The stress of giving bad news must be dealt with

People prefer to avoid spreading bad news, but for doctors, it is an essential part of responsibility, regardless of medical specialty. Having doctors perform this unpleasant task can lead to stress, anxiety, and difficulties communicating effectively [1].

To improve doctors’ ability to deal with these cases, different methods and strategies have been developed. These include training courses, conversation models (such as Spikes) and larger programmes, such as the Chronoberg Model and the Serious Illness Conversation Programme. Despite these resources, discussing diagnosis and feelings with patients and their relatives remains a challenge [2].

To explore this in more depth, we interviewed 22 doctors who were either fully specialists or at the end of their ST service. Their specialties included various fields, from rheumatology to ophthalmology and oncology. The interviews were ostensibly analyzed to find the meaning of giving bad news.

The study showed that conveying a bad message consists of 5 elements [3].

• He becomes the bad messenger. The process begins when doctors realize that there is bad news to be told or confirmed. There is often a concern that advertising will cause pain. This is difficult, and doctors feel a responsibility to do so with kindness.
• To expect the unpredictable. It is not possible to predict how patients or relatives will receive bad news. Some feel angry or afraid, while others express no emotion or understanding.
• Being on stage. Letting go of bad news can be likened to performance. Doctors must be present, focused, and manage their stress while at the same time focusing on the patient’s needs.
• Dealing with hope in a professional manner. Clinicians must consider the balance between information and room for hope, even when the prognosis is poor. They may need to help patients and their relatives transfer hope.
• Awareness of the emotional relationship. Maintaining a good relationship with patients is often crucial for doctors. They make an effort to be present and caring, realizing that their approach affects the feelings of both patients and their relatives.

These elements tie together to create an overall bad news delivery experience. The task can be described as a circular process, with the five elements gradually evolving and influencing how clinicians act and feel during different stages. Together, these steps affect the relationship between doctor and patient and the health of both.

The study confirms that clinical communication involves much more than simple transmission of medical information and management of patient reactions. It is a complex task that requires doctors to integrate medical knowledge, self-awareness, presence and flexibility into their communication with patients.

This can be exhausting and exhausting and cannot be overcome with communication training alone. Our study suggests that both nursing education and clinical operations should consider that delivering bad news is stressful for clinicians. The importance of continuity of care cannot be ignored when both patients and caregivers suffer from its absence.

It is also important that employers allocate sufficient time for conversations and take into account doctors’ feelings and needs in order to promote long-term, sustainable care and well-being among their employees.

Lakartidningen.se 2023-11-20