Clinical Communication

Delivering Bad News in the Context of Culture: A Patient-Centered Approach

Journal of Clinical Outcomes Management. 2015 January;22(1)

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Strategize and Summarize

Ask the patient if he or she is ready to have a discussion about treatment, including his or her goals of treatment. Continue to explore the patient’s knowledge, expectations and hopes. Always allow the patient to express his fears and concerns. Most importantly, let the patient know that you will share the responsibility of decision making with the patient and be there to support him.

Doctor: This is never easy and it’s a lot to take in. Would you like to discuss the next steps and possible treatments at this time or should we make another appointment after your CAT scan?

Patient: My wife is pretty upset and I think it might be better if we stop here for now. Is that ok?

Son: We want to come back as soon as we can after the CAT scan. In the meantime, can you provide me with some information or a good website to check out?

Doctor: Yes, of course. That sounds like a good plan.

Conclusion

The task of giving bad news is a necessity for physicians of most specialties and is often viewed as challenging and even stressful to some. However, the manner in which information is discussed with patients can impact patients’ satisfaction, understanding of their illness, adjustment to the diagnosis, expected quality of life, and intentions to adhere to recommendations [8,17]. Providing bad news in a culturally sensitive manner adds an additional level of complexity to an already challenging encounter. While an individual’s culture can strongly influence patient belief systems and utilization of care, there is an inherent danger when clinicians make assumptions about individuals’ culture and the role it plays in their lives. Instead of focusing on creating a mental list of cultural attributes, we recommend a patient-centered approach where few assumptions about the patient are made and instead, the clinician gains an understanding of each individual patient through queries and adjusts his/her approach and language according to each individual’s needs.

Corresponding author: Lisa K. Rollins, PhD, Dept. of Family Medicine, Univ.of Virginia, PO Box 800729, Charlottesville, VA 22908-0729, lkr2h@virginia.edu.

Financial disclosures: None.