Breaking bad news to patients: physicians' perceptions of the process.

The goal of this investigation was to gain a better understanding of the processes associated with communicating bad news to patients. A convenience sample of 38 physicians recalled a time when they delivered bad news and then answered a series of questions about what transpired. Data were also obtained about how well they thought the transaction had proceeded, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. The majority of physicians reported following most of the published recommendations for delivering bad news. However, the number of recommendations followed was not correlated with self-reported stress and effectiveness in news delivery or with physicians' estimates of patients' distress. The number of recommendations followed could not be accounted for by the closeness of the relationship between physician and patient or by the gender composition of the bad news encounter. Overall, physicians reported that the transaction was moderately stressful for themselves, that the stress lasted beyond the recalled transaction, and that they were effective in delivering the news in a way that reduced patient distress. These findings suggest that the sampled physicians are generally following a substantial number of published recommendations when delivering very stressful news to patients. The primary weaknesses in the delivery process occur while preparing for the encounter. The fact that many of the physicians reported that their stress lasted beyond the transaction itself suggests that training in the delivery of bad news should include guidance on cognitive and behavioral coping strategies to help physicians deal with their own discomfort.