Breaking bad news: can adversity be better told?

At times, patients have to be given unfortunate news. A survey conducted at Berlin's Charité Hospital shows many physicians feel inadequately prepared for this, by both their medical studies or daily work.

A look at how to transmit bad news to patients

In almost every medical field, sooner or later the point is reached when patients have to be told bad news. A survey conducted by the Charité Hospital in Berlin under the leadership of Prof. Dr. med. Jalid Sehouli and Dr. med. Klaus Pietzner entitled "Breaking Bad News" has shown a key issue: Many do not feel adequately prepared for this situation - both in medical studies and in their everyday work as physicians.

"Breaking bad news" is a core competence that physicians have to master in their daily work - regardless of whether it is about the transmission of a positive HIV test result, the initial diagnosis of Alzheimer's disease or about a failed surgical operation. Talking to patients about life-changing diagnoses is and remains a difficult challenge for both the medical profession and those affected, because it can have a major impact on how such diagnoses are dealt with in the long term. 

A research team at Berlin's Charité University Hospital led by Prof. Sehouli and Dr. Pietzner has found through a survey of over 1,300 medical students and physicians, that breaking bad news is by no means a topic where clarity prevails. Initial preliminary research results indicate that there is a great need among both students and physicians to be better sensitised and trained for conversations about life-changing diagnosis.

Breaking bad news is a big burden for physicians

The need to have state-of-the-art awareness in this respect is already evident when surveyed participants were asked: "Do you have a certain knowledge or techniques to conduct these conversations in the future or which you already used?"1. Although the majority of the physicians surveyed (n=831) were able to answer this question with "yes", almost a third of the respondents do not see themselves appropriately prepared. The result among the students surveyed (n=315) is more serious. More than 49.4% of the respondents answered "yes" to the question, but the majority, almost 50.6%, answered negatively. 

However, even if some of the respondents stated that they had corresponding strategies or knowledge, the special need to be better prepared for patient conversations about life-changing diagnoses is particularly evident in the question "How great do you rate your fear of giving bad news in your (future) professional life?" or "How great is your fear of giving bad news?". On a scale of 0 to 6, the medical students rated their fear of this task at over 5 on average. Among the physicians surveyed, the fear of having conversations with patients about bad news was also high: On a scale of 0 to 4, the fear of this was on average over 3.5. In addition, the survey of the physicians' group showed that the average stress caused by "bad news" was over 5 on a scale of 0 to 6 - so in this case, the patient conversations also have a strong effect on the condition of the treating physicians.

Further training urgently desired 

There was absolute unanimity between medical students and physicians with regard to the need for further education and training on "breaking bad news" as a skill. Both groups see an acute need for action here: In the student group (with a scale in this case ranging from 0 to 9) the need for such training opportunities was quantified with an average of a near 8. Among the medical professionals, for whom the scale ranged from 0 to 8, the desire for further training opportunities came to a value above 7.

The students and physicians surveyed also agreed on the forms of training that were considered most useful in order to acquire more knowledge on the transmission of bad news. In both groups, the items "seminars with...", "discussions with...", "supervision" and "learning from..." were in the lead. 

Prof. Sehouli summed up the interim results of the survey so far: "They show the high demand among both students and physicians for online services on the topic of delivering bad news." In addition, Sehouli's team has also compiled practical tips on breaking bad news. The Breaking Bad News project is seeking to offer advice to physicians, affected persons and their relatives on how to prepare and process information for such contexts.

1. Translator comment: Original survey question in German. English version drafted by our editorial team.