title: Breaking bad news: Effects of forecasting diagnosis and framing prognosis.
abstract: OBJECTIVE
  Research to support guidelines for breaking bad news is lacking. This study used an experimental paradigm to test two communication strategies, forecasting bad news and framing prognosis, in the context of cancer.
  
  
  METHODS
  In a 2×2 design, 128 participants received bad news in a hypothetical consultation. A videotaped physician presented diagnostic and prognostic information, varying warning (warning shot vs. no warning), and framing (positive vs. negative). Effects on psychological distress, recall accuracy, and subjective interpretations of the news were assessed.
  
  
  RESULTS
  Warning was not associated with lower psychological distress or improved recall. Individuals who heard a positively-framed prognosis had significantly less psychological distress, rated their prognosis better, and were more hopeful than those who heard a negatively-framed prognosis. However, they also showed a trend toward reduced accuracy in recalling prognostic statistics.
  
  
  CONCLUSIONS
  Results contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care.
  
  
  CONCLUSIONS
  Although research in clinical settings is needed to bolster results, findings suggest that when providers use positive framing to reduce distress about prognosis, they should also consider ways to overcome potential reductions in recall accuracy, such as repeating statistical information or supplementing with written information.
authors.affiliation: Department of Psychology, Washington University in St. Louis, St. Louis, USA. Electronic address: eporensky@gmail.com.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Porensky
authors.affiliation: Department of Psychology, Washington University in St. Louis, St. Louis, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D011939:Mental Recall; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D010817:Physician-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation; D014342:Truth Disclosure; D014743:Videotape Recording; D055815:Young Adult
keywords: Bad news; Cancer; Communication; Framing; Oncology; Warning