly and reassuring. It has been linked with better patient satisfaction and recovery rates, and subsequently better health outcomes. Take an inventory of your body language and consider what expressions or gestures of the person you are communicating with suggest. Do they fit the accompanying words or does the person’s body language convey a different message[9]?
  • Effective tips

To effectively deliver an unpleasant news to patients requires particular skills and techniques in order to avoid or minimize frustration and damages to the patients. In this regard, Edward Leigh, an health care communication expert and director of the Center for Healthcare Communication in Cleveland gives his opinions about strategies to use both before, during and after breaking bad news[10].

The below attached video summarizes 5 tips for breaking bad news to patients:

  • Protocols and techniques

Singh and Agarwal in a systematic review they carried out, they found that Six-step SPIKES & ABCDE & BREAK protocol are important protocols commonly used by health professionals for delivering bad news to patients and their families. The above acronyms of the protocols are explained as follows:

Delivering bad news in Physiotherapy[edit | edit source]

Announcing unfortunate news to patients may be part of interventions provided to patients attending physiotherapy. While challenging, it may be critical to the retention of optimism and participation in rehabilitation. Physiotherapist or any other rehabilitation professional have to be well skilled and knowledgeable as well to deliver a bad or sad news in a proper way that will not bring about negative impact on his overall expectations. Some of the patient received in physiotherapy services for physical rehabilitation are neurological conditions such as spinal cord injury and stroke patients. These patients are experiencing or facing mental or emotional issues due to the conditions they have which sometimes they are not aware of. They are wondering if they will regain the functional capability and maximize their participation in the communities. This brings about mainly a state of stress and anxiety.

They are eager to know their diagnosis and condition prognosis; some want to compare with what other health professionals told them about their conditions. And some of these professionals say nothing about the prognosis and prefer to say: “go to physiotherapy they will tell you everything you want to know”. Therefore, a physiotherapist needs to be well prepared to go about the above mentioned issues mainly regarding the prognosis of patient’s condition. When breaking bad news (BBN) regarding independence and mobility, for example, skill is required to communicate clear, realistic, and hopeful information. If we take an example of stroke and its uncertain trajectory of  recovery, BBN can be a challenging and critical task where successfully imparting the key qualities of hope and optimism is likely to motivate survivors toward optimal participation in rehabilitation programs. A physiotherapist needs to understand and master SPIKES which stands for Setting, Perception/Perspective, Invitation, Knowledge, Empathy/Emotion and Summary/Strategy. He/she must familiarize with Depression Anxiety Stress Scale (DASS-21) which will help to deliver sad news to patients in concise way.

Multidisciplinary collaboration[edit | edit source]

Additional Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Buckman RJBmj. Breaking bad news: why is it still so difficult? Br Med J (Clin Res Ed) 1984;288(6430):1597–9.
  2. ↑ Gorniewicz J, Floyd M, Krishnan K, Bishop TW, Tudiver F, Lang FJPe, et al. Breaking bad news to patients with cancer: a randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients. Patient Educ Couns. 2017;100(4):655–666.
  3. ↑ Rozveh AK, Amjad RN, Rozveh JK, Rasouli DJIjoh-o, research sc. Attitudes toward telling the truth to cancer patients in Iran: a review article. Int J Hematol Oncol Stem Cell Res. 2017;11(3):178–184.
  4. ↑ Goebel S, Mehdorn HMJWn. Breaking Bad News to Patients with Intracranial Tumors: The Patients' Perspective. World Neurosurg. 2018;118:e254–e262.
  5. ↑ Hafidz MIA, Zainudin LDJMJM. Breaking Bad News: An essential skill for doctors. Med J Malaysia. 2016;71(1):26–7.
  6. ↑ Rising MLJJoTN. Truth telling as an element of culturally competent care at end of life. J Transcult Nurs. 2017;28(1):48–55.
  7. ↑ Craxì L, Di Marco V. Breaking bad news: How to cope. Digestive and Liver Disease. 2018.
  8. ↑ C Cardona M, Kellett J, Lewis E, Brabrand M, Ní Chróinín D. Truth disclosure on prognosis: Is it ethical not to communicate personalised risk of death? Int J Clin Pract. 2018:e13222.
  9. ↑ UN High Commissioner for Refugees (UNHCR), Community-Based Protection in Action - Effective & Respectful Communication in Forced Displacement, 2016, available at: https://www.refworld.org/docid/573d5cef4.html [accessed 25 April 2023]         
  10. ↑ How to break bad news to patients: Experts offer best practices. Available from: https://thedo.osteopathic.org/2017/02/how-to-break-bad-news-to-patients-experts-offer-best-practices/ (Accessed 24th April 2023)
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