How to Deliver Bad News

As healthcare providers, you spend years learning and training for complex medical procedures, developing an innate understanding of the inner workings of the human body. Throughout your career, you gain invaluable experience in making complex diagnoses, creating and executing treatment plans and ultimately saving patients’ lives.

Yet traditional medical training may only barely cover how to communicate effectively with patients when delivering potentially life-altering news such as the presence of a brain tumor, cancer or a severe decrease in their quality of life.

In a study published by Baylor University Medical Center Proceedings, researchers found that only 40% of surveyed physicians felt that they were trained effectively in delivering bad news to patients. Additionally, 85% felt that they required additional training to effectively deliver bad news.

Empathy Simulations

Select schools are tackling this gap in training head-on. For example, Northwestern University Feinberg School of Medicine recently conducted a study that implemented a simulation-based mastery learning training program into a medical sub-internship to examine its impact on developing the skill of breaking bad news.

Participants included 79 fourth year medical students who were enrolled in a medicine sub-internship of either internal medicine, surgery, OB-GYN or pediatrics at Feinberg between September 2017 and August 2018.

Prior to training, the students had the opportunity to practice what they would say to a patient with a brain mass that was likely cancerous. These practice sessions were recorded by faculty and rated using a performance checklist.

Afterwards, students participated in a 4-hour breaking bad news skills workshop with didactic instruction and personalized feedback to practice giving bad news to trained actors. Two weeks later, they participated in a video-recorded test delivering bad news to a patient and were evaluated using the same performance checklist.

The study found that the students’ results improved significantly after the workshop, from an average score of 65% to 94% after training.

Tips for Delivering Bad News

Here are some best practices to consider when delivering bad news to patients and their families, according to the Northwestern study, American Family Physician and Medical News Today:

• • Establish rapport when first approaching patient. When you enter the room, patients may already sense that something is wrong. Greet your patient as you normally would to establish a sense of reassurance but be sure to give them the bad news within the first few minutes of the conversation.
  • Familiarize yourself with the patient’s chart and have it on hand during your conversation with the family. At a minimum, provide basic information regarding treatment options and prognosis.
  • Speak to the family in a private room where there will be minimal interruptions. Let them know that they are your main focus during this difficult time.
  • Assess the patient’s/family’s perception or understanding of the medical situation. This will allow the patient and their family to tell you what they already know, and how much information they would like to be given. Allow them to ask questions as needed.
  • Communicate clearly in simple terms, without excessive medical jargon. People need to be able to fully understand what’s happening to them, so they can process the information and make an informed decision.
  • Empathize and say “I’m sorry” when appropriate. Acknowledge that the news must come as a big shock, but don’t use phrases such as “’I know how you’re feeling.’’’ Attempts to connect the family’s situation to your own personal experiences may not always be helpful.
  • Validate and encourage patient/family’s emotions. Give them realistic hope whenever possible. Let the patient and their family know that you will be available to them whenever they need.

Balance of Empathy and Professionalism When Breaking Bad News

Improving how to deliver bad news will also ease your own stress as a healthcare provider, because preparing for these types of conversations can also take a toll on your own mental health. Dr. Gordon Wood, a study co-author and Feinberg associate professor of medicine and medical education, told Healthline, “Physicians who have not been trained to have these conversations well experience more burnout because of how stressful these conversations can be if you aren’t confident in your skills.”

Studies show that neurocritical care staff have particularly high levels of burnout.

Dr. Pantilat, founder of the Palliative Care Program at the University of California – San Francisco Medical Center, told Medical News Today, “We as physicians don’t always appreciate just how bad the news will be to someone who still thinks their tomorrows are infinite. My rule is I should not be so upset that the patient has to comfort me.”