How to Break Bad News: Physicians' and Nurses' Attitudes

By Arbabi, Mohammad; Roozdar, Ava et al. | Iranian Journal of Psychiatry, Fall 2010 | Go to article overview

How to Break Bad News: Physicians' and Nurses' Attitudes


Arbabi, Mohammad, Roozdar, Ava, Taher, Mohammad, Shirzad, Samira, Arjmand, Mohsen, Mohammadi, Mohammad Reza, Nejatisafa, Ali-Akbar, Tahmasebi, Mamak, Roozdar, Alale, Iranian Journal of Psychiatry


Objective: Bad news disclosure is one of the most complex tasks of physicians. Recent evidences indicate that patients' and physicians' attitude toward breaking bad news has been changed since few years ago. The evidence of breaking bad news is different across cultures. The aim of this study is to evaluate the attitude of medical staff toward breaking bad news to provide a clinical guideline in Iran.

Methods: A descriptive study was conducted during 2008-2009 on a sample of 100 medical staff (50 physicians and 50 nurses) at Cancer Institute of Imam Khomeini hospital. The subjects' demographic characteristics and their attitudes toward the manner of revealing the diagnosis were registered in a questionnaire.

Results: The majority of the physicians (86%, n=43) and nurses (74%, n=37) , mostly the older and more experienced, tended to reveal the diagnosis to patients . Only a few physicians (8%, n=4) had been trained how to disclose bad news, which discloused diagnosis more than non trained ones.

Physicians and nurses preferred to inform the patients about the diagnosis when either the patients were alone or in the presence of their spouse respectively .Only a few physicians (14%) and nurses (24%) agreed to explain life expectancy to patients.

Conclusion: Compared to past, physicians and nurses are more willing to share cancer diagnosis with patients. However, lack of adequate communication skills in caregivers, and their concerns about managing patients' emotional reactions reduce their tendency to disclose bad news to the patients. Therefore, training physicians and nurses to expose bad news to the patients seems to be necessary.

Keywords: Communication, Physician-patient relationship, Truth disclosures

Iran J Psychiatry 2010; 5:128-133

Emphasizing on technical skills rather than communication skills in medical education has led to physicians' incompetency to communicate with patients such as to expose them with diagnosis. Subsequent result is doctors' avoidance of such situations and stressing on treatment solely and ignore patients' emotional problems (1).

Verbal and non verbal communication skills plays a critical role in improving physician-patient relationship (2). It can lead to better caring for patients and helps them to comply with their illness and to accept treatment. Physicians' failure in communication skills leads to patients' resentment and also inspires the feeling of incompetency in physicians to control the patients' pain and symptoms (3,4).

One of the most famous and common definition of bad news has been presented by Robert Buckman: "any news that adversely and seriously affects an individual's view of his or her future ".

A physician is expected to be able to disclose bad news, and evaluate patients' demand for it. The way of presenting bad news affects the patients' understanding of the disease (5), their psychological adjustment to the disease (6-8), satisfaction of medical care (9,10) and level of hope (11). Disclosing bad news to patients may also encourage them to participate in complex decision makings (12).

Giving bad news to patients is one of the difficult tasks of physicians and nurses (13-16). Today it's highly agreed that being informed of ones disease is the patients' legal and ethical right (17,18) and concealing the information about the disease may lead to distrust towards physicians (19).

As the past treatments in some fields of medicine including oncology were not promising, most physicians believed that revealing the diagnosis is harmful for patients. Today, by advanced treatments, giving hope to patients has become easier, and skills of revealing bad news is felt to be more necessary for physicians (20). The moral duty to give knowledge of disease has mixed with concerns about making patients frustrated, and it has established a difficult situation for physicians to make a decision whether to disclose bad news to patients (18).

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