An audit of documentation of breaking bad news: can we tell who said what to whom?

Authors: Barnett, Mandy; Fisher, Joanne; Wild, Andrea; Cooke, Heather; Irwin, Clive; Dale, Jeremy

Source: Clinician in Management, Volume 11, Number 4, 1 November 2002 , pp. 181-184(4)

Publisher: Radcliffe Publishing Ltd.

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Abstract:

Introduction Breaking bad news of a life-threatening or terminal illness is an important and difficult task that can impact on patients' future adjustment. To enable good teamworking, clear communication including documentation is essential. We carried out a hospital notes audit to establish a baseline of documentation of the process of breaking bad news.

Methods 516 patients diagnosed with Stage 4 cancer who had died during 1999 were identified. These were stratified according to specialty and consultant involved in diagnosis to produce a representative sample of 95. Casenotes were evaluated using a proforma, which expanded on a combination of local and national guidelines.

Results In 72.6% (69/95) of cases, it was recorded that bad news had been broken, however, precise details on a number of other specific points were documented patchily or not at all: (1) who broke the news was recorded in 69.5% (66/95) of cases, but many of these (31.8% (21/66)) were identifiable only by an indecipherable signature; (2) who had been told was documented in 80% (76/95) of cases but in 13 cases the patient was not informed; (3) the terminology used to the patient (e.g. cancer, tumour) was recorded in 33.7% (32/95) of cases; (4) the level of patient's understanding was documented in 20% (19/95) of cases; (5) discussion of treatment options was indicated in 48.4% (46/95) of cases; (6) discussion of prognosis was only recorded in 29.5% (28/95) of cases; (7) although 76.8% (73/95) of patients were seen as outpatients or discharged, general practitioners received written details of what the patient had been informed in only 16.4% (12/73) of cases.

Conclusions This audit reveals a disturbing lack of documentation over important areas of communication with patients. Even where information was recorded, it was brief, limited in usefulness, and rarely allowed identification of the recorder. In addition, details regarding diagnostic information given to the patient by hospital teams was rarely passed on to the GP. Although written information may underrepresent the extent of actual communication, the lack of clear documentation does not bode well for co-ordination of patient management or for clinical governance. Key points included in the proforma will be utilised to modify guidelines.

Keywords: BREAKING BAD NEWS; CLINICAL GOVERNANCE; DOCUMENTATION

Document Type: Research Article

Publication date: November 1, 2002

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