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Delivering Bad News

By Lisa Schulmeister, MN, RN, ACNS-BC, OCN, FAAN
How to best deliver bad news has received a lot of attention in the healthcare community. Patients need to be accurately informed but at the same time, is a message of gloom and doom necessary? Researchers in an outpatient supportive care center at a Houston cancer center conducted a randomized clinical trial to examine how information is conveyed and perceived.

One hundred patients were randomized to observe two standardized 4-minute videos of a physician discussing treatment information with a patient with advanced cancer. One version presented a more optimistic message and the second presented a less optimistic message. Both physicians made five empathetic statements and displayed identical posture. After viewing each video, patients completed assessments including the Physician Compassion Questionnaire. Patients reported significantly higher compassion scores after watching the more optimistic video as compared with the less optimistic video. Higher perception of compassion was found to be associated with greater trust in the medical profession independent of message type: 63 patients observing the more optimistic message ranked the physician as trustworthy versus 39 after the less optimistic message. The researchers concluded that patients perceived a higher level of compassion and preferred physicians who provided a more optimistic message. These results are not surprising; however, they also raise concern about framing information so optimistically that patients believe treatment outcomes will be better than they actually are. Patients don’t need to be hammered about a poor prognosis but do need accurate information so that they can make plans for the future.

Tanco K, Rhondali W, Perez-Cruz P, et al. Patient Perception of Physician Compassion After a More Optimistic vs a Less Optimistic Message: :  A Randomized Clinical Trial. JAMA Oncol. Published online 2/26/15. doi:10.1001/jamaoncol.2014.297.
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