Review and commentary: two studies regarding giving "bad news"

Informing parents of the diagnosis of a chronic illness or disability in their child can be a difficult task. At the same time it is critical that the informing is done well. Two studies examining parental reactions to the "informing interview" (Krahn, Hallum, & Kime, 1993; Garwick, Patterson, Bennett, & Blum, 1995) support the conventional considerations that both parents, in a two-parent family, should be together when told of their child's diagnosis; parents should be informed early on; simple, direct language without medical jargon should be used; and the informing professional should be both empathetic and supportive of parental emotional expression. These studies raise additional considerations including the importance of meeting with parents in person, informing parents in a private setting, pointing out the child's strengths as well as limitations, and individualizing both the communication style and information shared. Cross cultural considerations, while not addressed in either of these studies, require attention to language interpretation, meaning assigned to the diagnosis, and potentially differing treatment preferences. In all cases, nurses should evaluate the effectiveness of the informing interview in relation to the family's affective and information needs. Each of these considerations should be part of the process of an informing interview.