National Survey of Psychologists’ Training and Practice in Breaking Bad News: A Mixed Methods Study of the MUM Effect

Abstract

Research on breaking bad news has involved undergraduates, medical students, and physicians. However, to date, no studies have examined how, or whether, psychologists are trained to break bad news, as well as their current practice of breaking bad news. This mixed methods study explored the training and practice of 329 licensed psychologists/APA members in breaking bad news, using the MUM effect as a theoretical backdrop. Results suggest (1) psychologists are, as hypothesized, significantly more reluctant to break bad news than good news, (2) anxiety accounts for 30.6% of the variance in their reluctance, and (3) three-out-of-four psychologists break bad news "to some extent" or more, most typically related to a patient's psychological health, major Axis I diagnosis, or learning disability. Results also suggest most psychologists are not trained to break bad news, with only 2.7% being familiar with existing recommendations and guidelines; and anxiety, concerns for self/other, context, and norms play an important role in the bad news breaking process. Implications for theory, research, and practice are discussed and a training model is proposed.

Before Breaking Bad News: Relationships Among Topic, Reasons for Sharing, Messenger Concerns, and the Reluctance to Share the News

“…This finding has practical implications for those who routinely deliver bad news. For example, health care providers experience anxiety when having to deliver bad news to a client, and this anxiety drives much of the reluctance to share the news (Merker, Hanson, & Poston, 2010). Consistent with this finding, our data also showed that messengers feel more reluctance when they themselves are the locus (H2).…”

Truth telling in medical practice: students' opinions versus their observations of attending physicians' clinical practice

“…Doctors and medical students have confessed that they encountered difficulties during truth telling . They felt psychological distress when telling bad news , which may have negatively impacted their emotional well‐being and work satisfaction. Most doctors (86%) indicated that they urgently needed clinical guidelines for truth telling , and 57–81% of doctors suggested the need for relevant in‐service education .…”

Evidence-based clinical psychological assessment (EBCPA): Review of current state of the literature and best practices.

“…While not all evaluations that include assessment (e.g., forensic evaluations) are followed with a formal feedback session, this should be explained to a client in advance (APA, 2013). It is unacceptable not to provide feedback because of anxiety about presenting “bad news” to clients (Merker et al, 2010) or not wanting to provide feedback about invalid test performance (Carone et al, 2010).…”