Articles and Case Studies

Responding to Patients’ Grief at Times of Difficult News

10 Apr 2014

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Are you thinking that communicating difficult news will just get easier as you gain more experience? Actually, the ability to discuss difficult news well doesn’t necessarily improve as a doctor’s career progresses. So it’s important to develop skills and confidence in this area early in your training.

What you do during difficult news conversations is extremely important for patients and their loved ones. It can have long-term effects on their physical and mental health. How well you communicate difficult news also affects your personal and professional satisfaction.

Doctors often worry about how to appropriately respond to patient grief during a difficult news conversation. Practical strategies for when a patient is distressed include the following:

  • Always actively listen, investigate emotions and communicate empathy.1
  • Tips for empathy include suggesting the emotion they are feeling (e.g. “Sounds like you were really frightened when you got that news…”), discussing their experience, allowing silence and maintaining eye contact.
  • Openly acknowledge any signs of distress and invite the person to explain their feelings.
  • Ask, “Do you want to talk about this now?”
  • You’ll learn things that will help you care for them.
  • Don’t dismiss or try to repress a person’s anguish. But don’t provide information that they don’t want to know because they find it distressing.2
  • If someone is substantially distressed, there’s no point in continuing the conversation. Just sit with them and let them cry or express their feelings however they wish. They’ll move to a place that allows the conversation to recommence, usually quite quickly. Don’t cover up your anxiety about their sadness by talking over or ignoring it.
  • Move closer to a person who is distressed and give them your full attention.

Also keep in mind the following:

  • Be confident when exploring patients’ emotions because there’s almost always something that you can do to assist. Simply discussing what a person is feeling can help them find a realistic and constructive perspective for themselves.
  • It’s critical to be alert for indirect signs of emotional matters and address them as you would address direct, verbal signs.
  • Never assume that you know what has caused distress, e.g. you may think that imagining their own illness prompted the response when they’re actually thinking about someone else who went through something similar, and they haven’t resolved difficulties associated with that experience. Do not advise or reassure until you’re certain you know all of the information about what a person is feeling.3

"It is possible to minimise the patient’s distress by as it were taking your place alongside them, sympathising with their predicament, negotiating an agreed policy and assisting the patient to achieve the best possible outcome in the circumstances." (p47)4



Nicole Harvey, MDA National Education Services



References

1. Minichiello T, Ling D, Ucci D. Breaking Bad News: A Practical Approach for the Hospitalist. J Hosp Med 2007;2:415–21.
2. Momen N et al S. Discussing an Uncertain Future: End-of-Life Care Conversations in Chronic Obstructive Pulmonary Disease. Thorax 2012;67(9):777–80.
3. Maguire P, Pitceathly C. Dealing with Strong Emotions and Difficult Personalities. In: Macdonald E, editor. Difficult Conversations in Medicine. Oxford University Press, 2004.
4. Macdonald E. The Doctor’s Perspective. In: Macdonald E, editor. Difficult Conversations in Medicine. Oxford University Press, 2004.
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