Breaking
Bad News: Glimpses from an Indian Subcontinent
Perspective.
Bad news is defined as “any information,
which adversely and seriously affects an individual’s view of their future.
Breaking bad news (BBN) is never an easy
task. Handling bad news in an effective and empathetic manner helps to improve
doctor patient relationship.
Methods:
Practicing Obstetrics and Gynecology
(OBGYN) doctors and allied personnel (based in India & subcontinent) participated
in an online questionnaire. 149 completed responses were analyzed.
Results:
Responders were aged between 25 -60 years
with most responses in 31-50 age groups. 95% of responses came from India.
61.1% female and 38.9% male professionals responded.
Amongst these, 128 were OBGYN specialists,
18 were allied specialty doctors and 3 were clinical scientists.
68.5 % responded
that they had to BBN on <5 occasions while 25.2 % on 5-10 occasions.
34.9% felt that discussing the diagnosis
with patient was difficult & uncomfortable.
26.2% felt that it was difficult to involve
family & friends in discussions with patients.
10.7% had doubts about their own skills and
competency while BBN.
Shockingly 10.1% were worried about their
own safety and the effects of vandalism afterwards.
Though, 90.6% participants never had any formal
training in BBN, 47% felt that their skills were fair while 40.3% thought it to
be good. Only 10.1% classed their skills as very good.
43% responders thought that their handling
of the BBN was neither good nor bad and were not sure how they performed. 40.9%
felt that they could have performed better. Only 15.4 % thought they did very
well.
85.2% participants had never heard about SPIKES
plan to BBN.
57% respondents had no formal plans of
structured approach while BBN.
62.4% thought it’s better to talk in consultation
rooms with other staff being present while 35% favoured the option of a quiet
room and a more private place.
Discussion:
BBN is a very sensitive topic and health
care personnel should be trained appropriately. Better support and definitive
plans beforehand helps them to boost their confidence thereby avoiding vandalism
scenes and thwarting assault by relatives.
Stricter laws against violence with medical
personnel and speedy implementation of the same should be stressed.
Conclusion:
BBN should be included in the doctor’s training
programmes in India and abroad. Large national and international meetings being
held in Indian subcontinent should have dedicated workshops to address this
issue. This will immensely benefit both patients and doctors equally.
