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Doctors Strategies: Breaking Bad News Research Paper

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Updated: Jun 2nd, 2020

Introduction

Breaking bad news in a health care setting simply refers to the way medical practitioners communicate unpleasant information to clients and their families as well as other people close to them. The term “bad news” has various meanings to different communities across the world. Some of the common definitions of the notion adopted by different cultures would include the following: a message which may imply that a person has limited choices in his/her life, a situation where there is a likelihood of a serious threat to one’s physical or mental well-being, and finally, a kind of information which may bring adverse effects on people’s perceptions, especially about their future lives.

Some examples of bad news to patients can be observed when they are informed that they are HIV positive or that they have been diagnosed with cancer or any other high-risk disease. In most cases, the bad news is likely to bring serious health problems to targeted patients. These problems, which may be characterized by deficits in behavioral, emotional, and cognitive aspects of human life, may persist for a long while after they have been delivered. The delivery of bad news to patients and clients in hospitals is actually one of the most complicated and demanding tasks that doctors have to deal with in the course of their daily routines in healthcare facilities. The reason this subject is chosen for analysis is that the delivery of bad news to patients has emerged as the most challenging and complex communication task that doctors have to deal with in hospitals.

Coming up with bad news has never been easy for doctors and other professionals in the healthcare sector. The main reason for this is because the news is likely to expose the patients to great distress resulting in serious emotional suffering for both the bearers and the receivers of the information. Doctors may tend to feel guilty sometimes, and that is when their own sense of morality prevails, making them go for what seems right to them according to what has been provided in the medical ethics (Fallowfield & Jenkins, 1999).

In this regard, doctors may decide to conceal the truth from patients as a way of avoiding the emotional reaction that is likely to affect them as the bearers of the information. As a matter of fact, hiding the truth about the condition of patients can be a better option for many doctors who may feel unprepared for this demanding task. Communicating bad news to patients can bring stressful moments to doctors as a result of the overwhelming sense of guilt that comes with the task. Even though disclosing unfavorable information to patients is a complex task for doctors, patients have the right to be told everything about their illnesses since this prepares them for an effective treatment and curing process. This, however, should be done in a proper manner to ensure that patients deal with the information without any serious complications. This paper highlights some of the effective strategies that may help to reduce stress on physicians as they deliver bad news to patients.

Literature review

According to recent studies on how effective communication between physicians and patients can help improve medical services in hospitals, there are numerous barriers to breaking bad news to patients in healthcare facilities. Effective communication between doctors and patients is an important clinical function that plays an important role in establishing good doctor-patient relationships. This is crucial when it comes to the provision of high-quality healthcare services to patients or clients. In this regard, it would be better for doctors and other professionals in the healthcare sector to ensure that they address their patients in a proper manner, as a way of ensuring that good doctor-patient relationships are ensured and maintained. This, however, has never been something easy for most physicians in modern healthcare settings, where breaking bad news to patients still remains a big challenge. Unveiling negative information to patients by the physicians is a complex task that requires a lot of preparation (Dias, Chabner, Lynch, & Penson., 2003).

However, some doctors do not take this crucial clinical function as a key responsibility that should be handled with a lot of precaution, and this has resulted in a violation of important interpersonal aspects of patient-doctor relationships. Communicating bad news to clients and patients is a normal medical practice that takes place in all healthcare facilities. In other terms, this is a necessity that physicians must do in ensuring that effective healthcare services are delivered to patients. Disregarding the benefits that may be associated with this complex communication task, it is often viewed as a potential threat to existing doctor-patient relationships that are significant for better patient care. It is for this reason why some physicians would find it difficult to deliver bad news to their patients, especially if they are likely to worsen their conditions further.

Apart from distorting the truth with the intention of retaining their relationships with their patients, doctors also tend to experience strong feelings when they deliver unpleasant information to patients. These emotions are propelled by such things as the burden of being the bearer of bad news, anxiety, and fear that this could result in negative evaluation. As a matter of fact, this imminent stress makes it hard for most physicians and other primary healthcare professionals to reveal bad news to patients.

More importantly, while some doctors would never dare conceal medical details from their patients even when it is apparent that this will negatively affect them, the others will find it very uncomfortable to tell their patients about their illnesses and the appropriate treatment options available for them. As it would be observed, there are various reasons for that, and these would include things such as doctors’ fear of killing the patients’ hope, embarrassment at having previously given patients wrong information about their illnesses, not being sure about the expectations of patients, and feeling unprepared to bear with the expected emotional reactions that may occur to the patients.

Patients have the right to be informed about the whole truth regarding their health since this helps them make important decisions about their future lives. This means that no matter the effects associated with the stressful task of communicating bad news to patients, it is necessary for their wellbeing. However, doctors tend to feel helpless when revealing undesirable details to patients, particularly in regard to their health conditions or the kind of therapy they will have to undergo as part of the treatment intended for them.

Another possible reason as to why doctors feel helpless when breaking bad news to their patients is that they are certain that there are no effective or assuring treatment options that are currently available to cure the patients’ conditions. Another common barrier of delivering bad news is presented by patients who have come to realize that they question information provided and authority granted to physicians by society. This way, patients sometimes tend to show resistance to the advice and suggestions given by doctors in regard to their illnesses, and this discourages the doctors’ possibility of delivering bad news to them.

Effect of delivering bad news on doctor’s performance

Delivering bad news to patients has brought many effects on the overall performance of physicians and other key professionals in the healthcare sector (Brown, Dunn, Byrnes, & Morris 2009). Numerous studies have shown doctors to be great sufferers of emotional and psychological problems as a result of this complex communication task. As observed, medical professionals who have constantly been involved in the practice are likely to suffer from extreme stress because of anxiety and the burden of being the bearer of the information. As a result of this stress, the affected doctors may find it difficulty to deliver bad news to patients in future.

This is likely to affect their overall performance at work, since it is clear that effective medical care heavily relies on well-communicated facts about illnesses and the suitable therapies or medication aimed at treating the conditions. Breaking bad news also presents serious communication problems to doctors, who may find it uncomfortable to continue reporting information to their patients because of fear of hurting them emotionally.

Discussion

There is no doubt that medical organizations are likely to suffer greatly when physicians are stressed up as a result of being constantly involved in regular delivery of bad news to patients (Fallowfield & Jenkins, 2004). The kind of stresses found in healthcare settings will tend to have a common denominator in that they are likely to continue for longer periods, since hospitals will not lack patients at any given moment. However, this prolonged stress can result in a condition known as distress, which can lead to stress-related symptoms and ailments, such as chest pain, headaches, and elevated blood pressure, among other conditions.

Apart from these disorders, stress as a result of complex tasks can also result in adverse health effects for physicians. As a matter of fact, these are serious health problems that are likely to cause workplace incompetence among the doctors. Worse still, this can lead to increased physician absenteeism from hospitals, and this can seriously affect the quality of health care given to patients and clients in various healthcare settings.

Numerous studies about stress and the use of alcohol and drugs by professionals from different areas of accountability have shown physicians to be among the highest consumers of these substances when compared to other professionals (Vandekieft, 2001).

When questioned about this issue, several doctors who had been interviewed had linked work-related stress to the inescapable conditions presented by their caring obligations in hospitals. Breaking bad news to patients, which happens more often inside hospitals, was among the most challenging complex tasks they have to deal with in their daily activities of administering healthcare services to patients and clients. In this regard, being the bearer of bad news to patients was viewed as the main reason as to why many physicians would end up becoming chain smokers and heavy drunkards. In an attempt to emphasize their point on the matter, the physicians would argue that “their responsibilities within various care settings are usually fraught with unbearable challenges and constraints, but all the same they have to deal with them, thus getting exposed to stressful moments” (Ptacek & Ptacek, 2001, p. 419). This explains the reason why doctors would tend to seek refuge in alcohol, cigarettes, and drugs.

Strategies in delivering bad news

When doctors are uncomfortable in breaking bad news, there are high chances that they would stop discussing undesirable information to their patients and clients in the hospitals (Rosenbaum, Ferguson & Lobas, 2004). This, however, may end up bringing serious implications on the quality of health care services provided to patients in hospitals. In this regard, there are numerous strategies that can be useful in helping both patients and doctors to deal with distress arising from the delivery of bad news in a better way. One effective approach that can help to reduce stress on doctors when delivering bad news to patients is through the six steps of a Six-Step Protocol for Delivering Bad News (SPIKES). This is an effective protocol for breaking unfavorable news to patients commonly applied in the units for high-risk diseases such as cancer and HIV.

A Six-Step Protocol for Delivering Bad News (SPIKES) is a program that consists of six stages the main role of which is to ensure that doctors successfully handle the role of delivering bad news to the patients and their clients. The strategy is conducted through four main objectives that include collection of information from a sick person, transmission of the data selected, provision of relevant healthcare services and support to the client (Baile, Buckmanb, Lenzia, Globera, Bealea. & Kudelka 2000). It also includes seeking the cooperation of the patient to come up with a treatment plan that would be effective for them in future (Baile et al., 2000). The six steps involved in the SPIKES protocol are as shown below.

Setting the interview

This step simply entails mental training of the bearer of the news as it helps one prepare for stressful roles. Some of the key guidelines for how to go about this first stage of the protocol include arrangement for some levels of privacy, involvement of other people who are close to the patient, ensuring that connections are established with the learner and keeping the patient informed about the time constrains and other disruptions.

Assessing the perception of the patient

This is a key step of the protocol which involves the assessment of the perception of the patient using open-ended questions. This helps create a perfect picture of the manner in which the patient would tend to perceive his/her health condition.

Obtaining patient invitation

The third stage is mainly about seeking and obtaining the invitation of the sick person, and here, the patients are given enough time to express themselves. This exposure may help to remove the anxiety which is associated with the breaking undesirable news to the patients.

Delivering the information

This is a stage in which the prepared information is partially revealed to the targeted patient by telling them that they should expect bad news. This may sound too harsh to the patient in the first time, but it can also be useful to some extent, since it helps to lessen the shock which follows the revelation of the bad news.

Addressing arising emotions with emphatic responses

This is a stage where patients’ emotions are addressed using emphatic responses. This has the meaning that physicians would tend to observe their patients using common emotional reactions, such as anger, disbelief, and denial. It is normal for patients to present negative expressions when bad news are revealed to them. At this point, it is the responsibility of the physicians to come up with emphatic responses that would be appropriate for the patients’ condition.

Strategy and summary

This is the final stage of the protocol which gives physicians an idea of the right approaches that need to be taken when delivering bad news to patients. Obviously, the final decision that is made by the physicians in this case will entirely depend on the findings made in the six stages of the SPIKE protocol.

Other helpful strategies

Apart from the SPIKE protocol, there are numerous other strategies that physicians and other professionals in the vast healthcare sector can use when delivering bad news to patients. Breaking bad news is not an easy task, since it requires a lot of preparation and precaution from the bearers. While the delivery of bad news to patients is likely to generate immense benefits to physicians and patients, poor delivery of the details could lead to serious negative implications on both parties. In this regard, it is always necessary for doctors to try to understand their patients and ensure that the right strategies are used to communicate undesirable news to them.

It is always necessary for physicians to understand the way to deliver bad news to be able to deliver information to their patients in a graceful manner (Goldberg, Guadagnoli & Silliman, 1999). Moreover, physicians should try to embrace effective communication strategies that will enable them to interact well with their patients and clients. For instance, it is necessary for the doctors to ensure that they have prepared themselves emotionally before delivering bad news to patients. This would not only make it easier for physicians to inform patients about their illnesses, but also help them manage stressful moments that tend to come with careless delivery of bad news. The other strategy here would be to identify solutions for any kind of problem that may tend to arise from the exercise (Barclay, Blackhall & Tulsky, 2007).

This ensures that physicians are well prepared to handle the complex communication task of passing bad news to the patients. Other effective strategies that will tend to play a significant role in the delivery of bad news include being genuine, focusing on the positive, and paying attention to timing and setting aspects.

Conclusion

As it is shown in this paper, breaking bad news is a very demanding task which calls for a lot of dedication from physicians and other professionals serving in various healthcare settings. As a matter of fact, the very task of passing undesirable information to patients has never been simple for the people in the healthcare sector. However, there is a need for doctors to ensure that the right guidelines are followed when delivering bad news to patients. Patients have the right to be aware of their condition and future outcomes, as this makes the treatment process easier for them and the physicians. This leaves the doctors no choice but to communicate the bad news to patients for the necessary procedures to follow right away. This, however, should be done in a proper manner to ensure that patients absorb the information without any serious complications on their side.

References

Baile, W., Buckmanb, R., Lenzia, R., Globera, G., Bealea, E.A. & Kudelka, A.P. (2000). SPIKES- A Six Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5(4), 302-311. Web.

Barclay, J., Blackhall, L., & Tulsky, J. (2007). Communication strategies and cultural issues in the delivery of bad news. Journal of Palliative Medicine, 10(4), 958-977. Web.

Brown, R., Dunn, S., Byrnes, K., & Morris, R. (2009). Doctors’ stress responses and poor communication performance in simulated bad-news consultations. Academic Medicine, 84(11), 159-160. Web.

Dias, L., Chabner, B., Lynch, T., & Penson, R. (2003). Breaking bad news: A patient’s perspective. The Oncologist, 8(6), 587-596. Web.

Fallowfield, L., & Jenkins, V. (1999). Effective communication skills are the key to good cancer care. European Journal of Cancer, 35(11), 159-164. Web.

Fallowfield, L., & Jenkins, V. (2004). Communicating sad, bad, and difficult news in medicine. The Lancet, 363(94), 312-319. Web.

Goldberg, R., Guadagnoli, E., & Silliman, R. (1999). Cancer Patients’ Concerns: Congruence between patients and primary care physicians. J Cancer Educ, 5(17), 193-199. Web.

Ptacek, J., & Ptacek, J. (2001). Patients’ perceptions of receiving bad news about cancer. Journal of Clinical Oncology, 19(21), 416-420. Web.

Rosenbaum, M., Ferguson, K., & Lobas, J. (2004). Teaching medical students and residents skills for delivering bad news: a review of strategies. Academic Medicine, 79(2), 107-117. Web.

Vandekieft, G. (2001). Breaking bad news. American Family Physician, 64(12), 78-85. Web.

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