[Breaking bad news by the respiratory physician: a therapeutic process]

The profession of respiratory medicine is often involved in communicating bad news, dealing with handicapping chronic disease or a poor prognosis.

Particularly when dealing with a cancer diagnosis, the "bad news" process is poorly described in the literature. The communication techniques that are used are specific to this highly charged encountered and they are neither innate nor widely taught. Yet the performance of the doctor at this crucial stage has a bearing on the patient throughout their clinical course and later complications. Ethical values, in particular respect of the patient's right to autonomy, as well as psychological and practical issues, govern the decision of giving the diagnosis to the patient or their next of kin.

From the patient's point of view, the breaking of bad news will be language, delivered with therapeutic intentions, which describes a significant loss. This language has the potential to unleash a mourning process, a calling into question and readjustment of direction and future plans. This process and its stages, if recognised by the doctor, can be harnessed so thatthe patient can by assisted into making correct therapeutic decisions whilst reinforcing their sense of autonomy. A study, which looks closely at the mechanisms of this process, and the benefits delivered, as well as the necessary training required by doctors, remains to be done.

Breaking bad news to a patient is therefore as much a therapeutic process as the sharing of information.