181- Sometimes the news is best delivered in stages. For example, you might call a
patient with a positive test result, offer to answer her or his immediate questions,
and schedule a follow-up appointment as soon as possible. As long as you leave
the door open for the patient to contact you with questions before the scheduled
appointment, this approach can be helpful. - Allow patients to react the way they wish. Don’t step in with false reassurances,
encourage them to stop crying, or go on at length with detailed information they
will not be able to hear. Information given too soon tends to block patients from
expressing their feelings of disbelief, anger, grief, etc. (Faulkner et al. 1995 ). Sit
quietly while they absorb the news, offer tissues after a few moments, and give
them time to pull themselves together. You may want to move your chair closer. - Be genuine when communicating positive test results. Sometimes you will feel
particularly connected to a patient and will find yourself becoming tearful. It’s
OK to show some of your distress as long as it does not become the focus of the
interaction. (Having tears in your eyes and feeling choked-up are probably OK;
breaking down and sobbing are not). - Try saying, “I’m sorry.” This simple phrase can communicate the depth of your
feeling for your patients and their situations. This is an example of what Kessler
( 1999 ) describes as providing consolation: “A simple, sincere word or two or
even a touch may have an enormous impact on persons who have been devas-
tated by calamity” (p. 339). We suggest you not rush to express your feelings.
Rather, wait to say this until after the patient reacts initially to the test result. - If patients start to cry, do not leave them alone. Stay psychologically and physi-
cally present while allowing them to express their feelings. You do not have to
say anything. Being there conveys support. - As appropriate, reassure your patients that mixed feelings are a natural response,
and try to draw out their emotions by asking them to tell you what they are
feeling. - Point out that their emotions may fluctuate and/or change over time, and tell
them you’ll be available to talk to and meet with them in the future when and if
new concerns or questions arise. - Talk with your supervisor or colleague to debrief after delivering positive test
results. This will help you to relieve some of your emotion.
Follow-up
- Once patients have regained some composure, assess their understanding and
gently inquire about the next steps, that is, what they need. This is a time when
an open-ended question such as “How can I be helpful to you right now?” may
be particularly effective for drawing out what a patient is feeling and thinking. - If relevant literature is available, you could give it to patients at the end of the
session. This will allow them to take in the information at their own pace, time,
and location. This may not be appropriate for all patients and situations, however.
For some patients, it’s better to provide details during a follow-up visit.
7.1 Communicating Information