Journal of Behavioral Medicine

, Volume 32, Issue 4, pp 380–387

Physician challenges in communicating bad news



Communicating bad news is never easy and for physicians these interactions may be a significant source of stress. To examine the characteristics that make delivering of bad news stressful, two studies were conducted. In the first study, 37 physicians generated 192 responses describing the characteristics that influence how difficult it is to break bad news. After sorting the responses in terms of common themes, six categories were identified: Physician, Patient, Institutional, Illness, Relationship, and Mishap. In Study 2, 115 physicians rated the degree of stress associated with each factor. Using principle component and reliability analyses, empirical support was found for six categories. A higher-order factor analysis suggested the existence of one over-arching factor. Items in the Mishap category were rated on average as the most stressful. Stress scores were largely unrelated to years in practice, experience delivering bad news or training.


Bad news Stress Communication Physicians 


  1. Arnold, S. J., & Koczwara, B. (2006). Breaking bad news: Learning through experience. Journal of Clinical Oncology, 24, 5098–5100. doi:10.1200/JCO.2006.08.6355.PubMedCrossRefGoogle Scholar
  2. Back, A. L., Arnold, R. M., Baile, W. F., Fryer-Edwards, K. A., Alexander, S. C., Barley, G. E., et al. (2007). Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of Internal Medicine, 167, 453–460. doi:10.1001/archinte.167.5.453.PubMedCrossRefGoogle Scholar
  3. Baile, W. F., & Beale, E. A. (2003). Giving bad news to cancer patients: Matching process and content. Journal of Clinical Oncology, 21((Suppl)), 49s–51s. doi:10.1200/JCO.2003.01.169.PubMedCrossRefGoogle Scholar
  4. Bergman, B., Ahmed, F., & Stewart, D. E. (2003). Physician health, stress and gender at a university hospital. Journal of Psychosomatic Research, 54, 171–178. doi:10.1016/S0022-3999(02)00484-1.PubMedCrossRefGoogle Scholar
  5. Buckman, R. (1984). Breaking bad news: Why is it still so difficult? British Medical Journal, 288, 1597–1599.PubMedCrossRefGoogle Scholar
  6. Cantwell, B. M., & Ramirez, A. J. (1997). Doctor–patient communication: A study of junior house officers. Medical Education, 31, 17–21. doi:10.1111/j.1365-2923.1997.tb00037.x.PubMedCrossRefGoogle Scholar
  7. Chopra, S. S., Sotile, W. M., & Sotile, M. O. (2004). Physician burnout. Journal of the American Medical Association, 4, 633. doi:10.1001/jama.291.5.633.CrossRefGoogle Scholar
  8. Colletti, L., Gruppen, L., Barclay, M., & Stern, D. (2001). Teaching students to break bad news. American Journal of Surgery, 182, 20–23. doi:10.1016/S0002-9610(01)00651-1.PubMedCrossRefGoogle Scholar
  9. Dosanjh, S., Barnes, J., & Bhandari, M. (2001). Barriers to breaking bad news among medical and surgical residents. Medical Education, 35, 197–205. doi:10.1046/j.1365-2923.2001.00766.x.PubMedCrossRefGoogle Scholar
  10. Doyle, D., & O’Connell, S. (1996). Breaking bad news: Starting palliative care. Journal of the Royal Society of Medicine, 89, 590–591.PubMedGoogle Scholar
  11. Engel, K. G., Rosenthal, M., & Sutcliffe, K. M. (2006). Residents’ responses to medical error: Coping, learning, and change. Academic Medicine, 81, 86–93. doi:10.1097/00001888-200601000-00021.PubMedCrossRefGoogle Scholar
  12. Fallowfield, L. J. (1993). Giving sad and bad news. Lancet, 20, 476–478. doi:10.1016/0140-6736(93)90219-7.CrossRefGoogle Scholar
  13. Fallowfield, L. J., Jenkins, V. A., & Beveridge, H. A. (2002). Truth may hurt but deceit hurts more: Communication in palliative care. Palliative Medicine, 16, 297–303. doi:10.1191/0269216302pm575oa.PubMedCrossRefGoogle Scholar
  14. Gillard, J. H., Dent, T. H., Aarons, E. J., Smyth-Pigott, P. J., & Nicholls, M. W. (1993). Preregistration house officers in eight English regions: Survey of quality of training. British Medical Journal, 307, 1180–1184.PubMedCrossRefGoogle Scholar
  15. Girgis, A., & Sanson-Fisher, R. W. (1995). Breaking bad news: Consensus guidelines for medical practitioners. Journal of Clinical Oncology, 13, 2449–2456.PubMedGoogle Scholar
  16. Glymour, M. M., Saha, S., & Bigby, J. (2004). Physician race and ethnicity, professional satisfaction, and work-related stress: Results from the Physician Worklife Study. Journal of the National Medical Association, 96, 1283–1294.PubMedGoogle Scholar
  17. Graham, J., Ramirez, A. J., Cull, A., Finlay, I., Hoy, A., & Richards, M. A. (1996). Job stress and satisfaction among palliative physicians. Palliative Medicine, 10, 185–194.PubMedGoogle Scholar
  18. Gundersen, L. (2001). Physician burnout. Annals of Internal Medicine, 135, 145–148.PubMedGoogle Scholar
  19. Hoffman, M., Ferri, J., Sison, C., Roter, D., Schapira, L., & Baile, W. (2004). Teaching communication skills: An AACE survey of oncology training programs. Journal of Cancer Education, 19, 220–224. doi:10.1207/s15430154jce1904_8.PubMedCrossRefGoogle Scholar
  20. Lazarus, R. S. (1993). Coping theory and research: Past, present, and future. Psychosomatic Medicine, 55, 234–247.PubMedGoogle Scholar
  21. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  22. Matud, M. P. (2004). Gender differences in stress and coping styles. Personality and Individual Differences, 37, 1401–1415. doi:10.1016/j.paid.2004.01.010.CrossRefGoogle Scholar
  23. Mawardi, B. H. (1979). Satisfactions, dissatisfactions, and causes of stress in medical practice. Journal of the American Medical Association, 241, 1483–1486. doi:10.1001/jama.241.14.1483.PubMedCrossRefGoogle Scholar
  24. McCue, J. D. (1982). The effects of stress on physicians and their medical practice. The New England Journal of Medicine, 306, 458–463.PubMedCrossRefGoogle Scholar
  25. Morgan, E. R., & Winter, R. J. (1996). Teaching communication skills. An essential part of residency training. Archives of Pediatrics and Adolescent Medicine, 150, 638–642.PubMedGoogle Scholar
  26. Orlander, J. D., Fincke, B. G., Hermanns, D., & Johnson, G. A. (2002). Medical residents’ first clearly remembered experiences of giving bad news. Journal of General Internal Medicine, 17, 825–831. doi:10.1046/j.1525-1497.2002.10915.x.PubMedCrossRefGoogle Scholar
  27. Ptacek, J. T., & Eberhardt, T. L. (1996). Breaking bad news: A review of the literature. Journal of the American Medical Association, 276, 496–502. doi:10.1001/jama.276.6.496.PubMedCrossRefGoogle Scholar
  28. Ptacek, J. T., Ptacek, J. J., & Ellison, N. M. (2001). “I’m sorry to tell you…” physicians’ reports of breaking bad news. Journal of Behavioral Medicine, 24, 205–217. doi:10.1023/A:1010766732373.PubMedCrossRefGoogle Scholar
  29. Ramirez, A. J., Graham, J., Richards, M. A., Cull, A., & Gregory, W. M. (1996). Mental health of hospital consultants: The effects of stress and satisfaction at work. Lancet, 16, 724–728. doi:10.1016/S0140-6736(96)90077-X.CrossRefGoogle Scholar
  30. Sarikaya, O., Civaner, M., & Kalaca, S. (2006). The anxieties of medical students related to clinical training. International Journal of Clinical Practice, 60, 1414–1418. doi:10.1111/j.1742-1241.2006.00869.x.PubMedCrossRefGoogle Scholar
  31. Schildmann, J., Cushing, A., Doyal, L., & Vollmann, J. (2005). Breaking bad news: Experiences, views, and difficulties of pre-registration house officers. Palliative Medicine, 19, 93–98. doi:10.1191/0269216305pm996oa.PubMedCrossRefGoogle Scholar
  32. Sise, M. J., Sise, C. B., Sack, D. I., & Goerhing, M. (2006). Surgeons’ attitudes about communication with patients and their families. Current Surgery, 63, 213–218. doi:10.1016/j.cursur.2005.08.007.PubMedCrossRefGoogle Scholar
  33. Surbone, A., Rowe, M., & Gallagher, T. H. (2007). Confronting medical errors in oncology and disclosing them to cancer patients. Journal of Clinical Oncology, 25, 1463–1467. doi:10.1200/JCO.2006.09.9218.PubMedCrossRefGoogle Scholar
  34. Tamres, L. K., Janicki, D., & Helgeson, V. S. (2002). Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6, 2–30. doi:10.1207/S15327957PSPR0601_1.CrossRefGoogle Scholar
  35. Taylor, K. M. (1988). “Telling bad news”: Physicians and the disclosures of undesirable information. Sociology of Health & Illness, 10, 109–132.Google Scholar
  36. Travado, L., Grassi, L., Gil, F., Ventura, C., & Martins, C. (2005). Physician-patient communication among Southern European cancer physicians: The influence of psychosocial orientation and burnout. Psycho-Oncology, 14, 661–670. doi:10.1002/pon.890.PubMedCrossRefGoogle Scholar
  37. Waterman, A. D., Garbutt, J., Hazel, E., Dunagan, W. C., Levinson, W., Fraser, V. J., et al. (2007). The emotional impact of medical errors on practicing physicians in the United States and Canada. Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources, 33(8), 467–476.PubMedGoogle Scholar
  38. West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M., et al. (2006). Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. Journal of the American Medical Association, 296, 1071–1078. doi:10.1001/jama.296.9.1071.PubMedCrossRefGoogle Scholar
  39. Williams, B. (2002). Physician stress and burnout. Tennessee Medicine, 95, 445–451.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Bucknell UniversityLewisburgUSA
  2. 2.Whitman CollegeWalla WallaUSA

Personalised recommendations