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Updated: Jul 4, 2026

Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
The False Dilemma in the Communication of Bad News
Jack Dowie1,2, Mette Kjer Kaltoft2, Vije Kumar Rajput3
1London School of Hygiene and Tropical Medicine, London, UK.
Introduction:
The literature on clinician communication of 'bad news' diagnoses is dominated by a perceived clash between 'fostering hope' and 'being realistic'. This dilemma reflects (i) a focus on the median survival in the research literature, and (ii) clinicians' difficulty in communicating the full survival curve (with its long right-hand tail) as the prognostic message.
Method:
The 'scenario' approach based on median multipliers represents a step towards remedying this in a clinically practical manner, but it does not see survival as a continuum of probabilities that embody both hope and realism at every point. We develop a candidate generic power function to convey the gist of this holistic message.
Result:
The function is presented in visual form with selected median multipliers up to a 1% probability of survival.
Discussion:
The huge uncertainty at the tail does not justify censoring on the basis of preference-sensitive statistical standards when the patient asks to be informed of the longest possible survival.
Conclusion:
The hope-realism dilemma is essentially a false one, that can be readily resolved in communicating with most competent adult patients.
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