Giving Patients Bad News

Communication of a cancer diagnosis: Patients’ perceptions of when they were first told they had cancer

“…A review of the literature suggests the following general guidelines for physicians communicating a cancer diagnosis to the patient: (1) it is best to let the patient set the pace of the communication, with the physician telling the patient everything he or she wants to know but rarely more; (2) it is useful and necessary to reiterate the important information, thereby ensuring that it is understood in the setting of stress, fear, confusion, or denial; (3) it is best, when addressing the patient's concerns, to determine all concerns before exploring any one in depth [9][10][11][12] ; (4) patients should be reassured that the physician will remain involved; and (5) support should be offered for continuing high-quality medical care, including an emphasis on quality of life. There are important pragmatic, 9 medicolegal, 10 and humanitarian 11 considerations to effective communication.…”

“…There are important pragmatic, 9 medicolegal, 10 and humanitarian 11 considerations to effective communication. There are well-described techniques available [12][13][14] to improve physicianpatient communication.…”

Parents' responses to their child's diagnosis of neurofibromatosis 1

“…Concordantly clinicians are giving attention to factors in the setting and process of disclosure of "bad news" and characteristics of the family that may contribute to family response, acceptance of, and adaptation to their child's condition. Current guidelines derived from suggestions of physicians and patients emphasize the importance of parents being told closely following birth; the physician's sensitivity and effectiveness in disclosing the nature of the child's condition by planning the setting; assessing the family's background, knowledge, and experience and choosing strategies suited to the family's particular situation; providing clear and detailed information on the condition in a positive fashion, with information on specialty referrals and community resources included; physicians allowing sufficient time for adequate communication, questions, and ventilation; and arranging for both parents or the parents' support network to be present [Turner and Sloper, 1992;Krahn et al, 1993;Sloper and Turner, 1993;Garwick et al, 1995;Girgis and Sanson-Fisher, 1995;Ptacek and Eberhardt, 1996;Chisolm et al, 1997;Shields, 1998]. …”

The context of health care communication in chronic illness

“…Because the vast majority of chronic disease management is typically conducted by the patient in the context of his or her own life, encounters bealizations about communication in health care are inevitably misleading [15,[22][23][24].…”