A Mapping of People’s Positions Regarding the Breaking of Bad News to Patients

Abstract

The objective of this study was to map people's positions regarding the breaking of bad news to patients. One hundred forty adults who had in the past received bad medical news or whose elderly relatives had in the past received bad news, 25 nurses, and 28 nurse's aides indicated the acceptability of physicians' conduct in 72 vignettes of giving bad news to elderly patients. Vignettes were all combinations of five factors: (a) the severity of the disease (severe but not lethal, extremely severe and possibly lethal, or incurable), (b) the patient's wishes (insists on knowing the full truth vs. does not insist), (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about communicating bad news (tell the patient that the illness is not severe and minimize the severity of the illness when talking to the patient's relatives, tell the full truth to her relatives, or tell the full truth to both the elderly patient and her relatives). Four qualitatively different positions were found. Twenty-eight percent of participants preferred the full truth to be told; 36% preferred the truth to be told but understood that the physician would inform the family first; 13% did not think that telling the full truth is best for patients; and 23% understood that the full truth would be told in some cases and not in others, depending on the physician's perception of the situation. The present mapping could be used to detect the position held by each patient and act accordingly. This would be made easier if breaking bad news was conceived as a communication process involving a range of health care professionals, rather than as a single occurrence in time.

Breaking Bad News to Togolese Patients

“…Results supported this hypothesis: five positions were found. Among them, four were the same as those reported by Igier et al (2015): "Always tell the full truth", "Tell the truth", "Depends on patient's wishes", and "Be gentle with patients".…”

“…The material was adapted from Igier et al (2015), using the same variables. It consisted of 72 cards containing a story of a few lines, a question, and a response scale.…”

“…These values are, however, not necessarily shared by other cultures of the world. Accordingly, while in European societies a majority of people expect physicians to disclose the news, either good or bad, directly to the patient (Hagerty et al 2005;Igier et al, 2015), in Asian and Arab societies, in contrast, people expect physicians to inform the patient's family first, who then decides whether the patient should be informed or not (Silbermann & Hassan, 2011;Wuensch et al, 2013).…”

“…The present study, which was modelled after Igier et al (2015), aimed at filling this gap. It examined the personal positions of African people in a way that allowed direct comparisons with findings from Western European samples.…”

“…In a study in France,193 adults rated the appropriateness of scenarios depicting Breaking bad news 4 circumstances of breaking bad news to elderly patients (Igier, Muñoz Sastre, Sorum, & Mullet, 2015). Cluster analysis found four different positions: 28% of the participants preferred that the full truth be told to patients in all circumstances, 36% preferred the full truth to be told, but understood that the physician would inform the family first, 13% did not think that telling the full truth was good for any patient, and 23% preferred the full truth to be told in some cases and not in others, depending on the physician's perception of the situation.…”