Breaking bad news and the cost of caring on physicians: a systematic scoping review

Caring for dying patients and their distressed families can be traumatic. For physicians, these encounters shape the way they see, act and feel as professionals, influencing the inculcation and display of their professional expectations and values-otherwise known as professional identity formation (PIF). When inadequately supported, such changes in PIF can impact patient care, family support and teamwork. With recurrent, brief yet emotionally charged interactions with patients and families especially likely to predispose to moral distress, compassion fatigue and burnout, we propose a review into how breaking bad news (BBN) to patients and families impacts PIF and this personal cost of caring.

Framed by the modified-Systematic Evidence-Based Approach, we conducted a systematic scoping review of studies on BBN published between 2000 and 2024 in PubMed, Embase, Scopus, CINAHL and PsycINFO. To chart changes in PIF, we employed the Ring Theory of Personhood (RToP). Thematic and RToP-guided content analyses were concurrently performed, supplemented by ChatGPT-5 to the triangulate human-led analysis.

15 786 titles and abstracts were identified, 346 full-text articles were reviewed and 31 were analysed. BBN demands physicians balance familial goals while preserving patient interests. This predisposes to the personal cost of caring and impacts PIF. These effects are aggravated by ineffective organisational support.

BBN impacts PIF and triggers the personal cost of caring. Greater use of team-based approaches in BBN to families should be adopted in practice while training and longitudinal assessment in these approaches should be integrated within purpose-designed, holistic programmes.