Beyond `Breaking Bad News': clinicians' experiences of disclosing a life-limiting illness to their patients
Degree GrantorUniversity of Canterbury
Degree NameMaster of Arts
The preference for open disclosure of a terminal diagnosis has become widespread in western societies. Disclosure practices are influenced and shaped by medical culture, the organisation of medicine and cultural and social expectations of the medical management of dying. In the literature clinician's performance of telling bad news to patients and their families is positioned within an array of expectations and critique. Within this are theories and commentaries on the motivations of physicians and the degree to which they still determine when and how much information on a terminal diagnosis is communicated. Yet little is known of the clinicians experience presenting a life threatening diagnosis to their patient. This research looks beyond the mechanisms of communicating bad news to examine how clinicians manage, cope and sustain their emotions over cumulative experiences of telling bad news to patients. Method: A qualitative study drawing on symbolic interactionist framework the research explores clinicians' experiences of disclosing a terminal diagnosis or prognosis to their patients and families. Semistructured interviews were conducted with five clinicians from a range of medical specialities in New Zealand. Narrative analysis of the data revealed the practice and processes of disclosing a terminal diagnosis to a patient are more nuanced and less distinct from an absolute of truth-telling or not. Balancing hope and honesty, clinicians communicate bad news to patients generally over a long period of testing, diagnosis, treatment and retesting. Consequently the experience for the clinician is mediated and managed through this trajectory of care. Positioned to negotiate an orderly and medically managed dying process with their patients, there is a risk clinicians can be demoralised when disruptions to the expected response to care occurs. Recognising broader societal responsibilities to consider the position of clinicians who act on our behalf and reflect on the generosity beyond the care required is called for.