Delivering bad news in writing: an evidence-based approach

Delivering bad news is something health writers need to do – along with writing inspiring, uplifting health content. There’s sometimes a darker side to our roles. We write about serious diseases and conditions; we describe dangerous symptoms and treatments.

For health writers, bad news – that is, information that produces a negative alteration in a person’s expectations about the future – is not necessarily going to involve giving a personal diagnosis.

Bad news could be information about prognosis, life expectancy or the progression of a serious disease.

Examples of themes or writing projects that could incorporate elements of bad news include:

Loss – miscarriage, infertility, stillbirth
Chronic disease – cancer, heart disease
Symptoms – disease progression
Death – suicide, mortality, accident or injury

As writers, we don’t have the luxury of face-to-face interaction.

We aren’t able to look at our readers in the eye, offer reassuring facial expressions, pause, use verbal cues or enhance our message with in-person communication.

Our tools are limited to the words on a virtual page of a PC, phone or tablet.

Plus, unlike in a doctor-patient consultation, we may not have our reader’s undivided attention.

Perhaps our reader is reading our content while watching television, browsing Facebook or talking to someone.

And while there are many evidence-based writing techniques we can use to engage readers to try and get their full, undivided attention, controlling how our readers react to bad news is just as important as engagement.

So, if you’re working on a project that requires you to deliver bad news, what’s the most appropriate communication strategy?

Delivering bad news involves identifying reader needs

One well-received approach to delivering bad news seems to be the patient- and family-centred approach.

Research from as long ago as 2005 and as recently as 2016 has suggested that a patient-centred communication style is associated with better health-related outcomes for patients.

A patient-centred approach is about conveying information according to your patient’s needs – taking into account the cultural, spiritual, and religious beliefs and practices of the individuals and their families.

In writing, this includes considering language and terminology specific to the industry or niche – mental health, disability, cancer, for example.

It’s also important to understand and acknowledge your reader’s mindset. Your readers are searching for answers and may be looking for reassurance.

Understand and define your audience, and identify their specific needs, before you start writing.

Check for understanding

In a doctor-patient communication, the doctor would deliver the bad news and then check that their patient understood everything.

However, we can’t check for understanding. We can ask our readers questions, but we can’t get real-time responses.

We can, though, make sure that our content is well written for people with a variety of health literacy levels. We can also provide resources in case our readers don’t understand a particular term or phrase. In text-hyperlinks to complex definitions, for example.

Researchers from the Department of Surgery, Baylor University Medical Center at Dallas wrote about delivering bad news in the journal Baylor University Medical Center Proceedings. The Dallas research team also suggest:

Giving clear, complete and honest information
Demonstrating empathy
Using simple language
Demonstrating confidence and competence

Ultimately, remember that clear writing creates better health outcomes. Your health writing is only useful if it is easy to understand.

Deliver bad news with honesty and sensitivity

“A crucial aspect of delivering a bad news message is that doctors maintain a balance between honesty and sensitivity,” writes Barbara Schouten in the International Encyclopaedia of Communication.

“An essential aspect of supporting the patient is acknowledging his or her distress and letting the patient know that it is all right to be emotional.”

However, it’s important to be aware that too much emotion and sympathy isn’t necessarily a good thing.

In fact, an emotion-centred approach – characterised by emphasising the sadness of the message and demonstrating an excess of empathy and sympathy – produces the “least amount of hope and hinders appropriate information exchange”, according to the Dallas research team.

Avoid the bad news buffer

Researchers from Brigham Young University and the University of South Alabama suggested that most people prefer it when bad news is delivered directly, without a buffer.

In the study of 145 people, participants responded to a variety of negative messages in a variety of message scenarios such as visual, textual, and conversational.

The researchers found that “polite” buffers or even explanatory information are generally not preferred in visual message scenarios.

Of course, in writing, flow is very important. But, we can still achieve a natural writing flow while keeping our messages clear and direct, without sidestepping.

Tell your readers what they need to hear, not what they want to hear

The BYU researchers suggested that delivering bad news directly, without beating around the bush, was ideal.

In other words, tell your readers what they need to hear, not what they want to hear.

One of the tasks I get students to complete in my Introduction To Health Writing course is an article about unexplained infertility.

It’s an extremely challenging task because it involves writing about a deeply personal and emotional topic without giving false hope or telling readers what they want to hear.

A direct approach doesn’t mean using clinical language, either. Content that reads and sounds too ‘medical’ can be extremely distressing for people who are already feeling vulnerable and emotional.

Delivering bad news requires actionable content

In healthcare communication, actionable messages are key to behaviour change. If appropriate, give your reader a next step, an actionable tip.

Think about what you (or your client) wants your reader to do when they’ve finished reading. Continue the journey with helpful suggestions for next steps.

Delivering bad news – take-home messages

Research into doctor-patient communication provides an insight into how patients respond to bad news – and, health writers can learn from these best-practice approaches. You can assess your writing to make sure you are using evidence-based methods.

While empathy in health writing is important, a balance of honesty and sensitivity is vital.

Remember that research suggests the following communication strategies will result in the best responses:

Be honest and upfront – and write clearly
Don’t beat around the bush – get to the point
Write with empathy and sensitivity – acknowledge readers’ feelings
Support health literacy – explain complex terms, and link out to medical definitions
Demonstrate an understanding of your audience’s needs – conduct audience research before writing
Provide helpful, actionable next steps – give the reader somewhere to go when they have finished reading