Don’t make ‘bad news’ worse with jargon and insensitivity

That moment when a patient is given a cancer diagnosis or worse, informed that their condition is terminal, is engrained in their memory forever. After the word “cancer” or “tumour”, they take in very little else of the conversation.

The way in which this “bad news” is communicated to somebody can add further to the trauma of the situation, if not done properly.

Despite advances in the communication skills training of healthcare professionals, there are still cases of patients being given cancer diagnoses or bad test results insensitively or in corridors and behind curtains on wards.

Naomi Fitzgibbon, cancer information services manager with the Irish Cancer Society, says the time of a cancer diagnosis can be the most horrendous time of a person's life and they never forget the way the information was given to them, particularly if they feel it was not done as it should have been done.

“A lot of research and education has been done around how doctors and nurses should communicate and interact with patients at such a vulnerable time in their lives. Some patients may have an understanding about what their tests were for, while for others a cancer diagnosis comes as a bolt out of the blue. Once a person hears the word cancer, they hear very little else after that.”

‘Avoid jargon’

Fitzgibbon highlights the importance of preparing the patient in advance of a difficult diagnosis and advises that they bring a family member or friend with them to their appointment.

“It is important that this kind of conversation should take place in a quiet, private space, not in a corridor or behind a curtain where other people can hear.

“There should be time for the doctor to give the patient the information they need and to assess if they are taking it in.

“The patient should be given time to ask questions and if somebody gets very upset, they should be dealt with appropriately and sensitively and not shuffled quickly out of the room,” she says.

Fitzgibbon stresses the need for healthcare professionals to avoid medical jargon, to use simple language and to repeat the information to ensure the stressed patient takes it in.

Patients should also be given a direct dial number to contact after they go home in case they have more questions, and given details of support services available to them in their area or hospital.

Dr Ian Banks, president of the European Men’s Health Forum and a retired emergency department doctor and GP, points out that despite improvements in communication training for healthcare professionals, there is huge variation in standards.

“Even with the best training in the world, the environment in which the person works and how much time they have all impact on their communication skills.

“Medical students, GPs and nurses are trained in an ideal medical environment but when they are thrown back out into the real world and are face to face with a patient, it’s difficult to predict what will happen. People are given information about what to say and how to say it, but are not given the skills to do so. Most people flounder through as best they can until they sort it out for themselves with an awful lot of time wasted and patients damaged along the way.

“They must not only be trained, but enabled to communicate in the best possible way, irrespective of where they find themselves and who is in front of them.”

Too shocked

Banks, who is an advocate for cancer patients, spoke on this topic at the recent European Cancer Congress in Vienna. He agrees that most patients are either too shocked or too overawed to ask questions after they have received life-changing bad news.

When his own wife was diagnosed with cancer by a senior registrar (who did not know Banks) in his own hospital, she was told “she had cancer, they were going to clear out her pelvis and her chances were very poor”.

“That first statement shattered my wife; she did not hear a word after that,” he recalls.

Unfortunately, in most cases, the person delivering the bad news tends to be the most junior doctor instead of the senior person who would have more experience in doing this, says Banks.

However, Naomi Fitzgibbon points out that the most senior member of the team might not necessarily be the most empathetic and sensitive when communicating with patients.

Banks says doctors should be writing (or typing) everything down for their patients during the conversation or inviting the patient to take their own notes.

He advises patients to bring a smartphone with a recording function and to tape the entire conversation so they can listen to it later at home and then erase it if they want to.

“Doctors should invite their patients to switch their phone on to record, then forget about it and chat.

“An inflection in a voice can make all the difference if a doctor is saying: ‘I’m telling you, we will beat this.’ The fear of litigation should not come into it, if anything this reduces litigation.

“If the doctor does not offer, I recommend that a patient asks if you feel you need to record the conversation.”

Healthcare professionals should sit next to the patient, not across a desk, say Banks, and should always invite the patient to give them a ring or get in touch with their secretary if they have any more questions.

“A lot of patients say ‘the doctor never told me’ when in fact, he did but they were unable to take it in. Don’t sit at home ruminating, ring in with your concerns and ask to speak to your doctor.

“Most nowadays will call back when they get a chance; that’s what they are paid for. And don’t ever apologise for asking a question, no matter how stupid you think it might be.”

Giving a cancer diagnosis or negative test results is also very difficult for the person delivering the bad news, points out Banks.

“Nobody likes telling their patient they will be dead in six weeks. Giving a person information that is going to turn their world upside down is also very difficult for the person who is giving the information; it’s a very difficult situation for all.

“There is a huge burden placed on healthcare professionals around giving bad news and they need to be educated and supported in this.”

Anyone who is concerned about cancer can contact the Irish Cancer Society's Cancer Nurseline Freefone 1800 200 700 to speak to a specialist cancer nurse who can offer information and support. Visit cancer.ie