National survey of psychologists\u27 training and practices in breaking bad news: A mixed method study

Research on breaking bad news has extensively utilized undergraduates medical students, and physicians. No studies have examined how, or whether, psychologists are trained to break bad news and their current practice of breaking bad news. The purpose of this mixed method study was to explore the training and practices of psychologists in breaking bad news. Particular attention was paid to whether theory related to the “MUM effect” could explain the findings, and whether psychologists are being taught practical skills related to breaking bad news. Results suggested that psychologists are more reluctant to break bad news than good news and support the existence of the “MUM” effect in a sample of psychologists. Anxiety was shown to moderate the breaking of bad news, with more anxious respondents being more reluctant, due to their concern for self/other and norms. Half the sample broke bad news at least monthly, indicated that they break diverse types of bad news, and that they received little training in breaking bad news. Psychologists also indicated that breaking bad news was an important skill to have and a need for training in this area. The qualitative portion of the study examined the reluctancy of respondents in more detail. Reluctant respondents most frequently cited concern for self/others, context, and norms as the reasons. In contrast, respondents who were not reluctant to break bad news most frequently cited their concern for the recipient and experience as reasons. Both groups were asked about the positive/negative effects of breaking bad news and most indicated that it leads to intervention (+), positive coping (+), emotional distress (+) and it changes the therapeutic relationship (+ and −). Alternatively, the positive/negative effects of not breaking bad news were that the recipient is better off/keeps them safe (+), endangers the recipient/communicator (−), maintains denial (−), maintains unrealistic expectations (−), and changes the therapeutic relationship (−). Implications and suggestions for training and practices for breaking bad news are discussed