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INTRODUCTION

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.”

Over time, 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 a dramatic upward trend in disclosure with 97% of surveyed physicians disclosing an unfavorable diagnosis to their patients. 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 deliver serious 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 also explore these less favorable scenarios with patients. Ninety-five percent of patients prefer to be informed of their diagnoses, though there is some variation in what specifically they want to know. For example, most want to know about their chances for cure and effective treatment options, and fewer want to know about their specific prognosis especially if this news is not positive. Unfortunately, the literature has shown that most doctors receive little or no training in communicating serious news to patients, and even those who do it regularly are unsure of their ability to do it effectively.

COMMUNICATING SERIOUS NEWS

Bad news is defined in the literature as any information likely to alter drastically a patient’s view of his or her future. Objectively, serious news can be a life-threatening 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 serious news is a subjective experience that depends on the patient’s expectations and understanding of the situation. For example, patients may be relieved by a diagnosis of a stroke if they had previously believed that they had a brain tumor. Alternatively, the diagnosis of hypertension may be ...

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