Delivering 'bad news' to patients

I had a large family meeting today to clarify goals. Family meetings can take a lot of preparation time, energy and emotional effort. I can't say I dread them, because I view them as a crucial part of my job, especially when I am attending on the wards, but there is a certain amount of psyching up that I need to do before them.

A recent opinion article in the New York Times discusses not family meetings exclusively but the delivery of bad news to patients, including providers' hunches about possible bad diagnoses. This article outlines why, when carefully choosing our words and being careful with our gazes and body language, we might be causing more harm than good. The author also advocates for us being more upfront with our hunches, early and openly. In general I agree with this. I believe providers avoid the conversation not because they want to protect their patients, or because they are being paternalistic, but because it is a very difficult conversation, and they don't know how to approach the topic, or address the very emotional responses that come from patients and their families during these conversations.

The great news is, it can be learned. I did the Oncotalk four-day communication skills retreat that the NYT references in the article, and truly, I use the skills I learned there nearly every time I meet with patients. I know now there are other resources out there to use to learn communication skills techniques, like the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) curriculum through the NCI. If you feel uncomfortable with giving bad news, think about checking it out.