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Bad News in Medicine, Communicating

Barbara Schouten

University of Amsterdam

Communicating bad news is defined as any information that produces a negative alteration to a person’s expectations about the future. Notwithstanding that there are instances in which information is probably universally appraised as bad, such as the sudden diagnosis of a fatal disease, interpreting information as bad news is regarded as subjective and depending on individual differences in personality, personal resources, cognitive appraisals, and expectations. Medical information, then, is defined as bad news only when a patient appraises it as such after its disclosure.

The dominant research questions in the field include how to successfully break bad news and how physicians and patients experience the delivery of bad news. Results indicate that patients and physicians agree on three main dimensions of the successful delivery of bad news: content of the message (what and how much information is given); facilitation (where and when information is conveyed); and support (emotional support during the interaction).

Crucial aspects of successfully delivering a bad-news message are maintaining a balance between honesty and sensitivity, ensuring that the information is communicated at a convenient time for the patient, and acknowledging the patient´s emotional distress. Adequate information provision during bad-news consultations is related to greater patient satisfaction, fewer depressive and anxiety disorders, ...

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