Communicating bad news

Determining how much and how best to communicate bad news to CALD patients is challenging.

It is clear that giving a patient’s serious diagnosis to their relatives before telling the patient is in breach of the New Zealand Code of Health and Disability Services Consumers’ Rights (1996). However, it is important to take note of the CALD patients level of acculturation. A first generation migrant with limited English proficiency living in New Zealand may have limited exposure to Western culture and may still fully retain their traditional beliefs and preferences. Conversely, a second or third generation New Zealand-born ethnic person whose parents were migrants may have developed a mixture of Eastern and Western beliefs or may be fully assimilated to Western cultural attitudies towards healthcare.

It is important to offer patients a choice about whether they or nominated family members should be told bad news first, although offering the patient the choice may not be in accordance with their cultural expectations (Windsor, 2008). Although a New Zealand study by Windsor et al. (2008) has developed a useful questionnaire to assess a patient’s preference regarding how bad news should be conveyed, this has yet to be implemented. The recommendation is to ensure that communication between patients, families and staff in hospital settings is culturally sensitive and appropriate (Windsor, 2008).

Tse et al’s (2003) study of breaking bad news to terminal cancer patients in a Chinese family context recommends that giving bad news should depend on what the client wants to know and is prepared to know, and not on what the family wants to disclose. Tse et al. (2003) recommend the standard palliative care approach to breaking bad news be adopted, with modifications to address the ‘family determination’ and ‘death as taboo’ issues.

The following are three videos showing how the clinician is trying to apply a culturally appropriate approach to discussing medical results with a CALD patient and her family members. The clinician needs to better manage non-disclosure issues than that which is demonstrated in the scenarios. Please watch and reflect on her practice and the questions posed after each video. Hidden answers are available after each question.

Please note:
The clinician needs to better manage non-disclosure issues than that which is demonstrated in the scenarios. Please watch and reflect on her practice and the questions posed after each video. Hidden answers are available after each question.e