Research by Munoz Sastre et al. (2011), in plain language
What’s this study about?
This study looks at how doctors’ different ways of delivering bad news comes off to patients.
Why did they do this study?
Most people will at some point be in a situation where they receive bad news from their doctor. How the doctor delivers the news can have a big impact on the patient. It can affect whether the patient follows their instructions, and even have an impact on the patient’s overall wellbeing. If bad news delivery isn’t handled well, it’s hard to undo the damage. That’s why it’s important for doctors to know the patient’s point of view on how to deliver bad news in the best way.
There’s already some research on this. We know that bad news delivery goes more smoothly if the doctor is empathetic. We know it’s better to deliver bad news in person, and for the patient to have a family member with them. We also know it’s helpful for the doctor to check what the patient expects and to gauge what information they can handle before delivering the bad news. Other important things are to be honest, and to give the information in a way that the patient can understand. On top of this, it’s helpful for the doctor to let the patient express their feelings, to give as much information as the patient asks for, and to see the patient again in another appointment soon after. But, we don’t know how well doctors follow these steps.
Studies involving cancer patients show that bad news delivery is generally done quite well in this setting. Patients particularly appreciate when doctors allow plenty of time for the conversation, and when they’re empathetic. Even small things, like sitting down to talk instead of standing, can make the patient feel that the doctor is more caring. Some researchers think that gender, culture, and other things related to the patient’s background can also affect how they want to receive bad news. For example, some researchers found that Japanese people, more so than Western people, prefer to have family with them and to talk less about life expectancy when receiving bad news. Researchers want to understand these different preferences more.
In this study, the researchers were particularly interested in four factors about how bad news is delivered: 1) whether the patient is asked to bring a family member, 2) whether the doctor checks the patient’s expectations before delivering bad news, 3) whether the doctor delivers bad news in an emotionally supportive way, and 4) whether the information delivered is easy to understand, complete, and specifically related to the patient. The researchers wanted to see how these four factors, taken separately and taken together, affect how happy patients are with how doctors deliver bad news. The researchers also wanted to know whether doctors and patients would agree or disagree on the importance of these four factors.
How did they do this study?
The researchers found volunteers off the streets off Toulouse, in southern France, to participate in their experiment. 245 people agreed to participate. They were a mix of male and female, 18-80 years old, in good health, and had been in a situation of receiving bad news from a doctor in the past. There was also a separate group of 11 doctors who participated in the experiment. They were general practitioners and 38-68 years old.
For the experiment, the researchers made 48 cards. Each card had written on it a hypothetical situation of a doctor delivering bad news to a patient. Each situation was slightly different in terms of: 1) how bad the news was, 2) whether the patient was asked to bring a family member, 3) whether the doctor checked the patient’s expectations before delivering bad news, 4) whether the doctor was emotionally supportive, and 5) whether the information delivered was easy to understand and complete. The participants (volunteers and doctors) had to read the 48 cards and rate how they felt about each situation on a sliding scale of ‘not at all acceptable’ to ‘completely acceptable’.
What did they find in this study?
The four factors the researchers were interested in all made a difference to how the participants felt about bad news delivery. The participants were more happy with the situation when the patient was asked to bring a family member, when the doctor checked the patient’s expectations before delivering bad news, when the doctor was emotionally supportive, and when the information delivered was easy to understand and complete. The participants felt it was especially helpful when the doctor was emotionally supportive at the same time as giving easy to understand and complete information. The female participants felt most strongly about this. But, the doctor group felt less strongly about this compared to the volunteers.
Before the experiment, the researchers guessed that as the news got worse, the participants would find it more and more important to have emotional support over easy to understand and complete information. But, this was not the case. How bad the news was didn’t actually make much difference to how the participants felt about the situation.
What do these findings mean?
From the patient’s point of view, how news is delivered is probably more important than the news itself. Most of all, doctors need to be emotionally supportive and give information in a way that’s easy to understand, complete, and specifically related to the patient. These two things combined are what makes the biggest difference to delivering bad news in the best way. Doctors should know that one without the other isn’t enough, no matter how serious or not the news is.
This experiment might have shown different results if it was done in another part of the world, because of cultural differences in how people want to receive bad news. The results might also be different if other health professionals or specialists did the experiment, because they might see the situation differently compared to general practitioners. Also, since this experiment only used written hypothetical situations, we can’t know for sure if this is what would happen in real life situations between doctors and patients.
Where can I learn more?
This blog post is based on the following study:
Munoz Sastre, M. T., Sorum, P. C., & Mullet, E. (2011). Breaking Bad News: The Patient's Viewpoint. Health Communication, 26(7), 649-655. doi:10.1080/10410236.2011.561919
You can read the original research paper here: