Communicating Bad News Requires Deep Empathy

To help patients cope with terminal illness, healthcare providers must imagine themselves in the place of these patients, according to Tami Borneman, MSN, CNS, a research specialist at City of Hope Cancer Center in Duarte, California.

In a presentation at the sixth annual Oncology Congress, she coaxed her audience to pretend their own deaths were imminent. “I really want us to take in what it’s like to be a person receiving bad news,” she said.

Healthcare workers need such exercise es, because communicating bad news is really difficult, she said.

Although few researchers have gathered empirical data about communicating bad news, Borneman cited a study that illustrated difficulties and misconceptions (Wittenberg-Lyles EM, et al. Soc Sci Med. 2008;66:2356-2365). In observing palliative care teams, re - searchers noted three misconceptions:

• Healthcare workers imagined that they could plan the time and place to deliver bad news. In reality, they must be prepared for spontaneous conversations. For example, when a patient receives a computed tomography scan showing her cancer has progressed from stage III to stage IV, a discussion about what this means might not be easy to postpone.
• Healthcare workers pictured a one-on-one conversation between a physician and patient. In reality, caregivers can and should be included.
• Healthcare workers pictured delivering the bad news as one conversation. “You can’t just lower the boom on a patient and think they’ve got it,” said Borneman. “It has to be repeated many times in different places and in different ways.”
• Often getting the news that death is imminent blots out everything else the healthcare worker says. At the same time, many patients believe that it is important to get only the truth. “Anything else is playing games,” said Borneman. “It’s wasting time, and they don’t have time to waste.”
• Borneman asked her audience to draw a series of timelines with birth at one end and death at the other, and to imagine themselves very near death. She then asked them to think of all the things they would like to do with the time they have left and to consider what kind of legacy they would like to leave behind.
• Patients often feel isolated when they get a terminal diagnosis, said Borneman. Their disease sets them apart, and they are losing the roles they had in their families and in society in general. “We need each other, especially when we are facing the end of life,” she said.
• Often the crisis prompts patients to review their lives, she said. “If we listen to what they’re saying, we will validate that their life had meaning,” she said.
• Many patients confronting death want to forgive people against whom they have grudges and to ask forgiveness for themselves, she said. She asked her audience to consider what would be necessary for them to forgive people in their lives.
• “Sometimes having this terminal illness provides the impetus for taking this inner journey, psychological and spiritual, they would not otherwise have the ability to do,” said Borneman.
• She suggested that healthcare workers list their values, their moments of fun, and aspects of their lives that give meaning or inspire hope or gratitude. “These are things you can walk patients through to show them they have had value and meaning in life,” she said. “Ask yourself, ‘Am I helping my patient prepare to die or to embrace living?’”