Breaking bad news: consultants' experience, previous education and views on educational format and timing

Abstract

Context: Breaking bad news is a difficult task for health professionals. Senior hospital doctors acknowledge the importance of breaking bad news well, but previous surveys have found them to be sceptical of formal training and disinclined to seek courses in this area. We sought to ascertain if this view was still held.

Methods: A postal questionnaire was sent to 285 consultants across 3 acute hospital trusts in the Midlands, UK. Questions included items on the frequency and types of breaking bad news situations encountered, and the timing and modality of previous training. Open comment on what forms of education would be useful, and when, was requested.

Results: Eleven consultants were no longer in post. Of the remainder, 173/274 (63%) replied; 153 (56%) returned questionnaires of which 150 (55%) were useable. Respondents represented 32/33 (97%) of the surveyed specialties. The majority reported breaking bad news frequently (> 1-2 times weekly); however, almost half (49%) had received no formal training in this specific area, although 53% described having received experiential training in either clinical, training or management contexts. Of 118 respondents who commented, only 5 believed no form of training was useful, whereas 47 specifically recommended some form of role play. Regarding timing, 72 thought it desirable at postgraduate level or at all stages of training, with 44 explicitly stating at consultant level.

Conclusions: Consultants in clinical specialties break bad news frequently. Although many have not received formal training, the majority believe it is useful and are increasingly willing to undertake experiential approaches. This augurs well for future training programmes.