Breaking bad news: A practical approach for the hospitalist

Abstract

This paper was submitted on behalf of the Palliative Care Task Force.Communicating bad news to patients and their families is a difficult but routine responsibility for hospitalists. Most practitioners have little or no formal training for this task. Preparation for, delivery of, and follow-up to these conversations should be deliberately planned in order to meet patients' needs. In this article, we review the literature that guides this process and, with a case example, describe steps practitioners can take to effectively deliver bad news and pitfalls that should be avoided. As competency in this skill set is necessary for effective patient care, hands-on training should be part of the core curriculum for all health care prac-

The P-A-C-I-E-N-T-E Protocol: An instrument for breaking bad news adapted to the Brazilian medical reality

“…19,[20][21][22][23] Most people, regardless of their own cultural characteristics, would like to be aware of their diagnosis, even if it means accepting that they are terminally ill. 6,11,13,[24][25][26] This information is important to patients, as they start to show a greater degree of adaptation to reality, with lower levels of depression and anxiety, better adherence to treatment, more acceptance of interventions, and suitable monitoring of dosages and recommendations 9,27 as well as preventing barriers between the family and the patient (conspiracy of silence). 28 Furthermore, it prevents the patient receiving futile treatments and heroic interventions, creating false hopes and expectations in treatments.…”

“…4,23 In line with the literature, there is a growing concern in changing the educational profile to include communication in the curricula. 19,22 The Accreditation Council for Medical Education in the United States has already included communication with patients as a fundamental skill in the curriculum of residents and graduate students. 10 Considering that, in our study, the percentage of professionals who received communication training does not present a significant difference in relation to the age of the interviewees, we can infer that there has been no important modification in teaching communication at medical and nursing schools in recent decades.…”

Is therapeutic non-disclosure still possible? A study on the awareness of cancer diagnosis in China

“…In more recent years, progress has been made concerning the best ways to communicate bad news to patients [4][5][6][7]. However, whether it is absolutely necessary to tell the truth to cancer patients remains controversial [8][9][10].…”

Circumstances Related to the Reporting of Bad News in the Medical Profession

“…Thus, training courses in communication skills are recommended to enhance the perception of information and the patients' satisfaction (Monden, et al 2016, Rabow & McPhee, 1999. In addition, the competency in the bad news communication skills should be included in the core curriculum for the health care training and education (Minichiello et al, 2007). Important personality characteristics include reflection skills and the ability to show empathy and to care.…”