In my journey as a nurse, I have been a bearer of bad news, I have heard bad news being revealed, and I have seen the shock, disbelief, and agony in the eyes of my patients and their relatives upon knowing of the bad news.
‘Bad news’ is defined as any information that is likely to alter drastically and negatively the patient’s view of his own future (Buckley, 1992).
Bad news comes in many forms: it may be cancer, Parkinson’s disease, diabetes, psoriasis, rheumatoid arthritis, or any other life-altering disease.
This column will focus on cancer, in observance of World Cancer Day on Feb. 4.
Being informed that one has cancer is devastating. It is likened to “dropping a bomb” or a death sentence.
After the diagnosis of cancer is made, feelings of shock, disbelief, fear, anxiety, guilt, sadness, grief, depression, anger may be experienced by the patient.
Delores, upon knowing that she has cancer, reacted: “There’s a fear that goes through you when you are told you have cancer. It’s so hard in the beginning to think about anything but your diagnosis. It’s the first thing you think about every morning. I want people diagnosed with cancer to know it does get better. Talking about your cancer helps you deal with all of the new emotions you are feeling. Remember, it’s normal to get upset.”
Who should break the bad news? Healthcare professionals are the ones who have to carry out the task of providing information to patients about their diagnosis and prognosis.
In the field of oncology, physicians are unavoidably forced to break bad news.
Breaking bad news is an essential skill for all physicians, because it is something which they repeatedly do in their professional careers.
It has been noted that before, this was given scant attention in medical training. This is, however, changing, with general and specific skills for breaking bad news, being a part of the medical school curriculum.
Breaking bad news is not an easy task and is a complex skill, because aside from the verbal component, it also requires the ability to recognize and respond to the patient’s emotions, dealing with the stress that the bad news creates, but still seeing to it that the patient is involved in any decision, and in maintaining hope where there may be little.
Bad news should be given in person, and not over the telephone, nor in the hallway. The patient should be accompanied by a spouse or someone close to them.
The physician should ensure that he has “protected time”, meaning, switching off mobile phones or locking the door. It may be just another working day for the physician, but for the patient and his family, it is a pivotal day of their lives.
Be fully conversant of the facts, as much as possible, particularly the facts about the case — the exact type of tumor and stage, and more general issues about the disease.
With modern technology, some offices have computers and the results of laboratory exams that can be viewed by the patients and their families. (This is true with my late sister, Dedita Cacdac who died in July 5, 2014; we were able to see the size of the lesion in her lung during visits to her doctor in Kaiser Permanente Hospital in California.)
In addition, if appropriate, the physician should inform his colleagues and consultants involved in the care.
Nurses may also break the bad news. Faulkner (1998) says that the person delivering the bad news should be someone whom the patient trusts, and feels comfortable with. For most patients, this person is their nurse.
In cancer nursing, communication is considered as one of the most important aspects. “Picking up the pieces” is a common scenario for a majority of nurses who work with cancer patients.
Since being an advocate for their patients in all situations, nurses should be more prepared, and should ensure that the patient’s true wishes are respected, or heard.
Healthcare professionals should remember that provision of health services is not a “one-man show,” everyone should do his or her responsibilities.
The duty of health professionals is first and foremost to the patient, and they have to remember that they should treat each patient as an individual.
Let us all raise awareness, find a cure, and continue the fight against cancer.
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Author’s email: nenita.tayko@foundationU.com
