Great expectations? A qualitative study of health professionals' perspectives on breaking bad news about rehabilitation potential after traumatic brain injury or spinal injury

Abstract

Background: Neurorehabilitation units play an important role in facilitating recovery for those with complex needs following a neurological event. National guidance highlights the importance of providing patients and their families with information and fostering realistic expectations. This may involve the breaking of bad news. The aim of this study is to explore health professionals’ perspectives on breaking bad news in the neurorehabilitation setting.
Method: 15 health professionals (physiotherapists, occupational therapists, nurses, speech therapists, psychologists and doctors) working at a 24 bedded neurorehabilitation unit in a National Health Service acute trust in England were recruited. A qualitative study was conducted using patient vignettes to facilitate discussions during semi-structured interviews and a focus group. The results were analysed using thematic analysis.
Results: Four major themes emerged: influencing factors, current approaches used, staff experiences, and strategies to improve breaking bad news. There was a need for better management of patients' and families' expectations. Breaking bad news was seen as emotionally demanding yet often unrecognised work.
Conclusions: Breaking bad news in the neurorehabilitation setting is complex and under-recognised work, involving multiple health professionals. There is a need for both experience and training to improve skills and confidence in breaking bad news.