How Do You Handle Delivering Difficult News to a Patient or Their Families?

How Do You Handle Delivering Difficult News to a Patient or Their Families?

Communicating difficult news to patients or their families is a delicate task that requires both skill and emotional intelligence. We've gathered insights from six medical professionals, including Pediatric Emergency Physicians and Nurses, on how they navigate these challenging conversations. Their experiences shine a light on the critical balance between professionalism and human connection that underscores compassionate medical care.

• Build Rapport Before Delivering News
• Convey Truth Directly
• Provide Clarity and Continuous Support
• Let Empathy Accompany Precision
• Listen and Give Space
• Practice Compassion and Honesty

Build Rapport Before Delivering News

Building a rapport with patients and their families before delivering difficult news is fundamental. It's not always possible, but developing a strong relationship with patients and their families over time helps a great deal. When it became necessary to share challenging information, I prioritized their emotional well-being by ensuring multiple family members were present for support. Meeting them face-to-face, maintaining eye contact, and communicating in clear, understandable terms helped foster trust and comfort during the conversation. Providing ample time for questions and processing ensured they felt heard and supported in their response. By approaching the situation with empathy and respect, I aimed to alleviate some of the distress associated with receiving difficult news and facilitate a constructive dialogue moving forward.

Convey Truth Directly

Recently, a client passed away, and I had to call a family member to inform them. It was challenging, and I was nervous; it was my first time relaying information like this. Most people prefer to be told the truth/facts about the situation and not to drag it out. When the family member answered the phone, I told them, 'I'm sorry to tell you, but X has passed.'

Provide Clarity and Continuous Support

During my trauma-heavy general surgery training, delivering difficult news, especially about a loved one's death after a traumatic event, became a necessary skill. Here's how I approached these moments:

Preparation: I made sure to fully understand the medical details to provide clear, straightforward answers.

Setting: Conversations were held in private, quiet spaces to respect the gravity of the situation.

Clarity: I used simple, direct language, avoiding medical jargon to prevent confusion and false hope.

Empathy: I focused on being genuinely empathetic, allowing families the space to process the news while offering my full presence and support.

Support: After delivering the news, I directed families to counseling services and remained available for follow-up, emphasizing continuous support to help them start their grieving process.

While these situations are extreme examples of delivering difficult news, the main points of clarity, empathy, and support are key to any situation that requires calm, directed medical information. This challenging aspect of my training underscored the crucial role of compassion and responsibility in our medical duties.

Let Empathy Accompany Precision

In my role as a Pediatric Emergency physician, the delicate task of informing parents of their child's passing often involves two distinct perspectives. Initially, as is typical in such encounters, I encounter families and children for the first time amidst the tragic circumstances. Unlike the journey of an oncologist, where relationships are often cultivated and the eventuality of death can be anticipated, my interactions lack a pre-existing emotional connection. While my empathy for the family's plight is profound, delivering the devastating news of a child's demise is an inevitable aspect of my profession, albeit a profoundly challenging one. Trained to navigate such delicate conversations with precision, I employ specific language such as 'death' or 'died,' acknowledging the gravity of the situation. If the parents desire, I offer insights into the resuscitation efforts, providing a measure of closure amidst their grief.

However, my perspective underwent a profound transformation upon becoming a parent myself. Suddenly, the encounter with grieving parents transcended mere sympathy, evolving into a deeply personal experience of empathy. Imagining the unimaginable loss of my own child, my emotions surge, and tears well in my eyes. Despite my professional demeanor, my voice quivers as I deliver the stark reality using the same precise terminology of 'death' or 'dead.' In these moments, I find myself instinctively reaching out to hold the trembling hand of a grieving parent or enveloping them in a compassionate embrace, offering solace in the face of unspeakable sorrow.

Listen and Give Space

Delivering difficult news to a patient or their family is never easy, but I approach it with honesty, empathy, and care. In such moments, I first ensure I have all the necessary information and understand it thoroughly to convey it as clearly as possible. I choose a private and comfortable setting, allowing for an uninterrupted conversation. I speak with a gentle yet direct tone, ensuring I convey both the reality of the situation and the available options for the next steps. Most importantly, I listen. I give them space to process the information, ask questions, and express their emotions. Offering support and being present in the moment has always been my priority, helping to build a bridge of trust during challenging times.

Practice Compassion and Honesty

There is no easy way to handle delivering difficult news to a patient or their family. These situations call for compassion, honesty, and non-medical jargon. The kindest thing we can do as physicians is to share what must be shared and not shy away from the hard conversation or sugar-coat things because of our own discomfort or out of fear of their reaction.

Having been on the other side of this situation with my own dad as the patient, I can speak to the frustration as a family member when our medical colleagues just don't say it like it is. It allowed and even encouraged confusion, unclear plans, and unrealistic expectations. And then, as a physician in the family, I was left to explain the really difficult news to my dad, who was bewildered.

We can and should do better by our patients. We owe it to them to be honest. To be fair. To be kind. And to let them know what is known, what is uncertain, what it all means. As my Chairperson in training used to say, 'We have special knowledge.' And as physicians, we do. It is incumbent upon us to use our knowledge to help explain and guide our patients, offering compassion along the way.