The challenge of breaking bad news

Abstract

Y are called to the Emergency Department to assess a 63-year-old man with acute onset of shortness of breath. He has no known health conditions but has a 40 pack-year smoking history. He thinks that he may have the flu since his wife was just recovering from flu-like symptoms. He has not seen a healthcare provider in quite some time and this is his first visit to the hospital. Following some initial workup and imaging which showed a collapsed right lung, a chest CT scan was ordered which revealed metastatic lung cancer. As the physician, how would you approach informing the patient of his diagnosis? Bad news can be defined as any information that can drastically and negatively change a person’s expectations or views about their future.1 While typical examples of bad news in the medical context include the diagnosis of terminal illness, it is important to step back and consider a wide spectrum of physical, emotional, social, and occupational factors that may impact a patient and thus could be considered bad news for that individual or their family.1 Breaking bad news is a difficult and complex communication skill to acquire yet one that is essential for physicians. How bad news is delivered can have tremendous implications not just for patients and their families, but also for the physician. Developing this communication skill requires practice, self-reflection, and flexibility to adapt one’s approach according to a given situation as well as to patient preferences, behavior, and understanding. While the focus of this article is on physicians, we acknowledge that other health care professionals are also frequently involved in such discussions and hence may also benefit from this article.2