How can we improve the experience of Breaking Bad News? A Systematic review.

Alice Laurandeau, Yaritza Carneiro

Keywords: breaking bad news, bad news, anxiety, stress, depression, satisfaction, preferences, hope, recall, quality of life

Background:

Breaking bad news is a frequent experience requiring communication skills. Existing protocols (SPIKES, ACBCDE...) provide guidance for physicians, but few studies have focused on patient preferences.

Research questions:

How can we improve the delivery of bad news according to patients?

Method:

To answer this question, formulated using the PICO method, a systematic literature review was carried out to extract elements relating to anxiety, depression, satisfaction, patient preferences, hope, memory and quality of life from ten databases and grey literature. In line with PRISMA recommendations, articles were screened by two readers, in double-blind conditions, and disagreements were resolved by a third reader.

Results:

Twenty-two studies included, including two literature reviews.
Involvement of a nurse reduced anxiety and depression. Use of the word “cancer” reduced depressive symptoms. Families of intensive care patients were more satisfied when doctors supported their end-of-life decisions. Parents of sick children were more satisfied when they were given time, clear, consistent and accessible information, and the opportunity to ask questions later.
Patients expressed preferences for a summary of the situation, a point of understanding, a choice of third-party presence, verification of the desired level of information and emotional support. Women valued content and wanted more emotional support. Men prefer to be consulted about the presence of a third party. Young adult cancer patients need more psychological and social support. Older patients are less likely to remember long, rich consultations.

Conclusions:

This literature review identifies ways of improving the experience of breaking bad news according to patients' preferences. Better integrating them into existing protocols would improve the experience of breaking bad news.

Points for discussion:

Despite general preferences, specificities of age, gender, context and culture need to be anticipated, while respecting each person's individuality.

Training seems necessary to learn how to adapt to the individuality of each person.

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