I will explore an experience I had whilst based in a local trust hospital, discussing a situation that I felt uncomfortable with and unsure how to manage emotionally, psychologically and professionally. This situation evolved after a patient had been giving bad news by a doctor and talks about the events after this occurred.
I feel it is important to discuss breaking bad news as this area of communication is often an area that even the professional person finds difficult. The inter-professional teams all have different education and preparation leading to different views as to how the subject should be managed and the best way to break bad news.
The bad news that is delivered may not be about terminal illness or death but could be a lifestyle altering condition like diabetes, heart disease or HIV. Traditionally delivering bad news has been considered the doctor’s role, despite having little education or preparation in this area. Although a nurse may not be delivering bad news directly, it is an inescapable part of healthcare and an integral part of their role. It is, however, important to remember that the role of breaking bad news is not the responsibility of just one profession but should be a shared responsibility with all the inter-professionals within the multidisciplinary team.
Mr. M, a 72-year-old male, admitted to the ward and initially presented with intense intermittent pain in pelvic area and legs. After several investigations with other hospital inter-professional teams Mr. M underwent tests such as x-rays, cat scans, and MRI scans. This led to a diagnosis that Mr. M had bone and lung metastases, this is also known as secondary cancer. Metastatic cancer occurs when the cancer cells break from the primary site, relocate to another area of the body and then forms secondary tumours. The junior doctor had discussed these results with Mr. M, whilst he remained on the ward and without another member of staff with him during the conversation. It is suggested that bad news should be delivered to the patient by someone they know. This leads to a much-debated subject as to who should break bad news , due to the belief that some doctors are not well prepared and have the lack of training and preparation for this task.
Whereas, the nurses have more communication with the patient and can build a better rapport. The doctor with Mr. M should have made him aware, that he had terminal cancer but we were unable to verify this. The written information in Mr. M’s notes was thought by the nurses to be brief and therefore not well recorded due to a lack of in-depth detail but the doctor could argue the notes were ok, they had acknowledged he had spoken to Mr. M about his results.
After the doctor’s consultation, Mr. M was positive and upbeat and still trying to do as much as he could for himself. Later that day he had spoken to me stating that the doctor wanted to run more test, informing me that they were going to look for the primary cancer site as this may be treatable. My intrinsic feeling was that Mr. M thought he could be cured. This made me feel awkward and uncomfortable being around him and I found it difficult to know what to say to him, as I was aware of his terminal diagnosis. However, it is normal when giving or receiving bad news to feel psychological distress but if supported and managed well you can avoid damaging long terms effects. I had discussed with the nurse in charge that I had concerns about Mr. M and queried if he had definitely been told of his terminal diagnosis. Mr. M’s mood and behavior were monitored by the nursing staff over the next two weeks, with occasional subtle prompts for him to ask any questions or to comment on how he felt. After this time the palliative care team were informed of Mr M’s situation and invited to the ward by the nursing team, to talk to Mr M and explain his illness was terminal, help him acknowledge this and start to come to terms with his situation and prepare himself and his family with what was to come.
I thought it was bad that no-one who had worked regularly with Mr. M i.e. a nurse was with the doctor when he was told his diagnosis and that it was a junior doctor that Mr. M did not know very well. The information about the discussion hadn’t been recorded in detail, as to what was said and if Mr. M had understood this information. So we had to make assumptions due to the lack of detail, we could only ascertain if Mr. M was in denial through time. Also that I felt I had to avoid communication with Mr. M as I found it difficult due to his terminal illness and was unsure what to say to him. I realized talking about dying directly with the dying patient an area I was uncomfortable with and felt unprepared for and therefore avoided the situation.
If I was presented with a similar situation, I now feel I would manage the situation better, as I have learnt through a reflection of these events. Sometimes caring for a dying patient can be daunting as in our nursing role we believe we are there to improve a patient’s health so they will get better but the reality is we have a unique role to assist the patient to health or to a peaceful death.