Unpacking the delivery of bad news within the hospital ward ‘environments’
A blog post written by Elizabeth Miller
Patients experiencing bad news within a diagnostic/prognostic conversation are greatly influenced by the timing, place and the way in which that news is delivered. Health Professionals play an essential role in the ability of a patient to understand the news that has been delivered and to assist the patient and family members to plan ahead.
Delivering bad news is one of the most difficult tasks a health professional has to undertake and requires empathy, tact, intuition and skill (Miller et al., 2021). The health professional needs to deliver bad news or diagnostic/prognostic information incrementally in language that the patient and family can understand, factoring in cultural and spiritual preferences. The art of conveying the repercussions of a life-limiting illness to people from all walks of life and with varying levels of health literacy is an essential skill. The development of a therapeutic relationship can assist in discussions about quality of life, fulfilling bucket lists and end-of-life preferences through open, honest and timely conversations. Patients and family members want to have confidence that their health professional is knowledgeable and has their best interests at heart. Yet often the fear of failure to cure or be cured is disguised by treatment that is painful and futile until it is obvious to all that the patient is dying, thus robbing the patient and family of quality time to move into the next stage of life with dignity and control.
The acute hospital is one such place where bad news or diagnostic/prognostic information is given. The architectural factors (room layout, space, windows, amenities), ambience (sound, light, smells, temperature) and aesthetics (colours, furniture, artwork) make up the physical environment which, in many acute hospital wards, is perceived by patients as sterile, bland, cold and unfriendly (Miller et al., 2022). Views and access to nature and greenery are therapeutic and provide an emotional escape but are not always available. Palliative and end-of-life patients also want to feel safe in the hospital environment. Feeling safe results from being surrounded with familiar belongings and the presence of family but also in receiving person centred care. The social environment (vibe, culture, communication, behaviour, quality of care) is also influenced by the physical environment and is often what patients and families remember and equate to either a positive or negative experience. The switch between an acute focus and a palliative approach for medical ward nurses and generalists is also difficult as they are constrained within their physical and social ward environments.
We can learn from understanding the therapeutic landscape of the hospital ward in order to improve the quality in which news is delivered and received by patients and their family. We want to give patients high quality health care through the use of evidence-based best practice and my research is exploring these issues by asking patients and family members about their experiences.
Elizabeth Miller, PhD candidate
Institute of Health and Wellbeing
Federation University Australia
Miller, E.M., Porter, J.E., & Barbagallo, M.S. (2022). The physical hospital environment and its effects on palliative patients and their families: A qualitative meta-synthesis. Health Environments Research & Design Journal, 15(1), 268-291. https://doi.org/10.1177/19375867211032931
Miller, E.M., Porter, J.E., & Barbagallo, M.S. (2021). The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis. Palliative & Supportive Care. First View August 25, 2021, pp1-12. https://doi.org/10.1017/S1478951521001243