This May, I will be celebrating the 32nd anniversary of becoming a registered nurse.

Most of my nursing career has been spent either in oncology (cancer care) or hospice (compassionate care). I began my career as a hospice admissions nurse and surprisingly, I often was the first person to sit down with the patient and family to have “the conversation” about hospice.

Patients are referred to hospice when they have a life threatening, non-curable illness with a life expectancy of six months or less. Think of the implications of that – and about how it might feel if that information was presented by a hospice admissions nurse instead of a treating physician.

“Breaking Bad News” certainly is challenging. There are many reasons for these challenges: sometimes, the news-giver has not received training about how to break bad news. Sometimes, there is a fear of causing the patient emotional harm or a fear of being blamed. Sometimes, people have internal fears about illness and death and cannot adequately communicate this type of information.

Dealing with a terminal illness is more challenging for patients and families. My years of experience have taught me that most would prefer knowing what to expect and how to deal with it.

The families of newly-diagnosed patients often have asked me not to say I’m from hospice, fearing that the patient might lose hope. But, I’ve learned that terminal patients know that they are not going to get better.

So, it’s my job to make the families understand that terminal patients have the right to make decisions about how they will spend the time they do have left. They have a right to determine their quality of life as long as they are able to do so.

Research has confirmed this, with studies revealing that patients would want to know if faced with a terminal illness.

One study defined bad news as follows: “…any news that drastically and negatively alters the patient’s point of view or his or her future.”

Receiving bad news is a traumatic event. How this information is presented sets the stage for how the patient and family will adjust and could affect treatment decisions. In addition, the successful delivery of bad news can reduce anxiety and depression for the patient and family.

Three Keys to Breaking Bad News:
Plan
Plan what will be discussed. Allow for adequate time. Ensure a comfortable and safe environment. And, most importantly, find out how much the patient knows and how much the patient wants to know. Bad news should always be delivered face-to-face and patients should be encouraged to receive this information with family or support present.

Share
Share by breaking the news gently and slowly. Communicate the information clearly, in the simplest terminology and in small doses. Wait for a response and allow the patient to express his or her feelings.

Care
Care by responding with sensitivity. Actively listen, repeat, reflect and paraphrase. Monitor how much the patient has absorbed. Assess the “meaning” of the bad news to the patient and family. Provide options and be available for follow up.

Despite how difficult or challenging delivering bad news can be, I have found that most families are very appreciative of the time you spend with them. The issues surrounding end-of-life care can be extremely challenging and overwhelming for families.

Compassion, quality care and knowing that there is someone there to support them on this journey truly can make a pronounced difference in the quality of patients’ and families’ lives.

Kathleen LaPorte, RN, BSN is a Senior General Manager with VITAS Innovative Hospice Care in Melbourne, which was licensed in 1980. For more information about VITAS services, call (321) 751-6671 or 800-93-VITAS or visit online at www.vitas.com.