Manual The D Word

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Fortunately, things are beginning to change in terms of the training and education physicians receive. Research suggests the opposite, she adds. Interestingly, clinicians perceive difficulties with patient and family responses as bigger barriers to these discussions than their own skills and limitations, but patient research does not quite jibe with those findings. Broaching the topic as early as reasonably possible also gives patients more time, information, and opportunity to make the decisions they want based on their values and their place in life, Ms Bishop added.

Nurses may develop a better sense than doctors for some of these answers because they are the ones implementing interventions, Dr Chapple added. That tweaking mindset often begins from the first conversation, when a physician tells the patient about a terminal diagnosis but hardly before launching into the treatments they can offer. She noted that some research has shown that patients are surprised when they learn their treatments were never intended to be curative, even if they were told. While that perspective is expansive, reaching toward larger philosophical ideas regarding how our culture thinks about death, it also contains a key to learning to grapple with those conversations, Dr Chapple suggested.

To be in this position where you have to give bad news is difficult, but it is important, and being trained allows you to do it well and work with that discomfort. For physicians who are interested in brushing up on their communication skills in the face of bad news, there are a number of available resources, including VITALtalk and the Association for Death Education and Counseling. A list of organizations who provide assistance and information on multiple topics related to trauma, grief, dying, and death can be found here.

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