After the Bad News… When Patients Hear Something Different than What Was Said

How many times have you begun a conversation with a patient or family, only to discover their understanding of the situation is far different from what the referring physician has shared with you?

All too often, it seems, judging from the large attendance at this informative, lively session that led attendees through the labyrinth of difficult, high stakes conversations. The role-play exercise—a PC consult with a determined mother of teens who believes she’s discharging to rehab to “get stronger for chemo” — stimulated a discussion that identified techniques, pitfalls, and ethical boundaries.

The take-away of techniques included three communication approaches: offering a hypothetical situation (have you thought about what you’d want if the chemo isn’t effective?), offering hope/worry language (I’m hoping you’ll feel better and be able to go home to spend time with your family, but I’m worried that your body is very sick, and this might not be possible) and naming the dilemma.

Some techniques to avoid common pitfalls included communication with the team after to conversation to ensure a common message and reduce team distress, and avoiding splitting, even bringing the referring physician to the meeting, if possible.

The concept of planting a seed—taking the conversation only as far as the patient appears able—emerged as we explored the ethical boundaries of sharing unwanted news, weighed with our duties to the patient and family to provide accurate information to empower informed decision making.

While we recognize that some patients and families may stay “stuck,” the goal of these conversations, and indeed all care, is to maximize the chances for better outcomes. Thank you Drs Jacobson, Thomas & Jackson for an enlightening session.

Karen Whitley Bell, RN, CHPN

2 thoughts on “After the Bad News… When Patients Hear Something Different than What Was Said

  1. Thanks for the report! I was also there and you captured the highlights. I think the three techniques presented seem very user-friendly and realistic.
    I plan to share a link to your review with my local HPNA chapter (and glad I didn’t have to write it myself!)

  2. I find that we often have to have several of these conversations with the same patient/family as everyone moves through the disease process. Sometimes we do not have the luxury of time and have a balancing act of supporting the patient and family along with finding the goals and ways to support them. I think the more we practice this skill it develops into an art form for those immediate need situations such as the ED and a fasy decline in the acute setting.

Leave a Comment