Curriculum · Professionalism and Medical Ethics
Breaking bad news: what it is and why it must be done
What it is
Bad news is any news that seriously, drastically and negatively alters the patient's view of his or her future (Buckman 1992).
That covers more than a cancer diagnosis:
- Life threatening illness, e.g. cancer, HIV
- Degenerative conditions, e.g. Alzheimer or dementia
- Chronic illness, e.g. rheumatoid arthritis, systemic lupus erythematosus
- Mental retardation in children, e.g. Downs syndrome, cerebral palsy
Breaking bad news is a critical skill and one of our most difficult duties, but medical education typically offers little formal preparation. Recent studies indicate that physician skills are suboptimal in breaking the bad news to patients and their caregivers.
Why it should be done
None disclosure is no longer considered ethical. It is legally and ethically wrong to withhold important information that may deny patients the opportunity to face up to it and begin to make the necessary adjustments in their lives, and it might be hazardous to withhold bad news until a later stage. Specific situations are named where this is weighed differently: psychotic patients, and children.
What telling well brings:
- Maintains trust
- Reduces uncertainty
- Prevents inappropriate hope
- Allows appropriate adjustment so as to make informed decisions about the future
- Better psychological adjustment by patients, and less stress in doctors
- Facilitates open talk among patients, relatives and doctors
- Empowers patients by allowing them a greater say in treatment
Facilitating breaking bad news improves patient satisfaction and physician comfort.