My experience in the palliative care world.

When patients are dealing with serious news, how we share this news with them can either help them feel supported or leave them overwhelmed. The core idea is simple: begin with the patient’s perspective, add the clinician’s knowledge, and then check back with the patient to see how it all fits into their life (Back et al., 2007; Bernacki & Block, 2014).

What matters is not just getting the facts right, but also paying attention to the patient’s own words, hopes, and fears. Telling the patient your view of their diagnosis should come only after you know their information preferences and what they already understand. A practical way to do this is to share information in small, easy-to-understand pieces, using plain language and connecting facts to what matters most to the patient (Back et al., 2007; Bernacki & Block, 2014).

Using plain language and grounding information in the patient’s daily life and goals is key. For example, instead of saying, “Your disease has progressed with multiple new metastases,” you might say, “The cancer has grown and spread, and that makes the treatments we used before much less likely to work.” Then you can relate this to what the patient values, such as walking to the mailbox, going to church, or staying out of the ICU (Back et al., 2007; Bernacki & Block, 2014; Bernacki et al., 2015). Serious illness conversation guides also encourage framing medical facts around what matters most to the patient—independence, time with family, or being at home—rather than presenting information in isolation (Bernacki & Block, 2014; Paladino et al., 2019).

Back, A. L., Arnold, R. M., & Tulsky, J. A. (2009). Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope. Cambridge University Press.

Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007 Mar 12;167(5):453-60. doi: 10.1001/archinte.167.5.453. PMID: 17353492.

Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014 Dec;174(12):1994-2003. doi: 10.1001/jamainternmed.2014.5271. PMID: 25330167.

Bernacki R, Paladino J, Neville BA, Hutchings M, Kavanagh J, Geerse OP, Lakin J, Sanders JJ, Miller K, Lipsitz S, Gawande AA, Block SD. Effect of the Serious Illness Care Program in Outpatient Oncology: A Cluster Randomized Clinical Trial. JAMA Intern Med. 2019 Jun 1;179(6):751-759. doi: 10.1001/jamainternmed.2019.0077. PMID: 30870563; PMCID: PMC6547155.

Paladino J, Bernacki R, Neville BA, Kavanagh J, Miranda SP, Palmor M, Lakin J, Desai M, Lamas D, Sanders JJ, Gass J, Henrich N, Lipsitz S, Fromme E, Gawande AA, Block SD. Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster Randomized Clinical Trial of the Serious Illness Care Program. JAMA Oncol. 2019 Jun 1;5(6):801-809. doi: 10.1001/jamaoncol.2019.0292. PMID: 30870556; PMCID: PMC12634133.

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Tamura-Lis W. Teach-Back for quality education and patient safety. Urol Nurs. 2013 Nov-Dec;33(6):267-71, 298. PMID: 24592519.

Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, Pollak KI. Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):593-601. doi: 10.7326/0003-4819-155-9-201111010-00007. PMID: 22041948; PMCID: PMC3368370.