On Telling a Patient a Terminal Diagnosis

When you are telling a patient for certain that they have a terminal diagnosis, there are a few things that can really set the stage for how a patient will walk away from the experience. Compassion and the human touch is the most important thing you can do. This is followed by giving the patient as much control as possible in their present situation.

Here are some tips:

1. Always sit down. Give the patient the feeling like you aren't going to be running out after a one minute delivery of bad news. Even if you only stay for three minutes, you'll make the patient feel like it was longer.

2. Look directly at the patient. Don't be afraid to show compassion and hold their hand or give them a hug if they are crying. Quickly exiting a room with the excuse of returning a page when the tears start flowing is a bad idea, even if it is an awkward/uncomfortable moment.

3. Start by asking them a simple question such as, "How are you doing? I know the work-up for this diagnosis has been long." To be a good listener you have to stop thinking--stop planning your answers and just listen to the patient and the subtleties in their speech. When you finally do answer, make sure you first validate whatever they just stated before continuing with your own thoughts. By using that simple technique you can gain an immense amount of trust and form the kind of intimate bond a patient needs when hearing this kind of sad news.

4. Don't forget to ask them if they understand the pathophysiology of their disease, and then explain in simple layman's terms what it is. Leave the medical terminology for your next conference and they patient will be left with a much clearer picture of what is going on.

5. To reinforce your teaching, give real-life examples of what you just explained so that the patient can understand how their lives will be affected.

6. Don't be afraid to ask the patient if they have any questions as they usually will. Make sure you remain seated during the questions. You don't want to ever make a patient feel you have more important things to do then informing them of their terminal status.

7. Ask how their family is coping, if they have told their family, or even if they'd like you to call a loved one for them. Sometimes patients are feeling overwhelmed and want to pass on the information but don't know how. They often don't feel like they have a good enough grasp of what is going on, and it can be a very difficult thing to tell one's children, "I'm going to die."

8. Talk to them about end of life decisions, it doesn't matter if it may be a ways off. People want to know that they have choices; they want to hear that they have some say in their final days and won't just end up a product of medical waste. Again, it's giving the patient some control.

9. Ask if they have more questions and offer to point them in a direction where they can find out more information. Most hospitals have some sort of library that is often liberating for patients and families to find, as it lets them get to take part in their care, and helps them become their own advocates. Knowledge is power, and when facing a terminal illness the more power the better. It can really mean the difference between a death with dignity surrounded by family or an ugly code situation where nobody understands what is happening.

10. When leaving give them your card. Don't just say, "Call my office and we'll schedule an outpatient visit." By giving your card they have something to hold on to, as your name and office location is the last thing they are going to remember when contemplating their own mortality. Also, at this time it's important to mention other potential team members by specialty so the patient can understand that they are going to be well cared for and not simply abandoned.