Communicative competence in the delivery of bad news

Grounded in the Cegala and Waldron (Communication Studies 43 (1992) 105) model of communicative competence, the present study applied the McNeilis (Health Communication 13 (2001) 5) provider-patient coding scheme to video tapes of 3rd year medical students delivering bad news to a standardized patient. The goal of the study was to understand the specific communicative moves that are associated with perceptions of competence during bad news delivery. The coding scheme assesses Content, Acknowledgment Tokens, Interruptions, Alignment, and Function of the message. Naïve observers also evaluated the tapes on several items, assessing empathy and communicative effectiveness. Nonmedical talk was the most common type of content, followed by discussion of the current health problem. Neither acknowledgment tokens nor interruptions were frequent. The most common function of a message was a closed question, followed by explanations, assertions, and open questions. Summing across the functions indicated that information giving was the most common behavior. The perceivers' data showed fairly neutral assessments of the medical students--they were generally not evaluated very positively, although they were not disliked. Regression analyses indicated numerous specific communicative behaviors that were associated with judgments of competence. Statements falling into the Nonspecific Content category were associated with more positive perceptions, while relational statements, moderately closed questions, solicited answers, expansions, restatements, assertions, explanations, open questions, bracketing, and small talk as well as information verifying, seeking, and giving (summed functions) led to more negative perceptions. The results indicate that the delivery of bad news requires communicative moves that differ from other kinds of medical communication. Depending on the results of future analyses of this topic, health care providers may be well advised to focus little of their communication on information seeking, giving, or verifying during the initial bad news delivery consultation, but rather to save most communication of information for a follow-up scheduled shortly afterwards.