Delivering bad news: How one form of injustice spawns another

2007 ◽  
Author(s):  
James J. Lavelle ◽  
Robert G. Folger
Keyword(s):  
Bad News ◽  
Delivering Bad News

Communication of Bad News

2018 ◽  
Author(s):  
Paul K Mohabir ◽  
Preethi Balakrishnan
Keyword(s):  
Bad News ◽  
Patient Anxiety ◽  
Patient Centered ◽  
Diagnosis And Prognosis ◽  
Centered Care ◽  
Physician Relationship ◽  
Complex Emotion ◽  
Based Medicine ◽  
Physician Job Satisfaction ◽  
Delivering Bad News

Delivering bad news is a critical part of the patient-physician relationship. Historically, physicians have withheld or incompletely related the diagnosis and prognosis of a patient’s disease. However, the trajectory of medical practice and patient expectations mandates a change in communicating bad news. Poor communication of bad news also affects physician job satisfaction and increases burnout. Empathy is crucial to communicating bad news well. It is a very complex emotion that requires the physician to identify the patient’s reaction to the news being delivered and to react to the patient in a supportive manner. Patients do not find it helpful when the physician underplays the bad part of the news. Emerging research shows that patients prefer pairing of bad news with hope to provide anchors in the overwhelming conversation but not to take away from the gravity of the news. Family and friends can help ameliorate or, unfortunately, augment patient anxiety. Physicians have to be cognizant of the dynamics family and friends bring to the interaction as well. A patient-centered approach—a combination of evidence-based medicine and patient goal-oriented medicine—to delivering bad news is most likely to benefit the patient-physician relationship and decision-making process. The SPIKES and the Expanded Four Habits Model can be used as guidelines for communicating bad news. This review contains 1 figure and 38 references. Key words: communicating bad news, empathy, Expanded Four Habits Model, patient-centered care, SPIKES

The language of profit warnings: a case of denial, defiance, desperation and defeat

2021 ◽  
Vol 35 (9) ◽  
pp. 28-56
Author(s):  
Victoria C. Edgar ◽  
Niamh M. Brennan ◽  
Sean Bradley Power
Keyword(s):  
Text Analysis ◽  
Design Methodology ◽  
Corporate Communication ◽  
Bad News ◽  
Board Meeting ◽  
Conference Calls ◽  
Content Type ◽  
Three Stages ◽  
Delivering Bad News

PurposeTaking a communication perspective, the paper explores management's rhetoric in profit warnings, whose sole purpose is to disclose unexpected bad news.Design/methodology/approachAdopting a close-reading approach to text analysis, the authors analyse three profit warnings of the now-collapsed Carillion, contrasting the rhetoric with contemporaneous investor conference calls to discuss the profit warnings and board minutes recording boardroom discussions of the case company's precarious financial circumstances. The analysis applies an Aristotelian framework, focussing on logos (appealing to logic and reason), ethos (appealing to authority) and pathos (appealing to emotion) to examine how Carillion's board and management used language to persuade shareholders concerning the company's adverse circumstances.FindingsAs non-routine communications, the language in profit warnings displays and mimics characteristics of routine communications by appealing primarily to logos (logic and reason). The rhetorical profiles of investor conference calls and board meeting minutes differ from profit warnings, suggesting a different version of the story behind the scenes. The authors frame the three profit warnings as representing three stages of communication as follows: denial, defiance and desperation and, for our case company, ultimately, culminating in defeat.Research limitations/implicationsThe research is limited to the study of profit warnings in one case company.Originality/valueThe paper views profit warnings as a communication artefact and examines the rhetoric in these corporate documents to elucidate their key features. The paper provides novel insights into the role of profit warnings as a corporate communication vehicle/genre delivering bad news.

Breaking bad news in the oncologic population: Residents' perspective.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24113-e24113
Author(s):  
Vihitha Thota ◽  
Mahati Paravathaneni ◽  
Sudheer Konduru ◽  
Bohdan Baralo ◽  
Sana Mulla ◽  
...  
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Confidence Level ◽  
Statistical Significance ◽  
Further Education ◽  
Bad News ◽  
Care Providers ◽  
Prior Training ◽  
Oncologic Patients ◽  
Delivering Bad News

e24113 Background: Delivering bad news to patients is a delicate but required skill for doctors as part of patient care. There has been evidence that good communication from health care providers can improve patients' compliance to treatment as well as be beneficial emotionally. While many studies have been done in regards to patients' perceptions of receiving bad news, there are limited studies looking at a physicians' perspective, and even more so concerning residents' perceptions. In community hospitals, many patients are diagnosed with cancer, and resident physicians are often responsible for informing the patients and their families regarding the diagnosis. The manner in which the news is delivered is important, however it is unclear how much training is provided to residents before they are required to break bad news to patients. The lack of training can often result in improper delivery and poor patient care. Methods: We surveyed Internal Medicine and General Surgery residents at Mercy Catholic Medical Center, a conglomeration of two community teaching hospitals in Philadelphia, about prior training, confidence level, attitudes, and need for further education on delivering bad news to oncologic patients using a survey created after extensive research. The factors associated with confidence level were analyzed using paired T-test and ANOVA methods. Results: A total of 65 residents (72%) participated. No statistical significance was seen between American versus foreign medical graduates, MD vs. DO residents, or among those in different specialties when assessing their confidence in delivering bad news. Though only 62% of participants reported having had prior training in delivering bad news, residents with previous training (p1) or who have had to deliver bad news previously (p2) reported higher confidence when it came to delivering a new diagnosis of cancer (p1 0.03, p2 0.001), delivering news regarding the progression of cancer (p1 0.03, p2 0.02), delivering news regarding the recurrence of cancer (p1 0.04, p2 0.002), and delivering news regarding end-stage cancer with little to no treatment options left (p1 0.04, p2 0.003). 100% of participants thought communicating bad news is an important skill for a physician, and 92% of participants thought further education would help prepare them for similar scenarios in the future. Simulated patient scenarios (64%), grand rounds lectures/presentations (59%), and feedback from faculty after actual patient scenarios (57%) were the most requested whereas pamphlets/brochures (17%) and online training courses (20%) were less popular. Conclusions: Our study highlights the importance of prior training or exposure among residents in being able to deliver bad news to patients effectively. We propose that implementing further training in the form of simulated scenarios and lectures can improve residents' confidence at delivering bad news and result in a better physician-patient relationship.

Delivering bad news

BMJ ◽  
2000 ◽  
Vol 321 (7270) ◽  
pp. 1233-1233 ◽  
Author(s):  
Anonymous
Keyword(s):  
Bad News ◽  
Delivering Bad News

Breaking Bad News and Discussing Goals of Care in the Intensive Care Unit

2015 ◽  
Vol 26 (2) ◽  
pp. 131-141 ◽  
Author(s):  
Sheryl L. Hollyday ◽  
Denise Buonocore
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bad News ◽  
High Stakes ◽  
Goals Of Care ◽  
Life And Death ◽  
Breaking Bad ◽  
Aggressive Care ◽  
Delivering Bad News ◽  
Practice Patient

The intensive care unit is a high-stakes environment in which nurses, including advanced practice registered nurses (APRNs), often assist patients and families to navigate life and death situations. These high-stakes situations often require discussions that include bad news and discussions about goals of care or limiting aggressive care, and APRNs must develop expertise and techniques to be skilled communicators for conducting these crucial conversations. This article explores the art of communication, the learned skill of delivering bad news in the health care setting, and the incorporation of this news into a discussion about goals of care for patients. As APRNs learn to incorporate effective communication skills into practice, patient care and communication will ultimately be enhanced.

scholarly journals Breaking Bad: An Assessment of Ophthalmologists' Interpersonal Skills and Training on Delivering Bad News

2018 ◽  
Vol 10 (01) ◽  
pp. e83-e91 ◽  
Author(s):  
Nicole Fuerst ◽  
Jessica Watson ◽  
Nicole Langelier ◽  
R. Atkinson ◽  
Gui-Shuang Ying ◽  
...  
Keyword(s):  
Linear Trend ◽  
The United States ◽  
Likert Scale ◽  
Bad News ◽  
Survey Study ◽  
Outcome Variable ◽  
Perceived Ability ◽  
Breaking Bad ◽  
Academic Center ◽  
Delivering Bad News

Purpose This article aims to assess ophthalmologists' practice patterns, experiences, and self-perceived skills when delivering bad news to patients and to compare this to patients' experience and preferences in receiving bad news from ophthalmologists. Design/Methods This is a prospective cross-sectional survey study of two populations: (1) Attending ophthalmologists and current ophthalmologists-in-training (N = 202) at accredited ophthalmology residency programs in the United States and Canada. (2) Patients (N = 151) 18 years of age and older at a single academic center who had received bad news from their ophthalmologist. An e-mail was sent to ophthalmology department chairs and resident program directors requesting that they distribute an online survey to their faculty, fellows, and residents. Patients were recruited from the clinics at an academic center and completed a self-administered survey before their scheduled appointments. Both populations were surveyed on their experience in breaking and receiving bad news, respectively. Questions were rated on a standard five-point Likert scale, and mean score was calculated for statistical comparison. The primary outcome variable was the quantitative rating (Likert scale 1–5) of physicians' communication skills when delivering bad news from physicians and patients' responses. Results Patients rated their physicians higher than physicians rated themselves with regard to ability to deliver bad news (mean score of 4.23 vs. 3.48, p < 0.01). Multivariate analysis showed frequent delivery of bad news (mean score of 3.66 for once per day, 3.53 for per week, 3.40 for once per month, and 3.22 for once per year, linear trend; p = 0.004) and years of practice were associated with better self-perceived ability to deliver bad news (mean score of 3.75 for ≥15 years, 3.48 for <15 years, and 3.30 for residents/fellows, linear trend; p < 0.001). Having received formal training in breaking bad news was associated with better perceived ability score, yet not statistically significant (3.51 vs. 3.39, p = 0.31). Most patients (97.5%) and physicians (92.1%) believe delivering bad news can be taught. Conclusion Physicians and patients agree that skills of delivering bad news can be learned. Patients are less critical of their physicians' ability to deliver bad news than physicians are themselves. Further study of best methods to deliver bad news is clearly indicated for the field of ophthalmology.

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