Clinical Communication

Delivering Bad News in the Context of Culture: A Patient-Centered Approach



From the University of Virginia School of Medicine, Charlottesville, VA.


  • Objective: To describe the impact of culture on delivering bad news to patients and to describe a patient-centered approach physicians can use when delivering bad news.
  • Methods: Descriptive report and discussion utilizing an illustrative case.
  • Results: Physicians often find it challenging to deliver bad news in a culturally sensitive manner. Patients vary in their preferences for how they receive bad news, both within and across cultural groups. A strategy to address these preferences is presented that integrates the ethnographic Kleinman model and the SPIKES model.
  • Conclusion: Delivering bad news is a challenging endeavor for many physicians. Strategies are available to guide clinicians through these conversations in a manner that is culturally sensitive and patient-centered.

A 52-year-old patient from Mexico is seeing his physician because he has been experiencing some fatigue and abdominal pain. The doctor asks the patient about his symptoms with the aid of an interpreter (in all the dialogues, a Spanish interpreter is present).

Doctor: How can I help you today?

Patient: I think it’s probably nothing, but my wife is worried and wanted me to see you. I don’t quite feel myself, just a little more tired than usual.

Doctor: Do you have any other symptoms?

Patient: Well, I have been having some pain in my stomach, just a little crampy feeling down low. My wife says I have lost some weight and she wanted me to see a doctor. I haven’t been eating as much as I usually do. I just don’t have much of an appetite, especially when I get the pain.

The doctor goes on to ask some additional questions and conducts a physical examination. He discovers the patient lost 20 pounds since his last visit 8 months ago. He is worried that the patient may have something serious going on, possibly colon cancer. He recommends some testing to the patient.

Doctor: I would like to do some tests to see what is going on.

Patient: What kind of tests?

Doctor: A few blood tests and a colonoscopy. Do you know what that is?

Patient: Yes, my brother had one a few years ago.

Doctor: Ok, my nurse will set that up and explain what you will need to do. We’ll schedule another appointment for you to come back to discuss the results. You mentioned your wife. Would you like her or anyone else to be with you at that appointment?

Patient: Yes, my wife and son. My son knows a lot more about medical things than I do, and I know he would want to come.


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