Breaking Bad News to Patients with Intracranial Tumors: The Patients' Perspective

OBJECTIVE: Bad news refers to information that subjectively impedes a patient's future prospects. Patients with intracranial tumors potentially face numerous pieces of bad news. This study assessed the patients' perspective regarding the content of bad news, patients' preferences for the communication of bad news, and clinical consequences of mismatch of patients' communication preferences. METHODS: We included 42 patients with an intracranial tumor shortly after neurosurgical tumor removal. Patients' preferences for communication of bad news was assessed via the Measure of Patients' Preferences Scale. Various areas of patients' psychosocial well-being were included (e.g., depression or quality of life). RESULTS: At this early stage of the disease trajectory, patients with a brain tumor had already received on average 2.2 (standard deviation, 1.38; range, 0-6) pieces of bad news. For most patients, these pieces included receiving the initial diagnosis. Patients reported a multitude of communication preferences, some highly specific for patients with brain tumors. On average, 30% of these preferences were not matched with the physicians' behavior. Communication mismatch was associated with lower patient satisfaction regarding information but no other areas of psychosocial well-being. CONCLUSIONS: Communicating bad news to the patient with a brain tumor in a way that is appreciated by the patient is a complex and demanding endeavor for the treating physician. Meeting patients' needs not only requires the skills regarding the communication of cancer-related news but also accounting for the specific needs ascribable to the neurologic features of the disease (e.g., regarding neuropsychological impairment or neurosurgical treatment).