Palliative-care physician Marcia Levetown, a regional hospice medical director, remembers several instances where she had to share bad news with patients. Though it's never easy for the physician or patient, she says employing a strategic and thoughtful communication strategy can help.
Here are some tips from Levetown, who teaches communication skills to physicians, and from other communication experts and physicians.
Prior to the encounter: Consider who else should be present when you tell the patient the news, such as his family members, says Levetown. "Usually bad news isn't something that you have to tell them this minute. You should ask who else needs to be here, and give them sufficient time within limits to get those other supporters there."
Remember that it's OK to feel anxious prior to the appointment, says pediatrician and assistant professor of pediatrics at Harvard Medical School Elizabeth Rider, who is also director of academic programs at the Institute for Professionalism and Ethical Practice at the Boston Children's Hospital and director of programs for communication skills at the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital.
Instead of ignoring your own emotions, acknowledge them, she says. Then, think about how you can best help the patient moving forward.
When preparing (and throughout the appointment) try to put yourself in the patient's shoes, says Jason Wolf, executive director of The Beryl Institute, an organization dedicated to improving the patient experience. Consider how you would like to be informed if you were the patient, or if you were one of the patient's family members.
During the encounter: While meeting with the patient, focus on staying "present" and "connected," says Wolf. "This means I'm sitting there with you, I'm listening with empathy, I am being very clear in my communication — so it's not some medical gobbledygook [I'm telling you], it's as simple and understandable as possible."
Also, if family attends the appointment, include them in the conversation, he says. That ensures they feel connected and that the patient feels less alone. And once you've shared the news, give everyone time to react and make it clear that you are there to listen and answer questions.
If the patient is expressing emotions, such as fear or sadness, take the time to acknowledge that, says Levetown. "They want to know that their fear is reasonable, that you heard that they were afraid, and that you're with them, and then, how you're going to help them."
When you are sharing bad news with a patient, expect to repeat yourself throughout the appointment, says Rider, noting that when patients hear bad news it's difficult for them to process it. "They're going to ask you the same questions again and again," she says. "... We need to understand that as physicians, be patient, and go on that journey step-by-step with them."
Concluding the encounter: Gauge whether the patient has an adequate understanding of the situation by asking how he would explain it to someone else, says Levetown, pointing out that that's less intimidating than asking the patient to repeat back what they have learned from you.
Also, "Lay out the options and your recommendations, what will happen next, and how you can be reached after you've come up with a plan so that they know how to reach you at any time," she says.
Finally — and this is critical — let the patient know that you are on his or her side, says Rider. "Patients need to hear that you won't abandon them. I often will say to mine, 'I will go on this journey with you,' and the relief is huge."