Physicians' perceptions of breaking bad news to cancer patients and family

Abstract

Background: Breaking bad news to patients with a cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and the 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 and undergo an abrupt change in their outlook on life. Objective: The aim of this study was to explore physicians' perceptions and perspectives of breaking the bad news to cancer patients before and after attending training workshops. Methods and Settings: A quasi-experimental design was performed among physicians working in a comprehensive cancer centre. It compared the performance of the respondents in breaking bad news before and after attending a communication skill workshop. It was conducted from March to April 2017. Results: Pre-intervention survey result showed 68% 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 the responders (86.3%) 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. Nearly 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 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 about the cancer diagnosis, and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into consideration, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.