Don’t Deliver Bad News

What is bad news? How does the news affect the field? How does it affect the reporter?

1995 World Medical Association Declaration of Patient Rights, Article 7; talks about the right to be informed.

In 1998 Turkish Medical Deontology Regulation, Patient Rights Regulation, Article 3/15; speaks of this right.

Bad news negatively affects the individual’s perspective, changes his perspective on the future. It threatens the individual’s mental and physical well-being, and threatens the settled way of life.

General Approaches to Reporting Bad News

“Should it be told?” not ”How should it be said?” Who should say it, when where, how should it be said, who should it be found?

ABCDE Model

A- Preparation Phase

B- Establishing Therapeutic Relationship

C- Good Communication

D- Handling Patient and Family Reactions

E- Ensuring Accepting and Expressing Emotions

Key Features of Delivering Bad News

The bad news should be given in a calm and private environment, sufficient time should be allowed for the first interview to be conducted without interruption, and the patient’s and relatives’ understanding of the information given and his or her mood should be evaluated. It should be honest, the patient and their relatives should be given the opportunity to express their feelings, the message that nothing else can be done should be avoided, and a new interview session should be determined to reconsider the situation. Treatment options should be discussed and other people to whom the diagnosis can be told should be identified, and information should be provided about sources of support.

Elizabeth Kubler Ross, in her book “On Death and Dying”, listed the psychological reactions after being diagnosed with such a disease as a result of her interviews with terminally ill patients:

Denial

Anger

Bargain

Depression

acceptance

A lost family heirloom earring,

Hope

Friendship

Dear

Health

Organ

Functionality

…it could be

Loss is the price of living. Rent due during stay (Annie Dillard ”Traveler in Tinker Valley”)

Denial;

Often symbolic, this first phase of grief helps us survive loss. Life has become meaningless, we wonder why and how to move on. Denial and shock help us meet as much as we can handle. We cannot look at the sun all the time, and we cannot come face to face with death all the time.

Anger;

It doesn’t have to be logical or valid, anger is a necessary part of the healing process, underneath the anger is the pain. Most of the time we know better how to suppress anger than to feel it, anger because it goes to the health system, life and the lost…..

Bargain;

Sentences that start with ‘if’, the possibilities of what could happen if we thought differently, the feeling of guilt are components of the bargaining phase. There is a higher level of awareness that there is loss in bargaining. But resistance takes long enough to force us into psychic bargains with fate. (V.VOLKAN)

Depression;

A normal response to a major loss, depression is necessary in the healing process of grief.

Acceptance;

The period when the good days of the person are more than the bad days, no one can replace the lost situation / person, but life has to go on. It is a necessity to listen to the needs of the person, change and develop.

The situation is different when it comes to lost health. It’s as if there is no more pain, the struggle is over and it’s time for some rest before the long journey. During this period, more families need help and understanding.

• The despair of the family while the patient needs hope…….
• Family clinging to hope as the patient prepares to die…….

Worden’s Model of Mourning Duties

Worden (2001) defines the mourning process as basic ‘tasks’ (tasks) that an individual must fulfill in order to adapt to the grieving process, rather than conceptualizing it as a process consisting of certain ‘phases/stages’. This model describes the individual’s approach to coping as a highly dynamic process. Because, the mourner does not passively experience the mourning after the loss, on the contrary, he tries to complete the mourning process by taking an active role in this process (Stroebe & Schut, 2001). In this model, not every grieving individual is expected to perform or complete these tasks, nor is there a specific sequence in which these tasks must be completed. However, it is still important for the individual to be able to complete the previous ‘task’ in order to work on a particular ‘task’ during the grieving process. For example, in order for the mourner to work on their emotional reactions after the loss, they first need to accept that the loss is real (Rich, 2002).

Stages of Worden’s Model of Grieving Duties

  Accepting the reality of loss

It is normal for an individual to experience a shock and unreality immediately after a loss experience and to display a belief as if everything happened and death did not occur. At this stage, the person experiencing loss is faced with many unanswered questions. Especially after sudden deaths, understanding the causes and events leading to death is of greater importance for the individual (Rich, 2002). At this stage, the primary task in the grieving process is for the person who has experienced the loss to come to terms with the reality that the lost person has died and will never return. The acceptance of this reality, albeit partially, is important for the individual to form a belief that they cannot be reunited in this world.

Working through grief and expressing emotions

The pain caused by bereavement is both physical and emotional pain. Acknowledging, identifying and working on this pain is a very important requirement. Otherwise, this pain can manifest itself with physical symptoms (symptoms) or atypical behaviors, significantly reducing the individual’s quality of life (Worden 2001). Emotionally, grief manifests itself in the form of deep sadness, crying, anxiety, anger, exhaustion, and weakness. Experiencing this pain is very important in terms of the emergence of a peace of mind afterwards. Hiding or suppressing the grief and the resulting pain causes the individual to experience temporary comfort and permanent pain (Rich, 2002). Therefore, by prolonging the grief, the process turns into chronic or pathological grief.

Adapting to an environment where the deceased is not present

The basic task of this process is for individuals who have been lost to adapt to the changing world without losing their memories of the deceased. In this process, the individual encounters many problems such as economic and legal issues as well as dealing with the pain after loss and has to cope with these problems. In this period, individuals may need support in different areas from close circles such as family, friends, colleagues and from various experts such as lawyers, financial advisors or psychological counselors (Rich, 2002).

Emotionally reorganizing relationships with the deceased and moving on with life

This task encompasses a process that can take quite a long time to fulfill compared to other existing tasks. Directing the individual’s existing emotional energy towards loss to other relationships and personal interests in his life is considered as the main task in this process. This duty is misunderstood by the mourners in general and especially by the mourners and can be considered as an attempt to forget the deceased. The truth is that the grieving individual does not have to ignore their past in order to rebuild their future. However, the grieving individual has to prevent the grieving process from negatively disrupting future life plans and activities by creating an appropriate memory formation [reminiscing] for the deceased. Therefore, the role of the psychological counselor is to help the grieving individual to find a suitable place in the emotional life of the deceased and to continue his life as an active individual, rather than ending his relationship with the deceased.

One of the basic things that should be told to individuals during grief counseling is that the grieving process can be long and that the most advanced point that can be reached is not the situation before the loss.