In medicine, we sometimes have to share horrible news. When doing so, hold the conversations in a private space, make sure the patient and family understand what you’re saying, acknowledge emotions, and answer questions.
The trauma rotation during my second year of pediatrics residency started with a workshop on giving bad news to patients. The session opened with a seemingly obvious question, “What is bad news?” In pediatrics, three answers come to mind: death, terminal illness, and abuse. These were spot on with the workshop’s focus and we practiced two scenarios: informing parents of a concern for abuse or letting them know their child is dying.
But I couldn’t shake the memories of other bad news I witnessed: an active young adult learning they needed a colostomy, a new parent’s disappointment after the team suggested a nasogastric tube for their baby, a family cancelling birthday cake plans after their child’s diabetes diagnosis, and many more. How do we define moments of significant change? “Bad news is any experience in a patient’s course that doesn’t meet their expectations,” I added to the workshop conversation.
Sometimes when we share changes about care plans we need to leave time for patients to feel and express a range of emotions and support them as best we can. We must keep our patient’s experience a central focus in our care. This can also help us remember that our everyday job is often caring for patients during their worst experiences. We may see their condition all the time, but it still may not feel normal for a patient to experience it or easy for them to accept.
GUIDE is one acronym that provides a flow for discussing serious news with patients:
1. Get ready.
Find a private space and gather the information and people needed for the conversation.
Explore what the patient knows and has retained from previous discussions.
Give a very brief medical update that includes the information the patient needs to know. Don’t use medical jargon. Then stop talking and give the patient time to process.
4. Demonstrate empathy
Respond to the patient’s emotions and acknowledge them explicitly.
Prepare the patient and family for next steps. Acknowledge their concerns and answer their questions. Also, share common scenarios that may occur to normalize experiences that could be perceived as disappointments. For example, with each new admission of a baby with bronchiolitis, I explain, “Treatment is supportive. Some babies can be managed at home, but others need to be in the hospital. Your baby required hospitalization for (insert reasons). We sometimes also see babies that require oxygen support and even transfer to the pediatric intensive care unit.”
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.