Research by Martins et al. (2013), in plain language
What’s this study about?
This study looks at possible reasons why different patients prefer different ways of receiving bad news from their doctor.
Why did they do this study?
When delivering bad news to patients, it’s important to do so carefully because it can affect how satisfied patients are with their care, as well as how well they adjust to their illness. Research has looked at the words health professionals use, the ways in which they give emotional support, and the circumstances in which they deliver bad news. But, not much research has looked at how and why different patients prefer different ways of receiving bad news. Some studies show that patients who are younger, female, and more educated tend to want as much detailed information as possible. Other studies show that patients who are more anxious tend to want more emotional support.
In this study, the researchers think that a patient’s ‘locus of control’ would also make a difference to how they want to receive bad news. ‘Locus of control’ is a way of thinking. It refers to whether a person believes things are within their own control (internal locus of control) or outside of their control (external locus of control), and whether they believe things are in the control of ‘powerful others’, like a doctor. The researchers wanted to do an experiment to see what styles of bad news delivery different patients prefer, why they prefer those styles, and whether their locus of control makes a difference to their preferences.
How did they do this study?
The researchers found 72 volunteers to take part in their experiment. The volunteers were all patients from a clinic at the Portuguese Institute of Oncology. 63 were female and 9 were male, their ages ranging from 17 to 84 years old. The researchers sorted the volunteers into two groups – those who had cancer, and those who had been tested but didn’t have cancer. About two thirds of the volunteers went in the cancer group.
In the experiment, the volunteers watched four different videos of a doctor delivering bad news to a patient. The first video showed an ‘emotionally burdened expert’ who tries to be kind but has a hard time coping with their own feelings (e.g. doctor touches patient and feels very sad). The second video showed a ‘distanced expert’ who gives no-frills health information without any emotion (e.g. doctor avoids showing and discussing emotions). The third video showed an ‘empathetic professional’ who pays attention to the patient’s physical concerns as well as their feelings (e.g. doctor keeps eye contact and shows empathy). And, the fourth video showed a ‘rough and ready expert’ who is short and sharp in giving information and insensitive to the patient’s feelings (e.g. doctor is harsh and ignores the patient’s emotions). Other than the style of delivering bad news, the news itself, the patient’s reaction, and the length of the conversation in the four videos were kept the same. After the volunteers watched the videos the researchers interviewed them to ask how they felt about receiving bad news. The volunteers also completed a questionnaire which gave a test score of their locus of control.
The researchers analysed the results of the experiment by running stats tests on the volunteers’ locus of control test scores and finding patterns in their interview responses, then looking for links between the two.
What did they find in this study?
The ‘empathetic professional’ was the most preferred style of receiving bad news. 78% of the volunteers liked it best. 12% of the volunteers liked the ‘distanced expert’ best, and 10% liked the ‘emotionally burdened expert’ best. No one liked the ‘rough and ready expert’. The ‘empathetic professional’ was more popular among the younger and more educated volunteers, whereas the ‘emotionally burdened expert’ was more popular among the older and less educated volunteers. The ‘empathetic professional’ was more popular among volunteers with cancer, whereas the ‘distanced expert’ was more popular among volunteers without cancer. Volunteers who preferred the ‘empathetic professional’ had much more of an internal locus of control and believed less in the control of ‘powerful others’.
In the interviews, 61% of the volunteers said they didn’t like the way they themselves had received bad news from their doctor. About one in five said that their doctor did it in the ‘rough and ready’ style. The volunteers had different reasons for choosing the style of delivering bad news they preferred in the videos. Some said it felt the most caring. Others said it was because it was more professional. Another reason was that the wording was clear and easy to understand. Some liked that the conversation was given time. And, being given hope was also a reason. Having time in a bad news conversation was more important to younger and more educated volunteers compared to older and less educated volunteers. Professionalism was the main reason given by volunteers who liked the ‘distanced expert’. Caring was the main reason given by volunteers who liked the ‘emotionally burdened expert’. All the reasons were mentioned by volunteers who preferred the ‘empathetic professional’. Volunteers with a more internal locus of control put more value in the wording and in having time in the conversation.
What do the findings mean?
This study shows that when receiving bad news most patients want their doctor to show concern for their health as well as pay attention to their feelings. Nobody likes a doctor who is insensitive and uncaring. So, it’s important for doctors to know their patients well so that they can deliver bad news in a way that suits the patient’s preferred style.
This study also shows that age and education make a difference to how patients want to receive bad news. Generational attitudes might be one explanation for the different value placed on getting emotional support from a doctor. Having lived through illness personally also seems to make a difference to how a person wants to receive bad news. Also, people who believe that things are outside of their control probably appreciate it more when doctors use thoughtful wording when delivering bad news. And, those who believe that things are in the control of ‘powerful others’ probably speak up less in bad news conversations with their doctor.
The researchers point out that their experiment was only done on a small group of volunteers, so the results might not be reliable. Also, since there are many overlapping demographics amongst the volunteers, it’s hard to tease apart clear groups, like young and old, educated or not, as reasons for the differences in preference.
Where can I learn more?
This blog post is based on the following paper:
Martins, R. G., & Carvalho, I. P. (2013). Breaking bad news: patients' preferences and health locus of control. Patient Education and Counseling, 92(1), 67-73. doi:10.1016/j.pec.2013.03.001
You can read the original paper here: