Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis. (February 2023)

• Record Type: Journal Article
• Authors: Francis, Laura; Robertson, Noelle
• Is Part Of: Patient education and counseling. Volume 107(2023)
• Publication Date: 2023-02
• Subjects: Breaking bad news -- Unacknowledged staff distress -- Isolation -- Challenging invulnerability -- Models of training; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2022.107574
• Languages: English
• ISSNs: 0738-3991

Abstract

Abstract: Objective: To provide an overview of healthcare practitioners' experiences of breaking bad news. Method: Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis. Results: Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised. Conclusions: Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged. Practice implications: Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice. Highlights: Breaking bad news provokes significant distress for practitioners. Breaking bad news is understood as an isolating experience. Non-disclosure of difficulties appeared to sustain a culture of invulnerability. Organisations should offer time for staff to process the delivery of bad news. A culture of collective care and space for reflective practice are recommended.