3 answers
Eve
Student
Ho, Volta Region, Ghana
3
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How to deliver bad news to a temporary ill patient
#doctor #nurse #surgeon
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3 answers
Kim Igleheart
Career Counselor | Police Officer
1728
Answers
San Antonio, Texas
Updated
Kim’s Answer
Hi Atiku,
So your patient is temporarily ill. But there is bad news to deliver. Why are you the one delivering it? Does it pertain to their health, or, perhaps a family member has passed away? These are all different scenarios.
Let's say a sibling has passed away. The hospital is in lockdown because of COVID. The news should not be delivered over the phone, so, you have been asked to deliver it. The first thing you have to decide is if the patient is capable of dealing with the news. If their own health won't allow it, then, you don't do it! If you think they can handle it, they you need to decide "when" and "how." If the hospital has social services, or religious service staff, you may want to ask one of them to be there (or at least be available!) when you deliver the news.
I've only once had to deliver such news. My cousin (My Mom's niece) had passed away while we were dealing with my Dad being in the hospital. Normally my Dad would be the one to tell my Mom. Now it was up to me. I did it by asking her to have a seat, and then telling her that I have bad news that I was asked to deliver. I then told her it had to do with a death in the family. and without giving her time to start guessing, proceeded to tell her.
Your challenge will be in offering emotional support, but, at the same time, not remaining in the room too long, as there are other patients to tend to. You probably can't give a hug, due to COVID. You can say "I'm sorry for your loss." and then say "I've asked the pastor to be here with me today, if it's okay I'd like to leave you with him at this this time? (or something like that.) You need to be emotionally supportive, but, at the same time, cannot be their "rock" as you do need to tend to other duties. Judging how much time and what to say is pretty much case-specific. As long as you show respect and compassion, you will probably do just fine. It will never be "Easy" but will become less difficult with each time you do it.
If it is about the patient's own health, then, again, you need to set the tone for the meeting. If you walk in and the patient is all happy and greets you with "hey Doc, so when am I going home?" you can't just blurt out, "not any time soon, your labs are really bad." You need to get them transitioned from happiness to ready to accept bad news. Follow the steps above. And go forward from there.
I hope this helps!
Kim
So your patient is temporarily ill. But there is bad news to deliver. Why are you the one delivering it? Does it pertain to their health, or, perhaps a family member has passed away? These are all different scenarios.
Let's say a sibling has passed away. The hospital is in lockdown because of COVID. The news should not be delivered over the phone, so, you have been asked to deliver it. The first thing you have to decide is if the patient is capable of dealing with the news. If their own health won't allow it, then, you don't do it! If you think they can handle it, they you need to decide "when" and "how." If the hospital has social services, or religious service staff, you may want to ask one of them to be there (or at least be available!) when you deliver the news.
I've only once had to deliver such news. My cousin (My Mom's niece) had passed away while we were dealing with my Dad being in the hospital. Normally my Dad would be the one to tell my Mom. Now it was up to me. I did it by asking her to have a seat, and then telling her that I have bad news that I was asked to deliver. I then told her it had to do with a death in the family. and without giving her time to start guessing, proceeded to tell her.
Your challenge will be in offering emotional support, but, at the same time, not remaining in the room too long, as there are other patients to tend to. You probably can't give a hug, due to COVID. You can say "I'm sorry for your loss." and then say "I've asked the pastor to be here with me today, if it's okay I'd like to leave you with him at this this time? (or something like that.) You need to be emotionally supportive, but, at the same time, cannot be their "rock" as you do need to tend to other duties. Judging how much time and what to say is pretty much case-specific. As long as you show respect and compassion, you will probably do just fine. It will never be "Easy" but will become less difficult with each time you do it.
If it is about the patient's own health, then, again, you need to set the tone for the meeting. If you walk in and the patient is all happy and greets you with "hey Doc, so when am I going home?" you can't just blurt out, "not any time soon, your labs are really bad." You need to get them transitioned from happiness to ready to accept bad news. Follow the steps above. And go forward from there.
I hope this helps!
Kim
Thanks a lot. I'm really grateful.
Eve
Suzanne Swain Brint
Nursing
169
Answers
Santa Monica, California
Updated
Suzanne’s Answer
Hello Atiku,
I see you are from Ghana, so I am not sure if the same rules and regulations would apply. This is Sue and I am a registered nurse in the USA. I worked with cancer patients for over 35 years.
In the USA, the physician is usually the first person to deliver "bad news" to a patient or the patient's family member. Typically, a nurse will be standing by for support. The doctor must have some degree of compassion in giving such news and will spend a bit of time with the person.
As a nurse, I had to support many people when they were given such news. I listened, held their hand if needed, developed a plan to help them cope and made sure that had all the resources in place to support them. Sometimes, there is nothing else to do but to cry along with the patient or family member.
There are very few patients in my line of work who are not aware that something bad is happening to them. My patients usually had some type of awareness that their treatment wasn't working. With COVID-19, at least here in the United States, there are too many Americans that are unable to understand the reality and ferocity of COVID. They get ill, develop respiratory symptoms and must be rushed to the hospital. At that point, they are separated from their family and friends to receive specialized care. Sadly, many patients die in hospital without any loved ones in their presence. Some of these patients deny the reality of COVID until the very last moments when the doctors must place a breathing tube in their throats. It is, in my experience, a much more difficult way of dealing the the reality of impending difficulty and sometimes mortality.
So, essentially, giving bad news requires compassion for our fellow human beings. It requires patience and kindness. It requires saying things realistically. No euphemisms. I would say something like this: your last scan has shown that the disease has come back. You have had many courses of chemotherapy and the doctors have nothing else to offer. You doctor has just informed you of this and I want to know how to help you at this time. We will not let you go through this experience alone". At this point I would offer hospice and palliative care services.
I hope this helps.
Best,
Sue RN
I see you are from Ghana, so I am not sure if the same rules and regulations would apply. This is Sue and I am a registered nurse in the USA. I worked with cancer patients for over 35 years.
In the USA, the physician is usually the first person to deliver "bad news" to a patient or the patient's family member. Typically, a nurse will be standing by for support. The doctor must have some degree of compassion in giving such news and will spend a bit of time with the person.
As a nurse, I had to support many people when they were given such news. I listened, held their hand if needed, developed a plan to help them cope and made sure that had all the resources in place to support them. Sometimes, there is nothing else to do but to cry along with the patient or family member.
There are very few patients in my line of work who are not aware that something bad is happening to them. My patients usually had some type of awareness that their treatment wasn't working. With COVID-19, at least here in the United States, there are too many Americans that are unable to understand the reality and ferocity of COVID. They get ill, develop respiratory symptoms and must be rushed to the hospital. At that point, they are separated from their family and friends to receive specialized care. Sadly, many patients die in hospital without any loved ones in their presence. Some of these patients deny the reality of COVID until the very last moments when the doctors must place a breathing tube in their throats. It is, in my experience, a much more difficult way of dealing the the reality of impending difficulty and sometimes mortality.
So, essentially, giving bad news requires compassion for our fellow human beings. It requires patience and kindness. It requires saying things realistically. No euphemisms. I would say something like this: your last scan has shown that the disease has come back. You have had many courses of chemotherapy and the doctors have nothing else to offer. You doctor has just informed you of this and I want to know how to help you at this time. We will not let you go through this experience alone". At this point I would offer hospice and palliative care services.
I hope this helps.
Best,
Sue RN
Thanks a lot. I'm very grateful.
Eve
John Patz
Physician
5
Answers
Monroe, Washington
Updated
John’s Answer
Ask, tell, ask.
Ask: What do you understand about your condition?
Tell: Here is your condition as I understand it.
Ask: What questions do you have for me?
communicate using language a patient can understand
do your best to not take the patients "hope"
understand that they may not "hear you" after delivering bad news, so plan follow up
Ask: What do you understand about your condition?
Tell: Here is your condition as I understand it.
Ask: What questions do you have for me?
John recommends the following next steps: