Half of physicians (51%) and more than two in five nurses and advance practice nurses (44%) say they have delayed giving bad news to patients, according to a Medscape Medical News poll.
The poll question was one of four pitched to readers September 6 after Medscape contributor and New York University medical ethicist Art Caplan, PhD, wrote a commentary in which he posed questions about whether physicians should get to decide the best timing for delivering bad health news and whether they should be punished if failure to disclose results in worsening of the condition.
Dr Caplan used the example of a physician who had determined a patient had incurable lung cancer. The doctor also knew the patient was going on a 2-week cruise the next week. He chose to delay telling her and the patient went on the cruise, contracted pneumonia, and died. The family was angry with the doctor and considered his actions paternalistic rather than compassionate.
Respondents to the poll of healthcare professionals and other Medscape members totaled 470; 145 were nurses/advanced practice nurses, and 222 were physicians.
Anxiety Is Top Emotion When Delivering Bad News
Anxiety was the top emotion reported by physicians and nurses in describing their experience when delivering bad health news to a patient. Among physicians, 55% reported that anxiety was the primary emotion. The percentage was even higher among nurses, at 59%.
Next were feelings of failure and frustration. Among physicians, 36% experienced feelings of failure and 32% experienced frustration. For nurses, 32% reported feeling frustration and 27% reported feelings of failure. Some even felt anger (6% of nurses and 9% of physicians.)
Delivering bad news is a common requirement for both groups, although twice as many physicians (50%) as nurses (26%) said they frequently had to deliver bad news to patients. Only 4% of physicians and 10% of nurses/nurse practitioners said they had never had to do it.
Reactions of the patient and patient’s family were drivers in how the professionals reacted, poll responses show.
The patient’s reaction is the biggest influence on the professionals’ reaction; 66% of physicians and 70% of nurses answered that way.
The next biggest influence for both groups was the family or caregiver’s reaction. It was listed by 53% for physicians and 60% of nurses.
Other factors influencing how physicians and nurses deliver bad news included access to a private space, lack of time, communication challenges between healthcare professionals, and lack of training/experience in delivering bad news.
Commenters Say Doctors Should Tell Patients Right Away
Those who posted comments on the poll leaned toward full and immediate disclosure by providers.
A commenter whose occupation was listed as health/business administration said, “Honesty between doctor and patient shouldn’t be an option. Trust is essential. If I took deductions that could get me in hot water with the IRS I’d expect my accountant to advise me so. If I had a disease that could threaten my life I’d expect my doctor to tell me.”
A critical care/intensive care physician said physicians need more training in communicating difficult news in order to feel comfortable and pointed to a gap in medical training.
“Many effective approaches exist but they have to be more broadly incorporated into the curriculum. That would be a useful topic to include in [maintenance of certification] instead of observing colleagues wash their hands!” the commenter wrote.
Need for more education was echoed in a Baylor University Medical Center survey conducted among 54 participants in the Department of Surgery (17 women and 37 men). The survey found that almost all (93%) of respondents felt that delivering bad news is a very important skill, but only 43% felt that they had the training to effectively do so.
An advanced practice nurse who commented on the Medscape Medical News poll said, “I have found that most people want to know the results as soon as possible following diagnostic testing. Even with an initial emotional outburst they usually want to know more about any options for treatment and palliative care.”
She added, “I have never believed that withholding information from patients is within our right, especially when they have sought out our knowledge and capability to provide answers.”
Dr Caplan took the same view in the case of the patient who went on the cruise: that there should have been full disclosure.
He said while he understood the doctor’s actions, the doctor also took away the patient’s right to decide how to spend the time she had left. That might have included forgoing the cruise and spending time with family or taking the time to get her affairs in order.
“It’s the patient’s choice,” Dr Caplan said, in how to manage bad news when “there’s nothing much medicine has to offer.”
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