How do you approach giving bad news to patients?

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: How do you approach giving bad news to patients?

“I make sure I have time. You don’t want to rush people. You want to sit down, spend time, and answer all their questions. Try to sit relatively close to them and just go over the news you have to tell them. With a prostate cancer biopsy, I actually make them all come in and I set time aside because it can take a good 45 minutes to go over all the options after a positive biopsy.

Also see: How will the ProtecT study affect your care of PCa patients?

I bring them back a week or two after giving them time to digest the information. I give them places where they can look through resources and bring them back to have the same discussion again. This time they’re more informed because they’ve heard the word ‘cancer’ and that’s all they’re focused on.

That way they can be comfortable with any decisions they have to make. The more comfortable they are with the process, the more comfortable with the outcome.

Don’t sugar-coat it, but don’t be too blunt. Be honest and forthright but try to do it as compassionately as possible. I’ll say, ‘let me go over the biopsy results with you. This is what we found.’ Let them know you have a plan for them.

The first time we talk it might be a generalized plan, but they have an option. Even if it’s patients with widely metastatic disease who are likely to be terminal, you can still offer them some sort of plan that is a way forward, so it gives them some hope.”

Carl Reese, MD

Lebanon, PA

Next: "I prepare the patient for a difficult situation, but say we always hope for the best."

Dr. Davis“One thing I’ve learned over the years is that sometimes things aren’t as bad as you think. So although you like to prepare patients, moderate what you say. I prepare the patient for a difficult situation, but say we always hope for the best. I’m a glass half-full kind of person-that really helps. Don’t ever lie. Never conceal anything. You have to be honest because patients have to deal with it.

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Patients will guide you as well. Your job is to educate them, but they will help you make the decision. Similarly, when you’re giving bad news, if you look at their body language and listen, you can tell how they are taking it. Sometimes it’s better to give them bad news in little increments.

When you’re involved in a team it’s important that everybody be on the same page. The team needs to communicate.

In a recent tumor board conference on a young man, we had 12 people: residents, attending, specialists. I asked why nobody had talked with the patient and family. It turned out nobody realized this guy was as sick as he was. They were so focused on his immediate problems-primarily pain and cosmetic issues-that nobody realized he was going to die, really soon. What seemed simple to me was not at all obvious to them. That’s why making sure everybody is on the same page is so important.

Also see: Are you seeing more advanced prostate Ca in your practice?

I don’t like telling people they’re going to die in a certain amount of time because that’s ridiculous. Everybody’s different. A patient with bladder cancer asked how much time he had if he didn’t do anything. I told him the literature said about 2 years. So he went about his business and ultimately died of his disease. He made sure, however, that his daughter told me that he had lived 4 more months past the 2 years I told him he had.”

Nina Davis, MD

Portland, OR

Next: "Patients appreciate an accurate assessment of their condition."

“I would say certainly not to candy-coat or minimize the problems or issues. Try to make it as realistic as possible when discussing bad news with patients. Patients appreciate an accurate assessment of their condition.

Have you read: What websites do you recommend to patients?

They appreciate me being straightforward, but trying to put it in a very realistic perspective: ‘You have cancer. Most of the time people who have cancer in this situation follow this course of treatment and progress. Yours could be different.’ Just saying, ‘You’ve got cancer and everything’s going to be OK’ is detrimental.

Be as honest as you can without sacrificing the accuracy of the clinical situation. It can help if you can give them some statistics, for example, ‘Most patients do well with this,’ or ‘Many patients do poorly with that,’ and ‘This is what I would recommend.’

I sincerely believe this is the most valuable thing that I say to patients: ‘This is bad news; however, I will always support you with this issue. Until you are dead or I am dead or both of us are dead, I will never abandon you with this issue.’ ”

Joseph Grocela, MD

Boston

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