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Communicating Difficult News to Patients

Healthcare professionals, by the nature of their job, have to convey unwelcome or challenging information to their patients from time to time. To impart this information in a sensitive manner is an essential skill that can have a great impact on our patients’ care.

Whether it’s a diagnosis, a change in prognosis, or an unexpected outcome or complication, the manner in which this news is delivered is crucial. In guidance from UK regulatory bodies the General Medical Council (GMC), the Nursing and Midwifery Council (NMC), and the General Dental Council (GDC), there is a collective emphasis on the importance of patient-centred, clear, honest, and empathetic communication in these sensitive situations.

Across the regulatory guidance, several core principles consistently emerge. All three bodies stress the need for clear and understandable communication. Professionals must use language that patients can understand, avoiding jargon and taking into account individual communication needs. Honesty and transparency are also paramount. Patients have a right to receive accurate information about their health and care. Furthermore, it is important to display empathy and respect the patient’s dignity, values, and emotional response.

In situations where things have gone wrong, in particular, openness and candour are essential. This means a healthcare professional must explain what has happened, apologise, and take steps to rectify the situation.

In general, the following practical advice could help you convey difficult news effectively:

  • Preparation: Before a difficult conversation, ensure you are clear on the facts and have a plan for what you need to communicate. Consider the environment; a quiet, comfortable, and private space where you are unlikely to be interrupted is essential. Ensure your phone is silent and you are free from other immediate responsibilities. Consider if a colleague, such as a nurse involved in the patient’s care, or a family member should be present for support.
  • Assess the patient’s understanding: Begin by asking the patient what they already know about their condition. Questions like “What is your understanding of your treatment so far?” or “What do you think has been happening recently?” can help gauge their current perception and provide a starting point for the conversation.
  • Provide a “Warning Shot”: Prepare the patient that you have difficult information to share. Phrases like “I’m sorry, I have bad news” or “This may be more serious than we originally hoped” can help the patient brace themselves. Allow a pause for them to process this.
  • Deliver the news clearly and simply: Use plain language and avoid medical terminology. Be direct and use understandable terms such as “cancer” or “terminal” if appropriate. Deliver the serious news gently but clearly.
  • Pause and listen actively: After delivering the news, allow silence for the patient to react. Be attentive to their emotional response. Ask how they are feeling and actively listen to their questions and concerns. Reflecting their words back can show you are listening. Avoid offering premature reassurance, especially about conditions you don’t treat or are unfamiliar with.
  • Check understanding: Use closed-loop communication to ensure the patient has understood the information. Ask them to repeat back key points or summarise what they have heard.
  • Address their emotions with empathy: Acknowledge and validate the patient’s feelings. It is important to show empathy, consider phrases like “I understand this is difficult” or “I can see this is upsetting” to acknowledge their distress.
  • Provide information in stages: If the patient is receptive, provide further information in manageable chunks. Regularly check if they want more information, and if they are coping with what you are saying. If they are not coping, consider bringing them back for further conversations.
  • Summarise and plan next steps: Towards the end of the conversation, summarise what has been discussed and clearly outline the next steps, including follow-up appointments and support available. Be clear about the next contact and offer follow-up.

By consistently applying these principles and practical strategies, healthcare professionals can approach the challenging task of delivering difficult news with greater confidence and sensitivity, which ultimately provides better care and support for patients during vulnerable times. It is important to consider that the way difficult news is communicated to patients profoundly impacts their experience and their ability to cope.

 

MDS can help

If you are a Medical Defence Shield member, and the above guidance does not answer your questions about Communicating Bad News to Patients, please do not hesitate to contact us on 0300 30 32 442 or [email protected] and we will be more than happy to assist you further.

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