In-patient suicide after telephone delivery of bad news to a suspected COVID-19 patient: What could be done to improve communication quality?

Abstract

<p>Breaking bad news is a critical communication competency for healthcare professionals. Any disclosure of a life-threatening event, such as a malignancy diagnosis, often causes significant stress to patients. While some patients may respond with acceptance and a determination to fight their illness, research has consistently shown that cancer patients often respond to the disclosure of their diagnosis with a range of negative emotions, such as anxiety, distress, and depression. These reactions are often accompanied by feelings of fear, uncertainty, and a sense of loss of control over their lives. Patients may also experience denial, manifesting as reluctance to accept or discuss the diagnosis. Avoidance is another common reaction, where patients may choose to avoid certain situations or people that remind them of their illness. These reactions are not uncommon and are a natural response to the stress and uncertainty of cancer diagnosis.</p><p>A common ethical dilemma in breaking a cancer diagnosis is that patients have different preferences and coping mechanisms when dealing with difficult news, and it is important to explore their wish to know about their health condition. Some patients may want to be fully informed about their diagnosis, prognosis, and treatment options, as they believe it empowers them to make decisions and take control of their healthcare. They may also value the opportunity to prepare emotionally and practically for the challenges that lie ahead. However, other patients may prefer to shield themselves from the potentially distressing information. They may prioritize maintaining hope, protecting their mental well-being, or focusing on the present moment rather than dwelling on the future. Previous students showed that different cultures or religions influence how patients perceive the disease, their desire to know about the health condition, or their willingness to accept a diagnosis. For example, in some cultures, cancer is seen as a death sentence, leading to denial or avoidance of diagnosis and treatment. There is a social stigma and gender label attached to cancer, which can lead to shame and embarrassment about the diagnosis. Patients may be reluctant to seek medical attention, disclose their diagnosis, or follow through with treatment due to fear of being ostracized or discriminated against.</p><p>Remote communication methods like video and phone calls are being used more frequently to prevent the spread of the virus during disease outbreaks, such as the COVID-19 pandemic. It has become more difficult for healthcare professionals to inform patients about their cancer diagnosis. However, giving a cancer diagnosis over the phone can be a challenge since it does not allow for in-person support, and can come across as impersonal and insensitive. Unfortunately, in some cases, delivering bad news can have tragic consequences. One such example occurred during the COVID-19 pandemic in Hong Kong, where an elderly patient, who had been hospitalized in an isolation ward, was informed of his malignancy diagnosis over the phone and subsequently suffocated to death using a plastic bag. This article will examine a real-life suicide case in a hospital after a patient was informed of their cancer diagnosis via telephone and discuss the implications of telecommunication on breaking bad news.</p>