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3 - Talking about Serious News

When the Emotional Channel Is On High

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
University of Washington Medical Center
Elise C. Carey
Mayo Clinic, Minnesota
James A. Tulsky
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Scripps Health, San Diego, California
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The VitalTalk roadmap for talking about serious news is GUIDE (Get ready, Understand, Inform, Demonstrate empathy, and Equip patient for next steps). Getting ready includes planning the details of the meeting, including why and how the information is to be shared. The next step is understanding what the patient expects from the visit and what they have been told so far. Prior to giving information, the clinician should ask permission to share what they know. The news should be shared using a headline containing both data and what it means for the patient’s life. Afterwards, the clinician should demonstrate empathy by recognizing and responding to emotion. Equipping the patient includes discussing next steps, summarizing, and checking for shared understanding. There may also be challenges of patients receiving potentially too little or too much information when families say “don’t tell” or due to asynchronous electronic results delivery respectively. How much patients want to know and how and when they get information can be clarified through preparatory discussions. Finally, medical errors are another form of serious news that require an apology along with the headline.

Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 36 - 51
Publisher: Cambridge University Press
Print publication year: 2024

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Further Reading

Back, A. L., Trinidad, S. B., Hopley, E. K., et al., What patients value when oncologists give news of cancer recurrence: Commentary on specific moments in audio-recorded conversations. Oncologist, 2011, 16(3): 342–50.CrossRefGoogle ScholarPubMed
Baile, W. F., Buckman, R., Lenzi, R., et al., SPIKES: A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist, 2000, 5(4): 302–11.CrossRefGoogle Scholar
Barclay, J. S., Blackhall, L. J., and Tulsky, J. A., Communication strategies and cultural issues in the delivery of bad news. J Palliat Med, 2007, 10(4): 958–77.CrossRefGoogle ScholarPubMed
Childers, J. W., Back, A. L., Tulsky, J. A., and Arnold, R. M., REMAP: A framework for goals of care conversations. Oncol Pract, 2017, 13(10): e844e850.CrossRefGoogle ScholarPubMed
Delbanco, T. and Bell, S. K., Guilty, afraid, and alone: Struggling with medical error. N Engl J Med, 2007, 357(17): 1682–3.CrossRefGoogle ScholarPubMed
Eggly, S., Penner, L., Albrecht, T. L. et al., Discussing bad news in the outpatient oncology clinic: Rethinking current communication guidelines. J Clin Oncol, 2006, 24(4): 716–19.CrossRefGoogle ScholarPubMed
Friedrichsen, M. J., Strang, P. M., and Carlsson, M. E., Breaking bad news in the transition from curative to palliative cancer care: Patient’s view of the doctor giving the information. Support Care Cancer, 2000, 8(6): 472–8.Google ScholarPubMed
Manning, A. and Amare, N., Bad news first: How optimal directness depends on what is negated. 2017 IEEE International Professional Communication Conference (ProComm), 2017: 110.Google Scholar
Parker, P. A., Baile, W. F., de Moor, C., Lenzi, R., Kudelka, A. P., and Cohen, L., Breaking bad news about cancer: Patients’ preferences for communication. J Clin Oncol, 2001, 19(7): 2049–56.CrossRefGoogle ScholarPubMed
Porensky, E. K. and Carpenter, B. D., Breaking bad news: Effects of forecasting diagnosis and framing prognosis. Patient Educ Couns, 2016, 99(1): 6876.CrossRefGoogle ScholarPubMed
Ptacek, J. T., Fries, E. A., Eberhardt, T. L., and Ptacek, J. J., Breaking bad news to patients: Physicians’ perceptions of the process. Support Care Cancer, 1999, 7(3): 113–20.CrossRefGoogle ScholarPubMed
Truog, R. D., Browning, D. M., Johnson, J. A., and Gallagher, T. H., Talking with Patients and Families about Medical Error: A Guide for Education and Practice. The Risk Management Foundation of the Harvard Medical Institutions, Inc., 2011.CrossRefGoogle Scholar

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