No one likes to be the bearer of bad tidings. For Physicians, delivering patients bad news is part of the job description. Despite being most practitioners least favorite part of the job, there are strategies you can employ to make this process a little less challenging.
Do Your Research and Prepare
This step may sound simple but it is essential to a successful delivery. Creating structure can provide you with some feelings of confidence regarding the task you are about to undertake and ways to handle possible outcomes.
It is important to determine:
- what the patient knows already about their condition
- their readiness to accept your message
- their level of comprehension and ability to understand what you are saying
- a meeting time and setting i.e. quiet, private area without distractions
- if any family members need to be alerted so they can attend and provide support
- if there any cultural or religious issues that need to be considered
- the amount of time necessary for the visit to ensure things aren't rushed
Once you have determined your patient's needs and your message, it is time to practice your delivery. It is important to drop the medical jargon and speak in plain, clear terms that are relatable to the patient and family members.
Be Empathetic
Delivering bad news can be very uncomfortable. Your instincts may make you want to disengage from your patient to make the delivery easier. Fight this urge and remain engaged and empathetic. An empathetic, composed delivery is best received and feels supportive. It is best to provide eye contact, a steady delivery and open body posture. Avoid standing over the patient, crossing your arms or positioning yourself as if you are wanting to exit when speaking.
Reflection
It is important to reflect back what a patient is saying or expressing. Be sure to do this with an empathetic and respectful tone. Don't rush things, let the patient and family absorb what has been said and take the time to fully answer their questions. Provide them with available ways to contact you if questions should arise after you leave. Some patients shut down after the initial delivery of the news and are unable to express what they are thinking until after you have left.
Summarize
It is important to summarize your message again at the conclusion of the conversation to ensure that your message has been received and understood. Define what is expected to happen next regarding follow up. For example, will they be receiving further treatment, hospice, who will contact them and when. Providing some structure about an uncertain future can provide patients and families with some level of reassurance during a difficult time.
Provide Support Resources
After delivering bad news it is best to provide the patient and family with information regarding available resources so they can seek further information and support. Examples might be a link to an informational website regarding a disease, local support groups, etc. Be sure to provide this information in writing as it will most likely be overshadowed and forgotten by your initial message.