Problem solved: How do you best deliver bad news to a patient?

Supports in placeI find as quiet a place as I can for myself and the patient. If possible, I have family members or a friend present too, so there’s another set of ears to help absorb the news, and so afterwards the patient has someone close for support. If that’s not possible, I try to have a social worker or some other hospital staff who can help. I’ll let the nurse know what is going to happen as well. I’ll sit down with the patient to deliver the news and try to make sure as best as possible that we won’t be interrupted. I give them time to ask questions. In addition, I make sure they know that I’ll be available later to answer questions if they come up afterward.Stay with the sufferingIt is important that we make an agreement with ourselves before we see the person that we will stay with them (physically, mentally and emotionally) through their suffering. Delivering bad news is only the beginning of helping someone cope with a life-changing situation. In our empathy, it is important to use a “beginner’s mind” approach, i.e., not to make assumptions about their reactions based on our own experience or expectations. Engaging in this whole-person way may help them make sense and find meaning in their suffering. It is difficult but meaningful for us, too. It has been found in the long run to bring meaning to our work and decrease the chance of burnout. Being compassionate with ourselves as well is as important as showing compassion to our patients.What do they know?First, ask them what they already know or suspect. Then, if they even want to know more now. The one time I forgot that first question was an absolute disaster that had effects persisting through many months until death. (I told a new-to-me patient it was a life-threatening cancer, which it was, but the specialist had already contacted them with a less certain interpretation.)The answer is usually brief but revealing in ways that can improve your delivery (and often save time). I’m not sure why this approach is not pushed by palliative care educators now, when it was considered standard advice when I prepared for my certificates of added competence in hospice and palliative care in the U.S. It has served me well since, except when I forgot it.Words of wisdomWhen it comes to delivering bad news, Dr. Robert Buckman, medical oncologist, now deceased, literally wrote the book: How to Break Bad News—A Guide for Health Professionals. Each of us develops skills and enhances others throughout our medical careers. There is nothing more challenging than that most personal of encounters when the doctor-patient relationship is at its most critical when the patient is at their most vulnerable. In the conclusion of his book, Dr. Buckman writes: “The task of breaking bad news is a testing ground for the entire range of our professional skills and abilities. If we do it badly, the patient or family members may never forgive us; if we do it well, they will never forget us.”

Problem solved: How do you best deliver bad news to a patient?

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