My experience in the palliative care world.

What should I do now

A female doctor or nurse wearing a white lab coat, blue scrubs and a blonde hair ponytail sits next to a smiling, older wo...

What we do after delivering bad news matters just as much as the words we use, because the way we share and follow up on this news can shape how patients cope over time (Ptacek & Eberhardt, 1996). Patients and families remember not only what we say, but also how we stayed with them after sharing serious news. Pausing to reflect on what you’re seeing, confirming what they’ve heard, and outlining what comes next can shift the experience from isolating to genuinely supportive. I have personally used tools such as GUIDE and SPIKES. Both are guides that taught me, as a clinician, how to deliver bad news with empathy and to anticipate patients’ emotional responses.  (Baile et al., 2000; VitalTalk, 2025).

After the first wave of emotion passes, it can be tempting to launch into a detailed plan with consults, procedures, and follow-up. But we know that most patients only remember parts of what we say in these moments. Rather than trying to explain everything at once, it helps to see this as a series of conversations and check-ins. Over time, these cycles of checking and clarifying build a shared understanding of what is happening and why. This is the foundation of true shared decision-making, not just getting a signature on a consent form.
We are affected too. The hard conversations we have with patients stay with us—they show up in our bodies, on our way home, and even in our dreams. Studies show that when clinicians feel more prepared for difficult conversations, they often feel less burned out and more confident in their care.

https://www.ariadnelabs.org/resources/downloads/serious-illness-conversation-guide/

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https://wvendoflife.org/media/1190/ask-tell-ask-2019.pdf

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https://www.hospitalmedicine.org/globalassets/clinical-topics/clinical-pdf/ctr-17-0031-serious-illness-toolkit-m1.pdf

https://www.pittwire.pitt.edu/pittwire/features-articles/expert-advice-for-better-communication

VitalTalk. (2025). Serious news: Talking about serious illness.

Wert K, Donaldson AM, Dinh TA, Montero DP, Parry R, Renew JR, Yip DS, Speicher L. Communication Training Helps to Reduce Burnout During COVID-19 Pandemic. Health Serv Res Manag Epidemiol. 2023 Feb 2;10:23333928221148079. doi: 10.1177/23333928221148079. PMID: 36756035; PMCID: PMC9900648.

 

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