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Breaking bad news 

Breaking bad news

Chapter:
Breaking bad news
Author(s):

Walter F. Baile

and Patricia A. Parker

DOI:
10.1093/med/9780198736134.003.0012
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date: 23 April 2017

Bad news is any information that adversely and seriously changes the patient’s and family’s view of the future. Factors that influence disclosure include the type of communication (e.g. diagnosis, treatment failure, medical error disclosure), cultural, ethnic and family factors, and clinician attitudes and skills. Patients in general wish to have as much information as possible, but important individual and situational differences exist. Disclosure can help patients and families cope and initiate appropriate goals of care. Barriers to giving bad news include lack of training, fear of one’s own and patient/family emotions, and concerns about destroying hope. While best practice guidelines exist, effective training using simulation, coaching, and practice is sporadic. Dealing with emotions (both the clinician’s and patient/family’s) are difficult challenges, and defensive behaviours such as avoidance of discussions, premature reassurance, and patient abandonment prove common. Controlled clinical trials of teaching bad news reveal that skills can be acquired.

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