The False Dilemma in the Communication of Bad News

Le résumé fourni par la source

INTRODUCTION: The literature on clinician communication of 'bad news' diagnoses is dominated by a perceived clash between 'fostering hope' and 'being realistic'. This dilemma reflects (i) a focus on the median survival in the research literature, and (ii) clinicians' difficulty in communicating the full survival curve (with its long right-hand tail) as the prognostic message. METHOD: The 'scenario' approach based on median multipliers represents a step towards remedying this in a clinically practical manner, but it does not see survival as a continuum of probabilities that embody both hope and realism at every point. We develop a candidate generic power function to convey the gist of this holistic message. RESULT: The function is presented in visual form with selected median multipliers up to a 1% probability of survival. DISCUSSION: The huge uncertainty at the tail does not justify censoring on the basis of preference-sensitive statistical standards when the patient asks to be informed of the longest possible survival. CONCLUSION: The hope-realism dilemma is essentially a false one, that can be readily resolved in communicating with most competent adult patients.

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