How do you break bad news to parents?

[TexasRose]

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I thought this might be an interesting question for the forum. It's very hard to give bad news to people about their health. I imagine it can be even more difficult to tell someone that their precious baby or energetic 10 yr old has a serious medical condition. How do you break that kind of news to parents?

 

[notstudying]

Funny you should ask this today...

I had a 10 yo girl present to our ED today in DKA-new onset type 1 DM. She had had a BG in her doc's office, and was sent to the ED with the parents only knowing that it had something to do with diabetes. So I had to sit down with the parents and explain to them what diabetes is, and what it means for them, and for their daughter.

I think the "best" way really depends on who you are, and what the parents are like. I started with basic information, and then got more detailed as they asked questions. I also printed out some basic Q and A about diabetes for them. It's important, obviously, to be empathetic, and remember that parents may be short tempered or demanding because they are emotionally vulnerable. Try to be patient and answer questions, and stop back when you can to check in. Reassure them about who will be taking care of their child-which specialists may be involved, that their PMD will still be a part of their care, and how long and in what capacity you will stay involved. Give them websites where they can go for information.

Be honest, too, no matter how hard you know it will be. The mom today was really upset on reading that her daughter would have to have shots every day (the poor girl HATES needles). We said that yes, her daughter would have to have shots several times a day, but also let her know some of the ways to manage shots (pumps, giving it to herself so it isn't so bad).

The good new is that most kids get better-even though DM is lifelong, it is manageable; most cancers have treatments, etc. There are exceptions, unfortunately, but parents for the most part will have a gut feeling when something is really wrong.

I'd be interested in others' experiences, too.

 

[oldbearprofessor]

A couple of thoughts for now:

A lot depends on how surprising the bad news is and of course how "bad" it is. In the worst case of a child's death, there is some literature out there to support some basic thoughts:

First, don't delay the fact of the death in your conversation. It is best not to start with "well, you know that things have gotten worse, and then today....." Rather, start with "I'm sorry to tell you that (insert ACTUAL name) died". Give this news a minute to sink in, then start your explanation of what happened. This applies if it is in person, or on very rare occasions, on the phone. It may not be nice to have to tell someone their baby died by way of a middle of the night phone call, but it is better than lying ("come in soon, things are going bad"), which destroys all trust.

Second, use clear terms and a straight forward description. In general this means using the word "dead" rather than "passed away" or "left us", etc.

Expect tears and upset from families - don't try to hurry or limit the emotional response.

Finally, (at least for now), be careful of what you say that might cause unintentional upset. "It was God's will" or "Now you have an angel in heaven" or "at least the twin is still with us" may not exactly represent the families perspective. Save religious comments for the ministers etc.

OBP

 

[jdog]

I think something important to do when discussing non life threatening lifelong conditions such as diabetes is to point out some positives. for example this is what I do with new diabetics.

"Even though your child has diabetes and it is a llifelong condition, they are still going to graduate high school, go to college, get whatever job they want, get married, ,etc.
I point out that some of my collegues in my residency class have type I diabetes, and with good management, it is usually very manageable.

Some conditions are obviously different in the way they will affect life, such as leukemia. I think it is important to answer questions but always to be totally honest, never give percentages, ie 50 percent survival. that is for a specialist who really knows to do.

 

[TexasRose]

Thanks for the great responses. I thought the forum could use some actual pedi discussion. 😉

I was wondering, do residency programs teach residents how to talk to parents about serious issues or death? Is that normally taught in a formalized way or is it left to house staff to teach?