How-To Tips

Health Literacy

Communicating Bad and Sad News

Jul 1, 2024

Health professionals often find it challenging to communicate upsetting or unexpected news. This includes sad news such as a grim diagnosis or prognosis. Or bad news like a lapse in communicating lab results.

I wrote an article on this topic a while ago, based on interviews with Steven R. Grossman, MD, PhD who then was Chair of Hematology, Oncology, and Palliative Care at Virginia Commonwealth University and Carin Smith, DVM who at the time was president of Smith Veterinary Consulting.

Here are some tips they shared then that are equally relevant today.

  • Establish a rapport and trusting bond. When meeting with a new patient, Grossman often starts by finding out what they already know. One way is with an open-ended question such as, “What is your understanding of what you have?” While one person might say, “I think I have cancer and you’ll tell me the rest,” another may talk about what they learned online or from other doctors.
  • Ramp-up to the news. Getting started can be the hardest part of communicating difficult news. Smith suggests ramping-up with a prefatory statement. For instance, “I’m really surprised and sad to tell you that ___.” But do not to spend an overly long doing so as it could feel to patients like you are withholding crucial information.
  • Use clinical judgement. The standard of care for Grossman is to openly discuss a patient’s diagnosis, prognosis, and treatment options. Within this standard, he recommends using clinical judgment in how to present the information. While one patient may want to know mostly about prognosis, another may be more eager to discuss treatment options. Regardless of the news, always find something positive to say. Grossman might focus on comfort and quality of life when talking with someone without treatment options.
  • Choose words and use teaching methods patients can understand and relate to. Grossman does this by matching his language to the patient’s words. For example, he might talk about a “cancerous tumor” with a scientist and a “spot on the colon” with someone unfamiliar with medical terminology. He also finds it helpful to communicate by drawing pictures, using metaphors, and showing patients their imaging scans.
  • Apologize and amend. When news is about something that went wrong or could have been avoided, Smith suggests that health professionals consider apologizing. Since this can have legal implications, Smith recommends first asking your organization about acceptable practice in regard to apologies. Making amends can also be helpful. For example, saying, “I am sorry we were late calling you with the lab results. Here is what we will do so this does not happen again.”
  • Follow-up. Patients and their families quickly become overloaded after hearing sad or bad news. They are unlikely to retain all that you say. To help those reeling from such news, Grossman summarizes the most important points and then brings closure to the conversation. He may follow with plans to connect again later on. For instance, he might say, “I know this is a lot to think about right now. Let’s find another time to discuss your other questions.”

This How-To Tip is adapted from Helen Osborne’s article, “Communicating Bad and Sad News” published in the Boston Globe’s On Call Magazine, May/June 2005. I’m posting it again now in memory of a good friend who received lots of sad news and recently passed away.

  • Steven R. Grossman, MD, PhD was Chair of Hematology, Oncology, and Palliative Care at Virginia Commonwealth University.
  • Carin Smith, DVM was president of Smith Veterinary Consulting, and works with medical professionals on communication issues.

Helen Osborne is author of the award-winning book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Third Edition. It includes lots more information about communication a wide range of health topics.