Have you ever been part of a conversation with a patient or family when bad news was delivered badly? And by badly, I mean the news was given in a harsh manner.
The recipients are clearly unprepared and befuddled, and no opportunity is given to identify what was actually heard. These are examples of situations I have seen over the years, and unfortunately, there are many more.
Diane Meier, MD, and the Director of CAPC (Center for Advancement of Palliative Care), challenges healthcare professions to view giving bad news as a medical procedure. By that, she means it's something that takes extensive training, observation, and practice. It's not something you send a junior resident in to do when the attending is occupied with other things.
Dr. Meier has a video entitled "Palliative Care and the Human Connection: Ten Steps for What to Say and Do." This video is a primer on how to deliver bad news in a caring and informative way.
Meier emphasizes three points: ask, tell, ask. She wants you to start the conversation by asking the patient/family the extent of what they want to know, give the information, and then stop talking. Once the information is appropriately delivered, ask them to give you feedback on what they have heard. This step is often the one that is missed because once the news is given, the physician or other professional will usually go on to talk about details of the condition without realizing that the recipients may be unable to process any further information.
Clearly, as nurses, many of us will not be in positions to be the primary person giving bad news. More often, nurses are present at the bedside or office when it's given; or are there, after the fact, to reinforce and support the recipients.
I encourage you to watch the video to see how such conversations can be handled, and then think about how you could implement some of these concepts into your own setting:
- Share the video with your team.
- Stage the setting for the meeting.
- Let your team know you want to participate actively in the meeting.
- During a family meeting, speak up to ask the family what they just heard.
- Encourage the doctor to write down the name of the diagnosis.
- Frequently ask the patient/family if they have questions.
- Encourage a pre and post family meeting with the healthcare professionals to establish a plan for presenting the news and after the meeting for a critique of how it went. You could be instrumental in changing the practice of both of these.
How would you rate your team at delivering bad news? Is there room for improvement?