Bad news not always broken sensitively to patients in final year of life
MedWire News: The way in which health professionals break bad news to patients in their last year of life could be improved, say UK researchers.
Despite a growing interest in ensuring that communication in cancer care, in particular, is improved, "relatively few studies have measured the outcomes that patients experience," say Barbara Hanratty (University of Liverpool) and colleagues.
To investigate patients' perceptions of the process of breaking bad news, the researchers used data extracted from in-depth interviews about living with a terminal illness or moving between places of care at the end of life.
Fifty patients who had been identified by health professionals as being in their last year of life were interviewed. The group comprised 31 patients with cancer, 13 with heart failure, three stroke patients, and three with neurologic conditions; all were between 30 and 93 years of age.
The researchers found that a direct approach, where patients were not given much prior warning, was used by the majority of health professionals. When this approach was adopted, patients were more likely to consider it sensitive when all three of the following occurred: they already knew the doctor delivering the news; when it had been suggested that someone accompany them to the appointment; and when there was sufficient time to discuss the information.
Some patients who were not asked to bring someone along to their appointment reported being particularly shocked by the news. One patient explained that he was expecting to receive treatment for a stomach ulcer, but instead was diagnosed with bowel cancer. He said: "I think if people had said, do you want to bring your wife with you, it would have given you more of an indication that something was wrong. So yes, it was quite a shock."
A minority of doctors provided their patients with a gradual build-up of information, which the researchers say seemed to make the news easier to hear. They found a long-standing professional relationship between doctor and patient is useful for this.
The study, published in the BMJ: Supportive & Palliative Care, also shows that patients with heart failure received the least information about their condition.
"Our findings suggest that there are some important but not necessarily simple changes to the way in which doctors communicate bad news that could benefit patients, and all are known to be good practice," conclude the researchers. These improvements include allowing more time to build up to the delivery of bad news, forward planning, such as advising a patient to bring along a relative, and finally, providing patients with heart failure with greater clarity about their condition.
By Chloe McIvor