Breaking Bad News: A Valid Concern among Clinicians

  • Gelareh Biazar Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Kourosh Delpasand Department of Medical Ethics, Guilan University of Medical Sciences, Rasht, Iran.
  • Farnoush Farzi Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Abbas Sedighinejad Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Ali Mirmansouri Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
  • Zahra Atrkarroushan Department of Statistics, Guilan University of Medical Sciences, Rasht, Iran.
Breaking Bad News, Clinicians, Guilan, Patients, way


 Objective: Delivering bad news is the duty of specialist physicians. However, they find it very difficult due to insufficient experience. In this study, the way faculty and residents of Guilan University of Medical Sciences (GUMS) delivered bad news to the patients was investigated.

Method: This study was conducted at hospitals affiliated to GUMS during 2017. A questionnaire containing 18 items on environmental and psychical support was filled through a face to face interview. The first 10 questions evaluated psychical support and the next eight environmental supports. The scoring of each question ranged from 10 to 50, with 10 indicating “never” and 50 “always”.

Results: According to the analysis of 235 questionnaires, only 32 (13.6%) of the participants had been taught to deliver bad news and 195(83%) felt they need educational courses. Also, 40 (17%) believed that they had enough ability to deliver these massages. No significant differences were observed among physicians who had taken teaching courses in breaking bad news to patients.

Conclusion: This study revealed that educational courses to improve physicians’ communication skill to break bad news to patients are strongly warranted.


1. Buckman RJBmj. Breaking bad news: why is it still so difficult? Br Med J (Clin Res Ed). 1984 May 26;288(6430):1597-9.
2. Munoz Sastre MT, Sorum PC, Mullet EJHc. Breaking bad news: the patient's viewpoint. Health Commun. 2011;26(7):649-655.
3. Ford S1, Fallowfield L, Lewis S. Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations? Br J Cancer. 1994 Oct;70(4):767-70.
4. Abazari P, Taleghani F, Hematti S, Malekian A, Hakimian SMR, Ehsani M. Breaking bad news protocol for cancer disclosure: an Iranian version. J Med Ethics Hist Med. 2017;10:13.
5. Gorniewicz J, Floyd M, Krishnan K, Bishop TW, Tudiver F, Lang FJPe, et al. Breaking bad news to patients with cancer: a randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients. Patient Educ Couns. 2017;100(4):655-666.
6. Motlagh A, Yaraei N, Mafi AR, Hosseini Kamal F, Yaseri M, Hemati S et al. Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey. Arch Iran Med. 2014;17(4):232-40.
7. Rozveh AK, Amjad RN, Rozveh JK, Rasouli DJIjoh-o, research sc. Attitudes toward telling the truth to cancer patients in Iran: a review article. Int J Hematol Oncol Stem Cell Res. 2017;11(3):178-184.
8. Goebel S, Mehdorn HMJWn. Breaking Bad News to Patients with Intracranial Tumors: The Patients' Perspective. World Neurosurg. 2018;118:e254-e262.
9. Hafidz MIA, Zainudin LDJMJM. Breaking Bad News: An essential skill for doctors. Med J Malaysia. 2016;71(1):26-7.
10. Bousquet G, Orri M, Winterman S, Brugière C, Verneuil L, Revah-Levy A. Breaking bad news in oncology: a metasynthesis. J Clin Oncol. 2015;33(22):2437-43.
11. Rising MLJJoTN. Truth telling as an element of culturally competent care at end of life. J Transcult Nurs. 2017;28(1):48-55.
12. Monden KR, Gentry L, Cox TR, editors. Delivering bad news to patients. Baylor University Medical Center Proceedings: Taylor & Francis; 2016.
13. Craxì L, Di Marco V. Breaking bad news: How to cope. Digestive and Liver Disease. 2018.
14. C Cardona M, Kellett J, Lewis E, Brabrand M, Ní Chróinín D. Truth disclosure on prognosis: Is it ethical not to communicate personalised risk of death? Int J Clin Pract. 2018:e13222.
15. de Zulueta P. Truth, trust and the doctor–patient relationship. Primary Care Ethics: CRC Press; 2018. p. 1-24.
16. Xue D, Wheeler JL, Abernethy AP. Cultural differences in truth-telling to cancer patients: Chinese and American approaches to the disclosure of ‘bad news’. Progress in Palliative Care. 2011;19(3):125-31.
17. Marschollek P, Bąkowska K, Bąkowski W, Marschollek K, Tarkowski R. Oncologists and Breaking Bad News—From the Informed Patients’ Point of View. The Evaluation of the SPIKES Protocol Implementation. J Cancer Educ. 2018.
18. Scheidt CE, Wunsch A, Afshar H, Goli F, Malekian A, Sharbafchi MR, et al. Breaking Bad News: Different Approaches in Different Countries of Iran and Germany-an Expert Panel. International Journal of Body, Mind and Culture. 2017;4(2):108-14.
19. Seifart C, Hofmann M, Bär T, Riera Knorrenschild J, Seifart U, Rief W. Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany. Ann Oncol. 2014;25(3):707-11.
20. Ghafari NA, Salari P, Mirzazadeh A. Study on breaking bad news to patients among physicians of kerman university of medical sciences [In Persian]. Medical Journal of hormozgan univirsIty. 2006;10(2).
21. Hofmann M, Seifart U, Rief WJP. Assessing patient’s preferences for Breaking Bad News: development of the MABBANs. Psychooncology. 2013.
22. Aein F, Delaram M. Giving bad news: a qualitative research exploration. Iran Red Crescent Med J. 2014; 16(6): e8197.
23. Arbabi M, Roozdar A, Taher M, Shirzad S, Arjmand M, Mohammadi MR, et al. How to break bad news: physicians’ and nurses’ attitudes. Iranian J of psychiatry. 2010;5(4):128-33.
24. Jalali M, Nasiri A, Abedi HJIJoME, Medicine Ho. Patients and family members’ experiences regarding receiving bad news from health providers [In Persian]. Medical Ethics and History of Medicine. 2015;7(5):83-93.
25. B Brown VA, Parker PA, Furber L, Thomas AL. Patient preferences for the delivery of bad news–the experience of a UK Cancer Centre. Eur J Cancer Care (Engl). 2011;20(1):56-61.
26. Saberi A, Nemati S, Fakhrieh Asl S, Heydarzadeh A, Fahimi A. Education of medical professionalism and the role of educators of Guilan University of Medical Sciences, Iran, according to its residents. Strides in Development of Medical Education. 2013;10(2):218-24.
How to Cite
Biazar G, Delpasand K, Farzi F, Sedighinejad A, Mirmansouri A, Atrkarroushan Z. Breaking Bad News: A Valid Concern among Clinicians. Iran J Psychiatry. 14(3):198-202.
Original Article(s)