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Breaking bad news sensitively: what is important to patients in their last year of life?
  1. Barbara Hanratty1,
  2. Elizabeth Lowson2,
  3. Louise Holmes1,
  4. Gunn Grande3,
  5. Ann Jacoby1,
  6. Sheila Payne4,
  7. Jane Seymour5 and
  8. Margaret Whitehead1
  1. 1Department of Public Health and Policy, University of Liverpool
  2. 2Faculty of Health Sciences, University of Southampton
  3. 3School of Nursing, Midwifery & Social Work, University of Manchester
  4. 4Division of Health Research, Lancaster University
  5. 5School of Nursing, Midwifery and Physiotherapy, University of Nottingham
  1. Correspondence to Dr Barbara Hanratty, Department of Population and Community Health, University of Liverpool, Liverpool L69 3GB, UK; B.Hanratty{at}liverpool.ac.uk

Abstract

Aim To understand patients' perspectives on how a diagnosis of a life-limiting illness was first communicated to them.

Study design In-depth qualitative interviews with 50 people ranging in age from 30 to 93 years, diagnosed with cancer (31), heart failure (13), stroke (three) or neurological conditions (three) and thought by the responsible health professional to be in the last year of life. Participants from two areas of Northern England were recruited through specialist nurses or hospital consultants and interviewed in their current place of residence. Transcribed data were analysed using Framework.

Results Patients were most likely to recall the pace and clarity with which bad news was conveyed. A direct approach was most common, without much prior warning for the patients. Direct information was usually received well when the patient knew the health professional and when it had been suggested that the patient should be accompanied to the appointment. Some professionals did work to set the scene for the eventual news, with a gradual build-up of information, and narrowing down of options. This approach was perceived as appropriate and sensitive. People with heart failure had engaged in much less discussion about their condition, and most did not recall a specific conversation with their doctor about their prognosis.

Conclusions Bad news is not always broken in a sensitive way, despite considerable efforts to address this issue. Relatively minor changes to practice could improve the patient experience: greater preparation, provision of sufficient time in consultations and cautious disclosure for new patients.

  • Received 6 July 2011.
  • Accepted 21 October 2011.

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  • Received 6 July 2011.
  • Accepted 21 October 2011.
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Footnotes

  • Funding This paper is based on data collection from two projects. BH was funded by a Medical Research Council Special Training Fellowship (2002–2006) and an NIHR Career Development Fellowship (NIHR CDF-2009-02-37). Data collection in the north west of England forms part of a project funded by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme (project number 08/1809/2320). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR SDO programme or the Department of Health

  • Competing interests None.

  • Ethics approval Sefton Research Ethics Committee (09/H1001/51) and the Yorkshire and Humber Research Ethics Committee (06/Q1104/32) approved this study. Informed written consent was obtained from all participants, including any caregivers who are quoted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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