Communicating difficult news: a medical perspective in the context of neurology

Soeiro, Ana Cristina Vidigal; Cabeça, Ana Carolina de Castro Ribeiro; Brito, Giovana Pereira Lobato; Elias, Maria Eduarda Cunha; Oliveira, Eduardo Azevedo de; Lima, Rebeca do Nascimento Pinto; Araújo, Wanessa de Barros; Silva, Sérgio Tibúrcio Segundo de Aguiar

doi:10.1590/1983-803420263910PT

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Update • Rev. Bioét. 34 • 2026 • https://doi.org/10.1590/1983-803420263910EN linkcopy

Communicating difficult news: a medical perspective in the context of neurology

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study investigated the challenges faced by neurologists in communicating difficult news in an oncology hospital. A descriptive, quantitative-qualitative methodology was adopted, and the study was conducted from August to October 2024, after approval by two Research Ethics Committees. In total, 12 physicians participated, including neurologists, neurosurgeons, and resident doctors from the Ophir Loyola Hospital in Belém, who responded to a questionnaire on the communication of difficult news. The results revealed differences in how specialist doctors and residents engaged with the topic, especially during their academic training. Although participants positively assessed their preparedness to handle difficult communications, challenges persist, particularly a lack of communication skills, inadequate environments, and insufficient team support. The study highlighted that communication protocols and clinical experience are important allies in promoting humanized care.

Keywords
Health communication; Truth disclosure; Neurologists; Cancer care facilities

Considering your role at HOL, what situation do you find most difficult to communicate?	Specialist physicians (n)	Specialist physicians (%)	Resident physicians (n)	Resident physicians (%)	Total participants (%)
Worsening and/or irreversible clinical condition	3	25.0%	5	41.67%	66.67%
Unfavorable prognosis	2	16.67%	3	25.0%	41.67%
Brain death	2	16.67%	1	8.33%	25.0%
Referral to palliative care	1	8.33%	2	16.67%	25.0%
Death	0	0.0%	1	8.33%	8.33%
Diagnosis	0	0.0%	0	0.0%	0.0%
Referral to ICU	0	0.0%	0	0.0%	0.0%
Other	0	0.0%	0	0.0%	0.0%

Response category	Discursive content
Seriousness and irreversibility of the disease	P1: “Life is a fundamental gift. Talking about death and the irreversibility of a condition requires an appropriate moment, and it is not easy to face this moment.” P5: “Outcomes where there is nothing more I can do to help the patient still sadden me greatly.”
Broken expectations and/or hope	P2: “Because there is a loss of hope at that moment.” P3: “The impossibility of returning to their familiarity or the absence of treatment, the shock more than the diagnosis itself.” P8: “Family members and the patient themselves tend to believe that the surgical approach will always be the cure for the disease.” P9: “Unsatisfactory outcome and expectations.” P10: “The difficulty of delivering the news of a poor prognosis and the termination of palliative care is the delicate part, because that is when the patient loses hope most of the time.”
Poor understanding and acceptance of the clinical condition	P4: “Little understanding that patients have about some diagnoses; acceptance by patients/family members about irreversible/progressive pathologies.” P6: “I realize that families here in the North have difficulty accepting/understanding scientific death, sometimes due to educational issues, other times religious ones.”

Response category	Discursive content
Lack of preparedness to communicate difficult news	P1: “I believe that interference from inappropriate speech or from a healthcare professional and/or the presence of a close family member who does not help in the process.” P3: “Lack of structure for communicating bad news, absence of a team that effectively applies the protocol.” P4: “Little/absence of training for new healthcare professionals at the hospital regarding the communication of bad news.” P6: “A team is needed, neurosurgeons (physician), psychologist, social worker to first identify the patients/family members regarding the profile of the person we are talking to for better diagnosing how to approach them and treat them with the correct words that we can reach them.”
Difficulties in understanding the information	P2: “Patient’s level of education and lack of support available at the outpatient level.” P8: “Understanding, as patients and family members generally have a low level of education and erroneous expectations.” P9: “The biggest challenge is the level of education of the target population, which makes understanding difficult.” P10: “Lack of understanding and low level of education, and lack of an appropriate channel for discussing the scope of the news of a difficult outcome.”
Inadequate environment	P4: “Absence of an appropriate space to communicate bad news; little/absence of training for new hospital healthcare professionals regarding the communication of bad news.”
Lack of emotional support for the medical team	P5: “Lack of care, from a psychological point of view, for the professional who delivers bad news. We have to deal alone with the feeling of helplessness, sadness, anger and other feelings, which are natural to have when building a good physician-patient relationship.”
Seriousness of the clinical condition	P7: “Patient with a very reserved prognosis.”

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[TFN1001] HOL: Hospital Ophir Loyola; ICU: intensive care unit.