The experiences of patients and their family members when receiving bad news about cancer: A qualitative meta‐synthesis

Abstract

Objective This qualitative meta‐synthesis explored the subjective experiences of patients and their family members when receiving bad news about cancer, with a focus on what was important to them during this process and making future recommendations. Methods A search of five electronic databases yielded 587 different records that resulted in 88 articles assessed against the inclusion/exclusion criteria. With the supplement of four additional records, 29 articles were analysed using thematic synthesis. A quality appraisal checklist was used to provide further information about the included articles. Results Patients and family members experienced receiving bad news as a process that involved three phases, labelled as follows: “preparation”, “delivery”, and “adjusting and coping”. The “preparation” phase had four themes: the setting, developing a relationship, knowing the patient, and forewarning. Four themes were identified during the “delivery” phase: emotional reactions, empathy not sympathy, active participation, and understanding. “Adjusting and coping” comprised four themes: hope, holistic support, being a protector, and ongoing relationships. Conclusions Receiving bad news is a significant experience for patients and family members. They want bad news delivered in an appropriate setting, in a manner consistent with their personal preferences, and have their psychological needs attended to within the context of an established relationship. Healthcare professionals can be assisted to deliver bad news in the best way possible by additional training and their workplace institutions providing quiet, private rooms, and sufficient time. Future research is needed to better understand family members' experiences and needs.

Single cases from multiple perspectives: a qualitative study comparing the experiences of patients, patients’ caregivers, surgeons, and nurses when bad news is delivered about cancer

“…[ 21 ] The inclusion of the perspective of adult patient caregivers in the current sample attends to the under-representation of this group in the existing qualitative literature. [ 7 ]…”

“…As a means to increase the credibility of the findings, and to address the possible influence of the primary author's previous knowledge of the topic (conducting a meta-synthesis [ 7 ] and interviews that were not part of the current study) and background (Clinical Psychology trainee, living outside of the study locality) on the themes identified, the themes and supporting evidence were independently reviewed by co-authors. The co-authors had >10 years’ experience with providing psychological services to oncology patients in the study locality, as well as expertise in qualitative research methods.…”

“…[ 2 ] However, caregivers can carry the additional burden of feeling they must withhold information from the patient or hide their own emotions in an effort to protect the patient from further distress. [ 7 , 8 ]…”

“…Given the complexity of the breaking bad news encounter and the importance of this task being done effectively, numerous qualitative studies and reviews have been conducted to explore the experiences of different parties involved: patients, patients’ family members or caregivers, and HCPs. [ 1 , 7 , 15 , 16 ] Key considerations commonly reported in oncology include the setting (private, quiet, unrushed), tailoring delivery to a patient's preferences and cultural background, attending to the emotional reactions of those receiving bad news, and maintaining hope.…”

A Challenging Issue for both Patients and Physicians: Breaking Bad News in Oncology

“…[17] A qualitative meta-analysis study reported that cancer patients wanted to receive the bad news in an appropriate environment and in accordance with their personal preferences and also to meet their psychological needs. [18] The education level of the majority of these patients was a primary school and below. Along with age and education, socio-cultural factors also determine the demands of the patients concerning learning the diagnosis and treatment information.…”