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In Reply

Wayne State University, Karmanos Cancer Institute, Detroit, MI

We agree with the comments of Baile et al that bad news interactions can be emotionally charged for all participants (including the clinician) and that self-reflection and other preparation by clinicians for such encounters is important in avoiding pitfalls and ensuring the most effective communication possible. However, we would extend that statement by suggesting that all interactions with patients and companions have the potential to be emotionally charged. Because bad news involves a subjective appraisal of information, clinicians may not be able to accurately predict and prepare to engage in a bad news encounter. In our article,¹ we suggest that physicians should prepare for all interactions by applying guidelines for effectively communicating during bad news interactions (for instance, ensuring adequate time and privacy, eliciting patients' and companions' perspectives on the current medical situation and expectations for the visit, and tailoring the information delivery process to the needs of the participants in the interaction). We referred to this preparation for all interactions as the universal precaution of communicating with patients and families.

We further agree with Baile et al that most communication skills can (and should) be taught and learned. Fortunately, this concept has been endorsed by medical education accreditation agencies at both the graduate and undergraduate levels. We therefore appreciate the work of medical educators who have developed excellent curricula in this complex area of medicine.^2,3 A major challenge to these curricula is that, similar to other rapidly evolving subjects, little empirical research has been reported, and therefore, the quality of the teaching may exceed the quality of available evidence to support the content. For example, reports of evidence on communication in the medical encounter resulted in a shift in emphasis away from an earlier paternalistic, biomedical approach to the medical encounter to a patient-centered approach; a similar process is once again facilitating a shift toward a "relationship-centered approach."⁴ Similarly, our observations of video recorded outpatient oncology interactions have pointed to some limitations of currently accepted communication guidelines for communicating bad news, especially as applied to the cancer setting, such as the fact that the guidelines were created based on ideal, linear conversations, which rarely occur in the clinical setting, and that the guidelines neglect the patients' companions. Through our analysis of observational data, we hope to provide the basis to improve the teaching of communication skills to be applied in this and other settings. Thus, we acknowledge the challenge faced by medical educators of continually updating curricula as new evidence emerges, and endorse the cooperation of researchers and educators in providing up-to-date, evidence-based communication curricula to clinicians.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

ACKNOWLEDGMENTS

Supported by National Cancer Institute research Grant No. RO1CA075003-03 (T.L.A.).

REFERENCES

1. Eggly S, Penner L, Albrecht TL, et al: Discussing bad news in the outpatient oncology clinic: Rethinking current communication guidelines. J Clin Oncol 24:716-719, 2006[Free Full Text]

2. Baile WF, Buckman R, Lenzi R, et al: SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist 5:302-311, 2000[Abstract/Free Full Text]

3. Delvaux N, Merckaert I, Marchal S, et al: Physicians' communication with a cancer patient and a relative: A randomized study assessing the efficacy of consolidation workshops. Cancer 103:2397-2411, 2005[CrossRef][Medline]

4. Beach MC, Inui T: Relationship-centered care: A constructive reframing. J Gen Intern Med 21:S3-8, Jan 2006 (suppl 1)

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Related Correspondence

• Breaking Bad News: More Than Just Guidelines
  Walter F. Baile, Robert Buckman, Lidia Schapira, and Patricia A. Parker
  JCO 2006 24: 3217 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Eggly, S. Articles by Ruckdeschel, J. C. Search for Related Content PubMed Articles by Eggly, S. Articles by Ruckdeschel, J. C. Related Articles Related Correspondence Social Bookmarking                            What's this?