Breaking Bad News in the Breast Imaging Setting

Rationale and Objectives

The aim of this study was to investigate the experience and desire for training breast imagers in discussing “bad news” with their patients. No such information has been previously reported.

Materials and Methods

Following University of Michigan (UM) institutional review board approval and approval from the Society of Breast Imaging (SBI), questionnaires were mailed to current UM breast imaging faculty members, fellows, and residents and to SBI fellows. The final questionnaire page was mistakenly omitted in the SBI mailing. After institutional review board approval, the final page was sent to the SBI fellows.

Results

The response rates were 65% (61 of 94) for SBI fellows and 65% (13 of 20) for UM physicians. Ninety-five percent of respondents were aged ≥ 40 years. Sixty-two percent of UM physicians were women, compared to 52% of SBI fellows. Sixty-four percent of respondents practiced in university settings and 34% in private settings. Thirty-five percent of respondents had breast imaging fellowships. The frequency of delivering bad news was most often weekly or daily, whether the news was a need for extra views, a biopsy recommendation, or positive core biopsy results. Recommendations for extra views and breast biopsies were reported to be usually given in person, whereas 59% of respondents delivered positive biopsy results by telephone. Eighty-five percent of respondents noted no previous training in delivering bad news. On a comfort scale ranging from 1 (very uncomfortable) to 10 (very comfortable), 95% of respondents rated their comfort at 8 to 10 for recommending extra views, 85% had the same comfort level for recommending biopsies, and 67% had the same level for giving positive biopsy results. Sixty-two percent of UM radiologists expressed interest in obtaining further training in how to deliver bad news, whereas only 32% of SBI fellows were desirous of such training.

Conclusion

Although radiologists commonly delivered bad news in the breast imaging setting, very few had training in how to do so. Comfort levels declined as the severity of news increased, yet a majority of respondents were not interested in obtaining training in how to deliver bad news. These findings raise the need for further study.

The majority of radiologic examinations occur without patients ever encountering the radiologists who will interpret their examinations. The field of breast imaging is unique in that radiologists frequently interact with their patients. Radiologist–patient interactions can occur during image-guided procedures, breast physical examinations, and breast ultrasound; while telling women the results of their mammographic studies; and/or during discussion of the results of examinations or procedures. Particularly in the latter case, the interaction may include informing a woman that she may have, or likely has, breast cancer.

Discussing “bad news” is known to be a complex and challenging task requiring a combination of compassion and effective communication skills. Both of these, however, receive relatively little attention during physician training, especially in fields such as radiology, which is not a primary care specialty.

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Materials and methods

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Results

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Table 1

Practice Types and Levels of Training of Respondents

Level_n_ SBI fellows University practice 39 Private practice 21 Both 1 Total 61 UM physicians Faculty members 8 Fellows 2 Residents 3 Total 13

SBI, Society of Breast Imaging; UM, University of Michigan.

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Table 2

Bad News Communication Strategies Listed by Respondents

Be honest and straightforward Use plain English Answer questions Have patience Be optimistic, give hope Sit down Speak slowly Repeat, rephrase Have empathy Listen Follow the patient’s lead Allow time Provide written information Make eye contact Include family and friends Phone the clinician first Show films Provide statistics Always have a plan Ask what the patient knows Have an appointment set with the surgeon Use the word “cancer” Try not to use the word “cancer” Never tell a patient “I think it’s probably cancer” State that “this is unlikely to affect your overall health”

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Discussion

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References

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Breaking Bad News in the Breast Imaging Setting

Rationale and Objectives

Materials and Methods

Results

Conclusion

Materials and methods

Results

Discussion

References

Further Reading

4-D Imaging in Cerebrovascular Disorders by Using 320-Slice CT

Abstracts of Funded National Institutes of Health Grants

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