Breaking Bad News to Families of Hospitalized Patients

Abstract

Breaking bad news to families In the hospital setting is one of the most difficult tasks facing health care professionals (HCP). Although HCPs the delivery of bad news regularly, few have had formal training in this experience (Quill & Townsend, 1991). Distress for both the HCP and the recipient can result when bad news is communicated ineffectively. Families who have a distressing experience receiving bad news may have negative long-term consequences (McLaughlan, 1990). Difficulty with this type of news delivery may be a throwback to the ancient custom of killing the messenger of bad news; HCPs may fear being blamed for the news. Decision making about treatment options and future planning depend on the adequacy of this communication. There are a number of useful strategies that can be employed by HCPs in the hospital which will enhance the delivery of bad news.Prepare in AdvanceFull preparations should be made in advance of meeting with the family. Determine what information the family already knows and how they have been coping. Other members of the health care team may have insight into the family's knowledge and reactions. Determine if there is a support person who should be available during the discussion. This indivdual could be another family member, clergy, or a hospital resource person, such as a nurse, social worker or chaplain. When multiple health care team members will be participating in the news delivery, a decision should be made in advance about who will break the news. An optimal setting for the news delivery needs to be planned before the family is convened.Establish a Therapeutic EnvironmentA therapeutic environment within the hospital needs to be established for the communication of bad news. Discussing confidential information about patients must be conducted using a to face approach in a private location. This practice permits exposure of both parties to the non-verbal aspects of the communication. This environment will enhance the HCP's ability to demonstrate empathy, compassion, and sincerity. Additionally, the HCP can determine the family's response to the news more directly and provide additional information or support. Telephone interactions may be useful for follow-up discussions.Families will be more likely to respond openly and naturally to the news if their privacy can be assured, which will strengthen the comprehensiveness of the discussion. The ideal environment for this type of discussion is a room that can be made private by closing the door, and which has sufficient seating for all parties involved. Attempt to have all parties at the same level; for example, all sitting or everyone standing. Avoid artificial barriers, such as desks or tables. This arrangement establishes a balanced atmosphere making all concerned more comfortable and minimizing psychological distance. In addition, HCPs must give attention to their appearance if the discussion follows an acute resuscitative effort. A disheveled or bloody appearance will be distracting and make the family uncomfortable.Allow Sufficient TimeA comprehensive discussion of the patient's test results, diagnosis, and prognosis may be time-consuming--requiring 45 minutes or more, depending on the complexity of the news and on the preparedness of the family. Choose a mutually convenient time of day that allows for sufficient time without interruptions, especially by electronic pages. Consider handing a beeper over to a colleague or storing messages during the family meeting.Deliver the Information ClearlyThe information given to the family must be honest, reliable and comprehensible. HCPs must be bilingual with regard to communicating technical information to families who may be unsophisticated in the use of medical terminology. Euphemisms, jargon, and acronyms should be avoided; families may be too intimidated or polite to ask for clarification. Table 1 illustrates some examples of lay equivalents for common medical terms used in the hospital. …