With the passage of time, attitudes about how much information is to be divulged to patients about their medical conditions have evolved. In Decorum, Hippocrates wrote, “… conceal most things from the patient while you are attending him. Give orders with cheerfulness and serenity, turning attention away from what is being done to him [because] a forecast of what is to come can cause a turn for the worse.” In 1847, when the American Medical Association (AMA) published their First Code of Medical Ethics they agreed stating that “The life of a sick person can be shortened not only by the acts, but also by the words or manner of a physician. It is, therefore, a sacred duty to guard himself carefully in this respect, and to avoid all things which have a tendency to discourage the patient and depress his spirits.”
There has been a dramatic change in attitudes and practice patterns in this regard among physicians. In 1961, 90% of physicians preferred not to share a cancer diagnosis with their patients. In 1990, the data showed an upward trend in disclosure with 97% of surveyed physicians telling patients about their unfavorable diagnosis. This could be partly due to the improvement in treatment regimens for chronic diseases, such as cancer and AIDS, over time; with these advances, it has become easier for physicians to give bad news to patients while simultaneously offering the hope for effective treatment necessary to sustain them through their illness. However, along with treatments come treatment failures, recurrence of disease and what may be irreversible side effects of those treatments, requiring physicians to explore these less favorable scenarios with patients. Unfortunately, the literature has shown that most doctors receive little or no training in communicating bad news to patients, and even those who do it regularly are unsure of their ability to do it effectively.
Bad news is defined in the literature as “any information which adversely and seriously affects an individual’s view of his or her future.” Objectively, bad news can be a serious condition, particularly cancer, but could also include other fatal or serious diagnoses, the death of a loved one, treatment failures, or transitions in care (i.e., to hospice). It is important to remember that bad news is a subjective experience that depends on the patient’s expectations and understanding of the situation. It is hard to know how news will affect a person without this personal knowledge, but effective communication can help a patient to better understand and move forward with the information tailored to their particular clinical situation.
Common sense dictates that there are better and worse ways to offer bad news to patients. This type of conversation is delicate and challenging and has implications for both the provider and the recipient, yet most physicians are not trained in the art of this kind of ...