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Talking with Your Older Patient

Breaking Bad News to Older Patients

Delivering bad news is never easy, but tested strategies can ease the process. Knowing how to communicate bad news can also help you make the process more bearable for patients. For instance, try to break bad news in a compassionate yet direct way.Close up of older adults holding hands with a doctor in the background

Prepare yourself. Before meeting with the patient, think about what you want to say and make sure you have all of the information you need. Be sure you have enough time to carefully explain the diagnosis and allow for questions, rather than trying to squeeze it between other appointments. If possible, ask your staff to hold calls and pages until the appointment is over. Find out what the patient knows about his or her condition. You might ask questions such as, "Have you been worried about your illness or symptoms?"

Spend a few moments finding out how much the patient really wants to know. People may have different expectations and preferences for how much they are told about their prognosis and what they would prefer not to know. If a patient's family has reservations about having the patient know the prognosis, you might ask them about their concerns. Legally, you are obligated to tell the patient; however, you may negotiate some elements with the family. If you cannot resolve it, an ethics consultation may be helpful.

Try to be as straightforward as possible, without speaking in a monotone or delivering a monologue. Be positive, but avoid the natural temptation to minimize the seriousness of the diagnosis or offer false hope. Communications experts suggest that you not start by saying, "I'm sorry..." Instead, try saying, "I feel bad to have to tell you..." After you have explained the bad news, you can express genuine sadness while reassuring the patient that you and others will be there to help.

Give the patient and family time—and privacy—to react. Of course, people will respond differently to bad news; shock, anger, sorrow, despair, denial, blame, disbelief, and guilt all are common reactions. In some cases, people may simply have to leave the office.

End the visit by establishing a plan for next steps. This may include gathering more information, ordering more tests, or preparing advance directives. Offer to write down important points of your discussion. Reassure the patient and family that you are not going to abandon them, regardless of referrals to other healthcare providers. Let them know how they can reach you—and be sure to respond when they call.

In follow-up appointments or conversations, give the patient an opportunity to talk again about the situation. Ask if he or she has more questions and needs help talking with family members or others about the diagnosis. Assess the patient's level of emotional distress and consider a referral to a mental health provider.

For More Information About Breaking Bad News

Education in Palliative and End-of-Life Care