Barriers to breaking bad news among medical and surgical residents

Abstract

Communicating "bad news" to patients and their families can be difficult for physicians.

Objective: This qualitative study aimed to examine residents' perceptions of barriers to delivering bad news to patients and their family members.

Design: Two focus groups consisting of first- and second-year medical and surgical residents were conducted to explore residents' perceptions of the bad news delivery process. The grounded theory approach was used to identify common themes and concepts, which included: (1) guidelines to delivering bad news, (2) obstacles to delivering bad news and (3) residents' needs.

Setting: McMaster University, Hamilton, Ontario, Canada.

Subjects: First- and second-year residents.

Results: Residents were able to identify several guidelines important to communicating the bad news to patients and their family members. However, residents also discussed the barriers that prevented these guidelines from being implemented in day-to-day practice. Specifically, lack of emotional support from health professionals, available time as well as their own personal fears about the delivery process prevented them from being effective in their roles. Residents relayed the need for increased focus on communication skills and frequent feedback with specific emphasis on the delivery of bad news. The residents in our study also stressed the importance of processing their own feelings regarding the delivery process with staff.

Conclusions: Although most residents realize important guidelines in the delivery of bad news, their own fears, a general lack of supervisory support and time constraints form barriers to their effective interaction with patients.