Living with Dying

How bad news was broken

In other Healthtalkonline collections people explain how they were told about their diagnosis of cancer, heart failure or other serious illness. Here we discuss how they were told that life would be shorter than expected.

It is not easy to break any bad news and it is particularly hard to tell patients that their disease has come back or that there are no more treatments that might lead to a cure.

Most patients want their doctors to be truthful, caring and compassionate, to speak in simple terms, and to use clear cut language, but doctors still have to decide when and how to tell the patient that they are unlikely to have long to live. Some patients decided to be open about their suspicion that the disease was terminal. A man with testicular cancer describes how he seemed to help his doctors by being open.

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People we talked to recalled both good and bad experiences. For example, a man with multiple sclerosis remembered being told very brusquely that he had an incurable disease, which upset him, but he said that later another doctor sat on the side of the bed and explained everything in detail, and he then felt “much happier”. He says that a gentle and sympathetic approach is needed to break such dramatic news.

A woman with ovarian cancer was devastated when told that her cancer had recurred. The doctor asked for a Macmillan nurse to be present when he broke the bad news, but she found this distressing because she remembered a time when Macmillan nurses were only brought in “at the last minute”, when death was imminent.

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Doctors need to be honest, but at the same time encouraging and supportive. A woman with cancer of the kidney said that her doctor talked to her about her diagnosis and prognosis for about two hours, and answered all her questions. She liked his approach but she would have liked it even better if he had suggested something positive she could do, such as trying complementary approaches.

If bad news is communicated badly it can cause much distress. A man with mesothelioma (lung cancer caused by exposure to asbestos) describes his shock when he was told that his operation was not expected to cure his disease, but might keep him alive for another year or so. Health professionals must choose words carefully and be aware of what other members of the team have already said to the patient.

People like to manage their emotions in different ways. One woman said that she was glad that she was alone when she received the bad news about her ovarian cancer, but another woman was angry and upset because she was told her diagnosis of multiple myeloma when she was alone in hospital.

Doctors must also make time and prepare carefully before giving patients bad news. One woman was shocked when a consultant told her that the chemotherapy wasn't working and then discovered that he had had looked at the wrong notes and made a mistake.

Giving bad news to the patient and the family together can avoid difficulties and mistrust. The daughter of a man with motor neurone disease recalled that the worst time for all the family was when family members knew the diagnosis but her father had not yet been told. Taking into account her experience when her mother was also diagnosed with a terminal illness, she concluded that they should all have been told at the same time.

Last reviewed August 2014

Last updated March 2012

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