Review Question - QID 100017

In this case, it would be most appropriate to tell the patient the truth about her condition: she has pancreatic cancer. That being said the first step in breaking bad news to a patient is to prepare them for the bad news that they will be receiving. It is important to first tell the patient that you have bad news and to then directly reveal the information you have to them.

When informing a patient of difficult information, the most appropriate course of action is to:
1) Get on the same level as the patient. It is most appropriate for both the physician and the patient to both be sitting when news is delivered.
2) Tell the patient that you have bad news to share. This will allow the patient to brace and be prepared for what is to come.
3) Immediately inform the patient of the bad news. Do not be vague and do not offer false optimism. In addition, do not rely on jargon to escape direct and efficient communication.
4) Give the patient a moment to think about and process the information. A moment of silence may be appropriate at this point. If the patient begins crying, a silent empathetic action such as offering them tissues may be appropriate as it shows that you care and gives them a moment to collect themselves emotionally.
5) Explain what the bad news means for the patient. Be succinct and clear in your explanations and do not offer false hope.
6) Answer any questions the patient may have

The most appropriate first statement is to brace the patient for the news that is to come. By letting them know directly that you have bad news to share they can begin to prepare what you have to say next which will be a concise diagnosis with no medical jargon.

VandeKleft reviews the process of breaking bad news. They find that frank disclosure and empathy are important when sharing bad news such as a terminal diagnosis. Patient satisfaction and physician comfort are improved with focused training in these areas.

Incorrect answers:
Answer 1: The doctor did not brace the patient for the bad news that is to come and is not being direct in sharing the diagnosis in this statement.
Answer 3: Although it may be appropriate to discuss appointing a healthcare proxy with this patient, it would be more appropriate to discuss her diagnosis first.
Answer 4: Do no ever have someone else deliver the diagnosis to the patient. You are the doctor and it is your responsibility to communicate with your patients.
Answer 5: This statement does not brace the patient for the bad news that is to come and also utilizes medical jargon to give the diagnosis.