Managing communication about serious illness and bad news

Here are some suggested approaches for managing communication about serious illness and bad news:

• Ask clients (who are competent to make decisions) whether they wish to be directly informed about their diagnosis and treatment on their own, or informed together with family member/s, or otherwise. If a client decides that they do not wish to receive their diagnosis, and their preference is that a delegated family member/s receive the diagnosis, find out which family member/s should be informed.
  NB. Clinicians must let clients know that they are obligated to inform/discuss the client's condition with the client directly, unless the client insists that they prefer otherwise.
• Ask clients (who are competent to make decisions) how they wish treatment decisions to be made. At this point, the clinician should determine the extent to which clients/family members wish to be involved in treatment decisions. It is important to when breaking the news to the family member(s), to inform them that in New Zealand it is legally not acceptable if the client is competent to make decisions, that a family member or family spokesperson makes treatment decisions or signs the informed consent for treatment on the client’s behalf.  Therefore it is necessary to ensure the family member(s) break the news to the client before treatment decisions are discussed or before the consent form is presented to the client.
• Ideally, the client’s preferences about communication should be asked before and not after the client is sent for medical investigations.
• The outcome of discussion with clients should be clearly noted in the clients’ medical records and should also be communicated verbally to subsequent care providers at ‘hand overs’.