How to Break Bad News

Chapter 15 How to Break Bad News




Clinical Case Problem 1: A 34-Year-Old Woman Just Diagnosed with Metastatic Malignant Melanoma


You have just received the computed tomography (CT) scan report on a 34-year-old mother of three who had a malignant melanoma removed 3   years ago. Originally, it was a Clark’s level I and the prognosis was excellent. The patient came to your office 1   week ago complaining of chest pain and abdominal pain. A CT scan of the chest and abdomen revealed metastatic lesions throughout the lungs and the abdomen. She is in your office, and you have to deliver the bad news of the significant spread of the cancer.



Select the best answer to the following questions




1. Regarding the delivery of bad news to patients who are unaccompanied when they come to the office, which of the following statements is true?


a. the fact that the patient is alone is irrelevant

b. you have no right to interfere with her decision to come alone to the office

c. you should go into the consultation room and explain that the situation is complex and it would be better if her husband or significant other were present when the test results are explained and treatment options are discussed

d. patients do not remember much of anything after bad news is delivered, so it does not really matter whether someone else is present

e. having a significant other present will only complicate an already difficult situation

2. Which of the following settings is not acceptable for the delivery of bad news?


a. a physician’s office

b. a quiet room in a hospital setting

c. the patient’s home

d. a private hospital room

e. a multibed hospital room

3. The first step in breaking bad news is to


a. deliver the news all in one blow and get it over with as quickly as is humanly possible

b. fire a “warning shot” that some bad news is coming

c. find out how much the patient knows

d. find out how much the patient wants to know

e. tell the patient not to worry


Clinical Case Problem 2: Communicating Bad News


A patient has had a breast biopsy for a suspicious lump seen on mammogram. The pathology report shows an adenocarcinoma. Arrangements for the patient to come to your office today, 3   days after surgery, were made when she left the surgicenter.



4. Which of the following were appropriate steps to have taken?


a. discuss with the patient and her husband before the biopsy that you would like them to make arrangements for someone to drive her home if it is bad news

b. suggest that she have someone accompany her to the follow-up so that there will be two sets of ears to hear the results and to recall the explanation and any plan for additional follow-up

c. have your office call the husband when the report comes back positive for malignancy and demand that he accompany his wife to the follow-up visit

d. check the next of kin listed on the hospital record and call that person to come to your office in case the patient chooses to come alone for the follow-up

e. none of the above

5. Which of the following steps might be considered a communication aid and be helpful to the patient in the days after the diagnosis?


a. an audiotape of the consultation discussion when you shared the results and plans

b. a patient education handout that discussed the same material you discussed

c. a follow-up letter after the consultation, reiterating the information shared at the consultation

d. a phone number of the last patient you treated who did well

e. a, b, and c

6. Which of the following statements regarding finding out how much the patient wants to know is not true?


a. every patient should be told everything about the condition

b. some patients would rather not know all of the details of their disease

c. most patients initially do not know how much they want to be told

d. some patients want to know the whole truth right away

e. in some instances, patients should not be told the full extent of the condition

7. There are two languages that physicians use in talking to patients: English and “medispeak.” Unfortunately, patients usually only understand English. Which of the following is an example of medispeak?


a. lesion

b. malignancy

c. tumor

d. cancer

e. leukemia

8. Which of the following statements is false regarding the involvement of family physicians in the care of a patient with cancer?


a. ideally, the family physician should be present when the patient is told of a bad diagnosis or prognosis

b. the family physician and the primary consultant should be in contact and should be certain that the same message is delivered

c. family physicians have a limited role to play once the patient is enrolled in a tertiary care cancer treatment center

d. the family physician has a responsibility to follow up on the care of his or her patients regardless of whether he or she is actively involved in all aspects of care

e. as cancer becomes a more chronic rather than fatal condition, much of the long-term care can be managed by the family physician

9. Which of the following is (are) true regarding the delivery of bad news to patients with a serious disease?


a. check the patient’s reaction to the situation frequently

b. reinforce and clarify the information you are giving

c. check the patient’s understanding of the facts

d. elicit the patient’s concerns

e. all of the above are true

10. In an interview in which news of a serious disease is presented, which of the following is the thing to do before the patient leaves the office?


a. make sure the patient understands every word

b. make sure the patient understands that you are doing everything you can

c. make sure you leave the patient with a follow-up plan and provide the patient with some hope

d. make sure the patient understands the dismal prognosis

e. make sure that you have left no question unanswered

11. When Joanne, a 14-year-old, was diagnosed with leukemia, her mother asked you what Joanne should be told and by whom. You replied how?


a. Joanne should be told she has mononucleosis and will feel very fatigued for a while but she will ultimately be cured.

b. Joanne should be told by the physician that she has cancer and may die of it, but if she survives the treatments, she may also be cured of the disease.

c. Joanne and her parents should hear the diagnosis from the physician together, including the name, a reasonable description of the treatment, and the hope for a cure as the outcome.

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on How to Break Bad News

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