Breaking bad news: Effect of physician communication on analog patients' response.

摘要

Breaking bad news is a difficult, yet unavoidable part of healthcare for physicians and patients alike. Although expert opinion suggests that certain strategies for breaking bad news may be better than others, there is little methodologically rigorous research to support current guidelines. This study used an experimental paradigm to test two communication strategies, forecasting bad news and framing prognostic information, when giving people a life-limiting diagnosis of colon cancer. Videotapes depicted a physician disclosing a diagnosis of cancer and discussing prognosis. Participants ( N = 128) were asked to imagine they were going to see a doctor for physical symptoms they had been experiencing and were randomly assigned to one of one of four videotape conditions: (a) bad news warning (i.e., "I'm afraid I have bad news."), positive outcome framing (e.g., chances of survival) (b) no warning, positive outcome framing (c) bad news warning, negative outcome (e.g., chances of death) framing or (d) no warning, negative outcome framing. Results showed that the type of warning recommended in current guidelines (and examined in this study) was not associated with lower psychological distress (i.e., anxiety, affect), nor did it improve recall of consultation content. In contrast, individuals who heard a positively framed prognosis were significantly less anxious and had lower negative affect than those who heard a negatively framed prognosis. They rated their prognosis as significantly better than those who heard the negative frame and were significantly more hopeful. Despite these desirable outcomes, a trend toward reduced accuracy in recalling the prognostic statistics was observed in the positive condition. Because the goal of a prognostic discussion is generally to balance accurate knowledge with optimal psychological well-being, these findings suggest indirectly that mixed framing (i.e., explaining prognosis with both positive and negative frames) may be best, although further research is needed. The results from this study contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care. Though individual differences preclude a one-size-fits-all approach, this empirical evidence should help doctors to communicate bad news in ways that enhance understanding while minimizing distress for each patient.