Chapter 49 Breaking bad news
What is bad news?
Bad news has been defined as ‘any news that drastically and negatively alters the person’s view of her or his future’ (Buckman, 1994). Bad news may be giving a terminal or life-changing prognosis, e.g. metastatic cancer or multiple sclerosis, but it could also be news of sudden loss, e.g. telling a young wife that her husband has died after a massive heart attack or parents that their teenage son has been killed in a motorbike accident. It may also be about something seemingly much less dramatic for patients but no less distressing, for example, telling the young man keen to be a pilot that he has diabetes. The impact of the news will have not only medical but also physical, social, emotional and occupational consequences, which health professionals often fail to appreciate (Fallowfield & Jenkins, 2004).
Why is it difficult?
There are several reasons why breaking bad news is an especially difficult task for doctors, irrespective of their age, speciality or professional experience. These may be personal (related to their own personality or past experience), social (to do with society’s attitudes), professional (influenced by role or peer values) or legal/political (Buckman, 1994). Some of these are listed in Box 1. In addition, it may be made more difficult if family members want to protect the person from bad news and distress (Kaye, 1996). Under these circumstances, the doctor may be asked to collude with the relatives in order to maintain a conspiracy of silence. This situation often puts strain on a previously healthy relationship both with the doctor and within the family, and can lead to feelings of mistrust and isolation on the part of the patient.
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