October 17, 2018

6 tips for breaking bad news, according to an oncologist

Daily Briefing

    Telling patients that they need further treatment or that their cancer is progressing is a "core function" of an oncologist's job, but that does not make disclosing the unwelcome news any easier, Andrew Neuschatz, a physician and partner with Arizona Oncology, writes for Quartz's "Quartz at Work."

    How to deliver and demonstrate clinical quality excellence in oncology

    After 15 years on the job, Neuschatz has identified six "practical steps" for making bad news "less painful." Whether you are a doctor having a difficult conversation with patients and their families, or a manager who is grappling with layoffs or delivering negative feedback, Neuschatz writes his "practical" action steps can apply.

    How to deliver bad news, the right way

    1. Always plan ahead: To ensure that the discussion goes smoothly and the takeaway is clear, Neuschatz said you should take time to review the necessary information and speak with all applicable stakeholders. For example, in his own practice, Neuschatz said he always reviews a patient's "case, films, and facts," before the appointment and confers with other medical professionals involved in the process before making decisions about next steps. It's also important to think through where you wish to have the conversation, choosing "an environment where it's comfortable to talk and have tissues ready in case of tears," Neuschatz writes.
    2. Get to the bad news quickly: It's normal to want to soften the blow with conversation, but "don't keep someone waiting for bad news," Neuschatz advises. Giving a long introduction before disclosing unwelcome news can make patients anxious, "and subconsciously or consciously, you are using it to stall," Neuschatz writes.
    3. Take a moment to pause: While it's natural for you "to want to move on quickly after giving bad news," Neuschatz writes, "[a] short period of silence can be helpful." He explains, "In my experience, allowing for a pause after the delivery of bad news is a wise practice," as it affords people time "to compose themselves and their thoughts."
    4. Express empathy:  When expressing empathy, it is important to be genuine, remain unassuming, and let your actions speak for themselves. "This is the time to really, deeply mean what you say or do," Neuschatz writes. Give the patient time to respond to the news and express how they're feeling. While you're listening, a sincere apology, "gentle hand on the back ... and a long, deep hug are all meaningful," Neuschatz explains.
    5. Answer questions: Create opportunities for the individual to ask questions about the situation and be sure to provide honest answers.
    6. Always have an action plan: It's important to never send someone home with bad news and no action plan, Neuschatz writes. After delivering bad news, you should have a concrete, easy-to-follow plan in place for the future. For example, Neuschatz explains, "If a patient needs to see a surgeon, I'll let him know I've already spoken to the surgeon ahead of time and have set up a visit," Neuschatz writes. "If there are no more good treatment options ... I'll let him know we will have the hospice ready to meet him in the next 48 hours."
    7. Give yourself time to process: Most of the actions on the list are meant to soften the blow for the person on the receiving end, but after the meeting you should "embrace [the] impulse" to protect yourself and take time to process any complicated or negative emotions like "fear, guilt, and pain," Neuschatz writes. "If the recipient of bad news got angry or even expressed hatred towards you, that's often a normal reaction and not a reflection on you," he writes (Neuschatz, "Quartz at Work," Quartz, 9/25).

    Next, get URMC's end-of-life conversation prompts

    When it comes to end-of-life care, most organizations struggle to meet patients' needs. In a recent poll, 87% of Americans age 65 and older said that they believe their doctor should discuss end-of-life issues with their patients; however, only 27% of those polled had actually discussed these issues with their doctor.

    Download URMC's conversation prompts to start improving end-of-life care for patients.

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