December 11, 1996

Delivering Bad News

Author Affiliations

Spokane, Wash

JAMA. 1996;276(22):1802. doi:10.1001/jama.1996.03540220026019

To the Editor.  —As a medical oncologist, I frequently participate in breaking various types of bad news, so I appreciated the article by Dr Ptacek and Ms Eberhardt.1 One point that deserves emphasis is to be sure of the information before it is delivered to the patient. The diagnosis, extent of involvement, and treatment plan must be as clear as possible before breaking the news. The following anecdote will illustrate my point.A young woman presented with abdominal pain. Abdominal computed tomographic scan showed a large gastric mass with extensive involvement of liver, spleen, and lymph nodes. At the gastroscopy, a tumor was biopsied, and the initial verbal report from the pathologist was lymphoma. The family physician broke the bad news and discussed treatment and prognosis of lymphoma optimistically. The oncologist (me) saw the patient the next day. At that time, additional study by the pathologist led to a verbal diagnosis of