Delivering Bad News Research Articles

The Ethics of Delivering Bad News: Evaluating Impression Management Strategies in Corporate Financial Reporting

Business communication textbooks offer impression management (IM) strategies to help students learn how to soften bad news. But corporations sometimes use these strategies in ethically questionable ways. This article analyzes IM strategies in a landmark case of ethically dubious corporate financial reporting. Findings suggest that the company, Ivax, manipulated three standard IM strategies by overamplifying its power to fix a financial crisis, substantially downplaying bad news, and concealing damaging information. Ivax also used a fourth, less familiar strategy: It buried contradictory information in legal disclaimers. Instructors need to help students become ethical writers who avoid questionable IM strategies like these.

United Voices: How Organizations Should Deliver Bad News

United Voices: How Organizations Should Deliver Bad News

Commentary on “Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation”

Commentary on “Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation”

Knowledge of doctors regarding breaking bad news to patients

Objectives: To assess the knowledge of doctors with regard delivering bad news to patients and breaking bad news protocols. Identify the knowledge and perspect of doctors towards communicating bad news to patients. Clarify knowledge of doctors about breaking bad news protocols. Identify the preferred protocol by doctors to break bad news. Methods: This is a cross sectional (descriptive study) done in Iraq from first of November 2020 to end of May 2021 involved 500 doctors ( periodic resident, senior resident, general practitioner and specialist doctors in different specialties ) working in different hospitals, primary health care centers and private clinics in Iraq, they are selected randomly. A self – administered questionnaire design in addition to online data collection, by using modified questionnaire and link sent to different online ways (WhatsApp, Viber, Facebook, Telegram). Results: from 500 respondents doctors there were 329 (65.8%) females, 171 (34.2%) males. Poor knowledge of protocols 315 (63%) did not know any protocol in breaking bad news. The SPIKES protocol is the most preferred protocol by doctors about (75.6%). Conclusion: High percentage of participants doctors(63%) did not know any protocol in breaking bad news and about (43%) of them rated themselves had good ability in delivering bad news. The SPIKES protocol is the preferred protocol by doctors.

The language of profit warnings: a case of denial, defiance, desperation and defeat

PurposeTaking a communication perspective, the paper explores management's rhetoric in profit warnings, whose sole purpose is to disclose unexpected bad news.Design/methodology/approachAdopting a close-reading approach to text analysis, the authors analyse three profit warnings of the now-collapsed Carillion, contrasting the rhetoric with contemporaneous investor conference calls to discuss the profit warnings and board minutes recording boardroom discussions of the case company's precarious financial circumstances. The analysis applies an Aristotelian framework, focussing on logos (appealing to logic and reason), ethos (appealing to authority) and pathos (appealing to emotion) to examine how Carillion's board and management used language to persuade shareholders concerning the company's adverse circumstances.FindingsAs non-routine communications, the language in profit warnings displays and mimics characteristics of routine communications by appealing primarily to logos (logic and reason). The rhetorical profiles of investor conference calls and board meeting minutes differ from profit warnings, suggesting a different version of the story behind the scenes. The authors frame the three profit warnings as representing three stages of communication as follows: denial, defiance and desperation and, for our case company, ultimately, culminating in defeat.Research limitations/implicationsThe research is limited to the study of profit warnings in one case company.Originality/valueThe paper views profit warnings as a communication artefact and examines the rhetoric in these corporate documents to elucidate their key features. The paper provides novel insights into the role of profit warnings as a corporate communication vehicle/genre delivering bad news.

Ocena umiejętności komunikacyjnych studentów ostatniego roku kierunku lekarskiego Warszawskiego Uniwersytetu Medycznego w zakresie przekazywania niepomyślnych informacji

Introduction. An important element of general medical skills is the ability to deliver bad news in an effective and emotionally burdensome manner for medical personnel as doctors usually are. Preparing graduates for such a challenge is to familiarize them with the elements of the SPIKES protocol, referring to the 6 elements of the interview that should be included during the giving information. Material and methods. The study has been conducted among the last-year students of the Faculty of Medicine, Medical University of Warsaw, participating in classes at the Medical Simulation Centre (MSC) as part of the “Specialty chosen by the student” block. As a part of that course was the participation of students in a scenario assuming the need to deliver bad news to the family of a patient who has died due to cardiac arrest. Students worked in four-person therapeutic teams, in which 1 student acted as the head of the therapeutic team, 3 other students acted as team member. A previously trained person played the role of a family member. The students’ behaviour was assessed by an independent observer based on audiovisual recordings. Results. Out of 369 students participating in the simulation classes described above at the MSC, 148 people making up 37 Emergency Medical Team (EMT) agreed to an audiovisual recording enabling the study to be carried out. 86% of those speaking with the simulated patient playing the role of the patient’s family ensured a sufficiently long conversation time related to the needs of the family. About 2/3 of the respondents (68.5%) reflected the emotions of the interlocutor and was able to name them and reacted on an ongoing basis to the patient’s reactions in terms of the bad news delivered (63%). Less than half of the respondents (48.5%) took care to maintain intimacy during the conversation. 20% of students provided preliminary information about the incident to introduce them to the interview, and less than 10% of the respondents summed up the interview and suggested further proceedings. Conclusions. The analysis of last year Faculty of Medicine students behaviour showed that practically all elements of the SPIKES protocol require a lot of attention and thorough discussion in the education of subsequent years of students of the medical faculty. Teaching the ability to communicate unfavourable information should take place both at the stage of undergraduate education and its completion in postgraduate education.

COVID-19 profit warnings: Delivering bad news in a time of crisis

Profit warnings (large negative earnings surprises) are important corporate reporting documents for delivering bad news and a distinctive corporate communication genre. The 2020 COVID-19 exogenous shock provides a unique worldwide crisis context for company disclosure of bad news.The research develops a genre-based typology/analytical framework for assessing COVID-19 profit warnings’ quality comprising: (1) Four profit warning/forecast quality characteristics and (2) Eight profit warning/forecast disclosures. For a sample of 160 profit-warning documents, the research manually analyses their content, culminating in a disclosure quality score/index. The research tests a model of the factors influencing disclosure quality.The research finds companies regress to silence when investors most need guidance and poor-quality disclosure, coy ambiguous language, possibly reflecting minimal regulatory guidance on this form of corporate report. Two variables are significant – Profit warnings disclosed following Financial Reporting Council guidance are of higher quality and quality varies by industry. The paper finds faux disclosure and the performativity of disclosure, which may allow boards of directors to tick-box compliance with market abuse regulations. The paper concludes with recommendations for policymakers on improvements required to enhance the quality of these highly important corporate documents.

Delivering Bad News to Patients: Survey of Physicians, Patients, and Their Family Members’ Attitudes

Background: Breaking bad news to patients is an unpleasant process, but it is essential for the medical team, which is giving information about a person’s illness; without proper planning, it leads to a negative impact on people’s feelings and quality of life. Cultural differences can be effective in telling bad news. Objectives: This study aimed to identify the attitudes of physicians, patients, and patients’ families towards breaking bad medical news. Methods: This cross-sectional study was performed among physicians, patients, and their families referred to Namazi Hospital, Shiraz, Iran, during 2016 - 2017. Their attitudes regarding how to tell bad news were evaluated by self-administrated questionnaires. Results: A total of 397 valid questionnaires completed by physicians, patients, and their families were analyzed in this study. All groups of participants preferred telling bad news to patients about the diagnosis of their disease; they also believed that in the case of a patient’s dissatisfaction, this information should not be given to other family members. Patients’ family members would rather tell lies to the patient about their diagnosis. Conclusions: There is a tendency towards not telling bad news in Iranian culture; Iranian people tend to protect those around them, and the desire to give bad news to those around them is lower than the tendency to hear bad news about one’s own illness. With increasing education, the tendency to telling bad news increases.

Delivering Bad News: Should Physicians Express their Emotions?

The traditionally assumed medical dictum is that a physician who expresses his or her emotions in font of patients or their families is almost deemed unprofessional. This feeling may be common place, particularly among traditional physicians who still hold the belief that professionalism is endangered if physicians deliver bad news laced with their true emotions. Discussion of this important topic surfaces now and then and are then hidden away without definite answers possibly due to lack of attention by physician's fraternity to dispense with this out-of-date dictum. Though we understand the protection of professionalism is the basis for this practice, the topic is rarely revisited because the community of physicians remains distant from this sensitive issue, in spite of its importance in achieving high care satisfaction from patients and their families. In view of the increased emphasis on enhancing patients’ hospital experiences and satisfaction, the demonstration of sensitivity on the part of physicians in some form as a component of their compassionate care may require renewed attention.

Perceptions Regarding Optimal Breast Imaging Education for Radiology Residents: Results of a National Survey

ObjectivesTo assess perceptions among breast radiologists regarding optimal breast imaging rotation organization and educational activities for radiology residents. MethodsAn IRB-exempt anonymous questionnaire was developed in REDCap and distributed as a member survey email by the Society of Breast imaging to 2188 members June 2019. A form with 33 questions asked questions about opinions related to resident rotation composition, read-out strategies, study/procedure volume, simulation and educational materials specific to breast imaging. ResultsA total of 109/2,188 (4.98%) complete survey responses were received. Of the responders, 69/109 (62%) work in academic practice, 16/109 (15%) work in private practice with residents, and 24/109 (22%) work in private practice without residents. There was no significant variation in opinion between those who have >10 years of experience teaching breast imaging 49/109(42.2%) to those with less <10 years’ experience 60/109 (55%). A range of opinions is demonstrated regarding the multiple questions asked with more support for diagnostics and procedures on the second and thirds rotations compared to first rotations. There was strong support of in-person staffing, checklists, simulation for ultrasound-guided procedures (91%) and formal training on delivering bad news (90%). Radiology-pathology conferences and faculty-developed teaching files were highest-rated for effective educational tools. ConclusionsThe results from this survey show varied opinions regarding perceived best practices for resident breast radiology rotations . Further research is needed to determine training outcomes related to rotation organization. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

P–502 Reproductive specialists should be offered additional training in providing emotional support to patients

Abstract Study question Should medical professionals working in fertility care have additional training on how to deliver bad news and provide emotional support to patients? Summary answer Medical professionals providing assisted reproduction treatments should be offered more training to better assist the emotional burden that accompanies the treatment as described by patients. What is known already Pursuing fertility treatment provides a large physical and medical burden on patients. Many patients describe going through IVF like having a second full time job, adding stress, anxiety and social pressure to an already difficult time of trying to conceive. As specialists in reproductive treatment the main focus is trying to assist patients in achieving a healthy pregnancy and baby. In recent years it’s become evident that the emotional aspect is equally important and often patients are left feeling that their emotions and concerns are dismissed by the very healthcare professionals that are trying to help them have a baby. Study design, size, duration This qualitative study recruited 100 women who have had received assisted reproductive treatment in the United Kingdom during 2020. An online survey was presented to women who fit the inclusion criteria and and recruitment ended when data saturation was reached. The survey design consisted of open-text qualitative answer format. Participants/materials, setting, methods Inclusion criteria were women aged between 24–45 years old who had an infertility diagnosis and received assisted reproductive treatment. A survey was presented to them to describe any negative communication they had from medical professionals, specifically what was said and how it made them feel. Main results and the role of chance The most frequent answers were “you’re still young” (26%), “just lose some weight” (18%) and “it only takes one” (10%). Additional information included in responses had a message of “don’t worry” (50%) and “just relax” (32%). 20 participants had experienced miscarriage and 8 of them had been told “at least you can get pregnant”. The emotional response that accompanied messages like these from their healthcare professionals included anger, frustration and discouragement from “feeling invalidated”, “my feelings don’t matter” and “feeling like my baby didn’t matter”. Limitations, reasons for caution As the results are based on qualitative data from 100 women, the results can not be readily generated to larger populations. Furthermore, the questionnaire was specifically focused on negative experiences and therefore bias would have occurred. The survey was only advertised on social media. Wider implications of the findings: Women undergoing fertility treatment commonly experience guilt, shame and lack of confidence. Given the question was open ended and similar responses were given, indicates that additional training in emotional support throughout treatment would be recommended and stresses the need to better integrate these aspects of patient care into daily practice. Trial registration number Not applicable

Breaking bad news about glaucoma: a SPIKES strategy primer.

Most ophthalmic physicians are not formally trained for breaking the news of having sight threatening diseases, requiring lifelong therapy. This study aims to ascertain physician practices and patients' experiences regarding delivery of bad news. An online, anonymous questionnaire was sent to 400 ophthalmologists practising glaucoma to gather information as to how they deliver bad news to their patients. A parallel survey was also conducted amongst 100 established glaucoma patients to know whether how their doctor had delivered the diagnosis of glaucoma to them. After this, resident doctors were trained in SPIKES strategy and the patient survey was repeated in 100 new patients. Two hundred and eighteen out of 400 ophthalmologists responded to our survey resulting in a survey yield of 54.5%. About 56.5% ophthalmologists dealt with disclosing the diagnosis >20 times a month; 70% of responders always discussed about the true severity of disease up-front. Only 8.70% respondents had formal training for breaking the bad news. Results of first phase of patient survey revealed that nearly one-third of patients (27%), felt that their doctor used incomprehensible medical terminology and 42% patients said that their doctor downplayed their diagnosis. Only 12% provided information to their patients about reliable sources to gather additional information. After the resident doctors were trained in SPIKES strategy, the second phase of patient survey had marked positive change in the way information was delivered. The current study shows that despite years of clinical experience, many ophthalmologists face difficulty in delivering bad news for a sight threatening disease such as glaucoma. Therefore, SPIKES strategy or a similar protocol must be taught to practising ophthalmologists at all levels, to alleviate worries of patients suffering from chronic, visually debilitating diseases.

Healthcare interpreters and difficult conversations: a survey

ObjectivesThe aims of this survey of healthcare interpreters were to assess the impacts of difficult conversations such as discussions involving explanation of a serious diagnosis, goals-of-care or death or dying...

Telehealth Training for Surgeons to Empathetically Deliver Bad News Via Video-Mediated Communication.

The COVID-19 pandemic resulted in a sudden increase in the need to effectively use telehealth in all realms of health care communication, including the delivery of bad news. A single arm, unblinded, feasibility study was performed at a tertiary care center located in Central Virginia to explore the value and utility of providing a telehealth training program based on SPIKES to teach surgical residents and faculty best practice for disclosing difficult news via video-mediated communication (VMC). Surgical interns (categorical and preliminary), surgical residents, and surgical faculty from General, Neuro, Pediatric, Plastics, Oncology, Urology, and Vascular surgical specialties were recruited via email to voluntarily participate in a telehealth simulation-based workshop, with 33 surgical learners participating in the training and 28 completing evaluation surveys. Only six respondents (22%) indicated they had prior formal training on telehealth communication with patients or families, while 13 (46%) said they had prior experience giving bad news via telehealth. Comments about improving the training focused on providing more scenarios to practice and more time for feedback. Overall, 25 learners (86%) agreed the activity was a valuable learning experience and the majority (61%) of responses were positive for future use of telehealth for breaking bad news. Practicing communication skills with VMC was found to be valuable by surgical interns, residents, and faculty. Formal training should be provided for surgeons at every stage of training and practice to improve skill in the delivery of bad news to patients and their families.

The Effectiveness of Communication Skills Training on Nurses' Skills and Participation in the Breaking Bad News.

Background:Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news.Materials and Methods:This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t-test) in SPSS software.Results:The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between-group difference was statistically significant (t59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses' participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between-group difference was statistically significant (t75,48 = 3.94, p < 0.001).Conclusions:It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.

How to deliver bad news

You’re at the end of a meeting with a senior manager at your company, updating her on the status of an important project. She looks concerned but not displeased. She says, “Thank you for letting me know, and please keep me updated.” When you walk out of the room or hit “End meeting for all,” you sigh and say to yourself, “That didn’t go as badly as it could have.” Congratulations! You’ve just delivered bad news on a project to the boss, and while it was painful, it wasn’t a disaster. In fact, you may have advanced your career and made a good impression. Let’s rewind a day, or perhaps a week. You are in the middle of a high-profile project within your company. You’re looking at some new data, and they don’t look good. Perhaps it’s an impurity that cannot be removed or an unusually low yield. This is

Video-mediated breaking bad news simulation.

Communication between clinicians, patients, and families is a core component of medical care that requires deliberate practice and feedback to improve. In March 2020, the COVID-19 pandemic caused a sudden transformation in communication practices because of new physical distancing requirements, necessitating physicians to communicate bad news via telephone and video-mediated communication (VMC). This study investigated students' experience with a simulation-based communications training for having difficult conversations using VMC. Thirty-eight fourth-year medical students preparing for their surgical residency participated in a simulated scenario where students discussed a new COVID-19 diagnosis with a standardised family member (SFM) of a sick patient via VMC. Learners were introduced to an established communications model (SPIKES) by an educational video. After the simulation, SFM and course facilitators guided a debrief and provided feedback. Learners completed surveys evaluating reactions to the training, preparedness to deliver bad news, and attitudes about telehealth. Twenty-three students completed evaluation surveys (response rate=61%). Few students had prior formal training (17%) or experience communicating bad news using telehealth (13%). Most respondents rated the session beneficial (96%) and felt they could express empathy using the VMC format (83%). However, only 57% felt ready to deliver bad news independently after the training and 52% reported it was more difficult to communicate without physical presence. Comments highlighted the need for additional practice. This pilot study demonstrated the value and feasibility of teaching medical students to break bad news using VMC as well as demonstrating the need for additional training.

Breaking Bad News: A Randomized Trial Assessing Resident Performance After Novel Video Instruction.

IntroductionDelivering bad news to patients is an essential skill for physicians, which is often developed through patient encounters. Residents in our program participate in objective structured clinical examinations (OSCEs) on an annual basis to evaluate their skills in these scenarios. Our objectives were to develop an educational video and determine if an educational video provided to residents prior to OSCEs would improve performance.MethodsPrevious OSCEs were reviewed to identify best practices and to create a four-minute video highlighting the “do’s and don’ts” of delivering bad news. Residents in two post-graduate year (PGY) classes were randomized to watch the video prior to or after a standardized patient encounter. Three masked reviewers assessed resident empathy, attention, and understanding on 10 five-point Likert scales and assigned a total score (scale: 0-50). Hedges’ g was used to assess mean scores and effect size.ResultsA total of 17 residents participated in the evaluation: nine in the pre-OSCE video group and eight in the control group. Residents randomized to the video prior to the patient encounter had a mean score of 37.01 (SD=3.6). Residents randomized to the control group had a mean score of 35.38 (SD=4.85). Hedges’ g was 0.37 (95% CI: -0.59 to 1.33).ConclusionResidents randomized to the video group had a small increase in OSCE performance, which was not statistically significant. The novel video was helpful and addresses the need for a quick pre-assessment educational tool, though interns and graduating medical students may be a more appropriate target audience for instruction.

Patient Expectations on How Doctors Deliver Bad News (Case Study of Cancer Patients in Jambi City)

Abstract:&#x0D; Research related to patient expectations has existed, but not specifically in Indonesia, especially in Jambi. For this reason, this study is aimed, firstly, to find out the patient's opinion on how doctors deliver bad news according to the SPIKES stage. The second objective was to explore patients' opinions regarding their expectations about the way doctors communicate bad news, namely cancer diagnosis and prognosis in breast cancer patients, taking into account the SPIKES protocol. This case study research uses a qualitative approach. Research in the city of Jambi in January - November 2019, used interviews with eight informants, namely female patients who saw an oncologist (cancer). Interviews were conducted with each informant and also to the group. Doctors only use some stages, namely stages, interview, giving knowledge, strategy, and summary. The patients studied think that the doctor passes through stages, perception, and invitation. There was a large tendency in the Emotions with the empathic response stage, patients who felt that they were given attention to the patient's emotional condition with an empathetic response, only a small proportion did not feel the doctor's empathic response. Expectations of patients, doctors pay attention to the stages of SPIKES as well as the dimensions of content and dimensions of relationships in delivering bad news about a diagnosis of the disease.

Breaking bad news in the oncologic population: Residents' perspective.

e24113 Background: Delivering bad news to patients is a delicate but required skill for doctors as part of patient care. There has been evidence that good communication from health care providers can improve patients' compliance to treatment as well as be beneficial emotionally. While many studies have been done in regards to patients' perceptions of receiving bad news, there are limited studies looking at a physicians' perspective, and even more so concerning residents' perceptions. In community hospitals, many patients are diagnosed with cancer, and resident physicians are often responsible for informing the patients and their families regarding the diagnosis. The manner in which the news is delivered is important, however it is unclear how much training is provided to residents before they are required to break bad news to patients. The lack of training can often result in improper delivery and poor patient care. Methods: We surveyed Internal Medicine and General Surgery residents at Mercy Catholic Medical Center, a conglomeration of two community teaching hospitals in Philadelphia, about prior training, confidence level, attitudes, and need for further education on delivering bad news to oncologic patients using a survey created after extensive research. The factors associated with confidence level were analyzed using paired T-test and ANOVA methods. Results: A total of 65 residents (72%) participated. No statistical significance was seen between American versus foreign medical graduates, MD vs. DO residents, or among those in different specialties when assessing their confidence in delivering bad news. Though only 62% of participants reported having had prior training in delivering bad news, residents with previous training (p1) or who have had to deliver bad news previously (p2) reported higher confidence when it came to delivering a new diagnosis of cancer (p1 0.03, p2 0.001), delivering news regarding the progression of cancer (p1 0.03, p2 0.02), delivering news regarding the recurrence of cancer (p1 0.04, p2 0.002), and delivering news regarding end-stage cancer with little to no treatment options left (p1 0.04, p2 0.003). 100% of participants thought communicating bad news is an important skill for a physician, and 92% of participants thought further education would help prepare them for similar scenarios in the future. Simulated patient scenarios (64%), grand rounds lectures/presentations (59%), and feedback from faculty after actual patient scenarios (57%) were the most requested whereas pamphlets/brochures (17%) and online training courses (20%) were less popular. Conclusions: Our study highlights the importance of prior training or exposure among residents in being able to deliver bad news to patients effectively. We propose that implementing further training in the form of simulated scenarios and lectures can improve residents' confidence at delivering bad news and result in a better physician-patient relationship.