Breaking Bad News in Oncology: A Metasynthesis

Breaking Bad News in Oncology: A Metasynthesis

My book covers this extensively. It is sad that you will find little literature that addresses this issue in the US. This is from France. A MAJOR aspect of my book is that you start the relationship and team building and addressing of faith and spirituality and two way eye to eye heart to heart  with the patient and their loved one on day 1. You get under the rocks of despair they are foundering on and you lift them away together. You engage office personnel who you handpick and your glorious nurses, handpicked also, and you create a family of friends dedicated to hero making from the start. You address the notion of prognosis and odds and the common what if UP FRONT and IN PERSPECTIVE TO EACH INDIVIDUUAL CASE. When you start the fight you start as fighters do, . If you have done all this with every visit , your patient and family are VERY WELL PREPARED  compared to what almost always happens- the hanging on one last scan or test. You get them in support groups and talking with other patients, you work on diet, meditation, prayer, spirituality and EXERCISE and always tell the truth and always ask the patient to have a scribe so they can remember what was said when. Do this  from the start- which is not when you meet the patient, it is when you start medical school and residencies and oncology fellowships and you will see love, laughter , beauty, heroism  and autonomy and acceptance. Moves toward alternative medicine when there is no other therapy left are thoughtful not reactionary, if at all. Patients will know you scoured the literature and our colleagues in print and person for other thoughts- any clinical trials -all part of being Captain of the ship with the patient- do this  and you will see grace and growth and patient dying to live not living to die, with indignity and more control and more peace.I have a few thousand tutors over thirty+ years. I think this in more on track. This article gets it   Dr Kevin Ryan

  1. Guilhem Bousquet,
  2. Massimiliano Orri,
  3. Sabine Winterman,
  4. Charlotte Brugière,
  5. Laurence Verneuil and
  6. Anne Revah-Levy

+ Author Affiliations

  1. Guilhem Bousquet, Université Paris Diderot, Sorbonne Paris Cité; Guilhem Bousquet, AP-HP-Hôpital Saint-Louis; Massimiliano Orri and Anne Revah-Levy, INSERM U1178; Massimiliano Orri and Anne Revah-Levy, Université Paris Sud and Université Paris Descartes, Paris; Massimiliano Orri, Université de la Picardie Jules Vernes, CRP-CPO, Beauvais; Sabine Winterman, Institut de Radiothérapie des Hautes Energies; AP-HP-Hôptial Avicenne, Bobigny; Charlotte Brugière and Laurence Verneuil, CHU Caen; Charlotte Brugière and Laurence Verneuil, Université de Caen Basse-Normandie Medical School, Caen; and Anne Revah-Levy, Hôpital d’Argenteuil, Argenteuil, France.
  1. Corresponding author: Guilhem Bousquet, MD, PhD, U1165, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, F-75010, France; e-mail:
  1. Both G.B. and M.O. contributed equally to this article. L.V. and A.R.-L. are co-senior authors.


Purpose The delivery of bad news by oncologists to their patients is a key moment in the physician-patient relationship. We performed a systematic review of qualitative studies (a metasynthesis) that focused on the experiences and points of view of oncologists about breaking bad news to patients.

Methods We searched international publications to identify relevant qualitative research exploring oncologists’ perspectives about this topic. Thematic analysis, which compensates for the potential lack of generalizability of the primary studies by their conjoint interpretation, was used to identify key themes and synthesize them. NVivo qualitative analysis software was used.

Results We identified 40 articles (> 600 oncologists) from 12 countries and assessed their quality as good according to the Critical Appraisal Skills Programme (CASP). Two main themes emerged: the patient-oncologist encounter during the breaking of bad news, comprising essential aspects of the communication, including the process of dealing with emotions; and external factors shaping the patient-oncologist encounter, composed of factors that influence the announcement beyond the physician-patient relationship: the family, systemic and institutional factors, and cultural factors.

Conclusion Breaking bad news is a balancing act that requires oncologists to adapt continually to different factors: their individual relationships with the patient, the patient’s family, the institutional and systemic environment, and the cultural milieu. Extending the development of the ability to personalize and adapt therapeutic treatment to this realm of communications would be a major step forward from the stereotyped way that oncologists are currently trained in communication skills


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