BREAKING BAD NEWS TO A FAMILY Various ways and steps of breaking bad news have been formulated primarily within a framework of a one to one interaction between patient and doctor. However, in countries such as India, where filial ties are strong and patients are almost always accompanied by one or more relatives, how should steps of breaking bad news be revised and adapted? Relatives are often reluctant to leave the patient alone with the doctor and they may give strict instructions to the doctor not to reveal the diagnosis. The doctor may be quite comfortable with the ‘recovery plot’ and enters this conspiracy too readily. “Collusion is not always a conspiracy of silence, it may be a conspiracy of lopsided communication as well!” Authors have written about the ‘recovery plot’ that patients and relatives may follow to spare each other distress and anguish. In addition, they often encourage healthcare providers to rely on this approach as well.[6] The ‘recovery plot’ involves focusing mainly on treatment and recovery issues and not addressing prognosis, long-term disability, distressing symptoms and possibility of relapse, recurrence, and death. It is hence important in filial cultures to guide doctors in breaking bad news with more than one family member present with the patient. More than one relative is involved in the care of the patient and they would all like to know the clinical details. In situations where several family members are present, the health professional may need to identify who the patient thinks is the key relative or the ‘head’ of the family, who can then be involved in the disclosure and discussion process. ncbi.nlm.nih.gov/pmc/articles/PMC2886207/
Posted on: Mon, 01 Jul 2013 12:11:59 +0000
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