"I am sorry, I have bad news...": Principles in informing patients on the gravity of a disease and the treatment

Abstract

The discovery of the appearance of a serious disease, and the necessity for diagnostics, treatment and rehabilitation, particularly when malignity is involved, represents exceptionally stressful news for the patient and his family. Most often this is a task for the physician. In this paper the authors consider the meaning of bad news in unexpected life events which significantly disturb the individual psycho-social ballance of the patient, as well as the familly dynamics and structure. It presents a review of available literature on the subject of the definition of so-called "bad news", the development of approaches in announcement, and current practical approaches and models which assist physicians in helping suffering patients in professional and humane ways. It points out inadequacies in the education of phisicians for this kind of task, and the variety of approaches. With the aim of improving the education of phisicians, and especially clinicians in surgical fields, the authors recommend a number of educational programs: education in the area od psychological and psychiatric aspects of learning of a serious disease, including acute reactions such as depressive states, reactive psychotic states, consumption of alcohol, etc.; education in the area of the family life cycle, and the effect of the disease as an unexpected life crisis on the family dinamic; education in the area of fundamental principles of psycho-and pharmaco-therapy, as well as the provision of support to the patient and his familly; training in the skills of announcing bad news to the patient and his familly through the explanatory presentation of the case and supervised simulation of sessions.

Can empathy be taught? A cross-sectional survey assessing training to deliver the diagnosis of end stage renal disease

“…Simulation has also successfully been used to improve interprofessional socialisation [ 30 , 31 ]. Simulation is particularly useful in regards to skills coming into play when announcing bad news to the patient and his/her family [ 32 – 35 ]. Because setting up this training is both easy and low cost, we believe it can be replicated everywhere in the world, with a most likely high impact on participants.…”