✔ The physician should provide key information and advice for greatest impact; other team members can build on that.
✔ To explain diagnoses, start by asking the patient what he or she understands and how much more he or she wants to know.
✔ After proposing a treatment plan, check with the patient on feasibility and acceptability; confi rm that the patient understands the plan.
✔ Encourage the patient and caregivers to take an active role in managing a chronic problem.
supporting patients with chronic conditions 39
Breaking Bad News
Delivering bad news is never easy, but tested strategies can ease the process.
“I wish I had better news.”
Since Dr. Callas got Mrs. Larson’s test results, he had been thinking about how to tell her she has Parkinson’s disease. Because he didn’t want to feel pressured for time, Dr. Callas made sure Mrs. Larson had today’s last appointment. He knew she’d have a lot of questions. Knowing that Mrs. Larson suspected something was seriously wrong, Dr. Callas decided the best approach was to be gentle, but direct. He reviewed her chart for details, took a deep breath, and opened the exam room door . . .
Knowing how to communicate bad news can help you to make the process more bearable for patients. The Education in Palliative and End-of-Life Care Project (EPEC), www.epec.net, offers a module, “Communicating Bad News,”
that provides a practical approach. It indicates that breaking bad news in a compassionate yet direct way can help physicians and patients. And, although some of the advice may seem obvious, it may also be the sort of thing that is easily overlooked.
The fi rst step is to prepare yourself. Before meeting with the patient, think about what you want to say and make sure that you have all of the information you need. Be sure there is enough time, rather than trying to schedule it between other appointments. If possible, ask your staff to hold calls and pages until the appointment is over.