Delivering Bad News

When giving "bad news" to a patient, do so privately and without interruption (see eTable 5-1 online). Use language the patient can understand; allow the patient to be emotional; offer to help break the news to family and employer; and be sure that care providers know what the patient has been told (Field and Cassel, 1997).

Health care professionals caring for patients at the end of life should assess the patient's readiness to engage in the discussion and appreciate their level of understanding about the situation and how much they want to know. Once physicians know the patient's preferences, they can tailor the discussion appropriately, checking periodically for the patient's level of comprehension and desire for more. It is best to provide small amounts of information at a time, frequently assessing the patient's desire to continue. Also, besides comprehension, what are the patient's expectations?

When sharing information regarding a fatal diagnosis with a patient, eye contact, touch, and personal closeness are important. If possible, sit with the patient and hold her or his hand or touch the forearm. Such gestures convey a sense of support, closeness, and compassion, reinforcing verbal assurance that the patient will not be abandoned during the difficult time remaining. Be positive whenever possible (Table 5-2).

Table 5-2 Positive Language to Use with Dying Patients

Sitting with the patient on the bed or at the bedside rather than standing puts the physician on the same level and conveys in a clear, nonverbal manner a willingness to talk and listen. In one study, physicians visited with hospitalized patients for exactly 3 minutes. Half the visits they sat down, and the other half they remained standing, a little removed from the bed. "Every one of the patients [with whom] the physician had sat down thought the physician had stayed at least 10 minutes. None of the ones [with whom] the physician remained standing estimated that it was as long" (Kubler-Ross, 1975, p. 20).

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