Managing the delivery of bad news: an in-depth analysis of doctors' delivery style.

OBJECTIVE: The purpose of this study was to identify and describe the delivery styles doctors typically use when breaking bad news (BBN). METHODS: Thirty one doctors were recruited to participate in two standardised BBN consultations involving a sudden death. Delivery styles were determined using time to deliver the bad news as a standardised differentiation as well as qualitative analysis of interaction content and language style. Communication performance was also assessed. RESULTS: Analysis of BBN interactions revealed three typical delivery styles. A blunt style characterised by doctors delivering news within the first 30 s of the interaction; Forecasting, a staged delivery of the news within the first 2 min and a stalling approach, delaying news delivery for more than 2 min. This latter avoidant style relies on the news recipient reaching a conclusion about event outcome without the doctor explicitly conveying the news. CONCLUSION: Three typical bad news delivery styles used by doctors when BBN were confirmed both semantically and operationally in the study. The relationship between delivery style and the overall quality of BBN interactions was also investigated. PRACTICE IMPLICATIONS: This research provides a new template for approaching BBN training and provides evidence for a need for greater flexibility when communicating bad news.