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The mode of communication—telephone or face-to-face—does not affect patients’ emotional responses to bad news.
Breaking bad news—such as a new cancer diagnosis—can be one of the most challenging moments in medicine, often leaving a lasting impact on patients’ emotional well-being. But does it matter whether this news is communicated face-to-face or over the phone? A systematic review and meta-analysis led by Jonas Mueller et al. suggests it may not influence the patients’ psychological outcomes.
For exploring adult patients’ levels of anxiety, depression, and post-traumatic stress disorder (PTSD) after receiving life-altering news by telephone versus in person, the team searched 4 major databases—PubMed, Embase, PsycINFO, and CINAHL. Both randomized and non-randomized studies were considered. Out of 5,944 studies screened, 11 met the criteria for qualitative analysis and 9 were included in the meta-analyses. Notably, 4 of these were randomized controlled trials. The evidence quality was moderate-to-good, lending weight to the findings.
The results were striking! Psychological distress levels were virtually the same, regardless of how the news was communicated. For anxiety, 3 studies with 285 participants found only a negligible difference (standardized mean difference [SMD] 0.10). Similar patterns were seen for depression across 284 participants (SMD 0.10) and PTSD across 171 participants (SMD -0.01). Satisfaction with care was also comparable across both methods of communication.
While the findings may challenge the traditional belief that bad news must always be delivered in person, the authors caution that the available evidence is still limited, with relatively few and varied studies included. The authors conclude that the manner in which bad news is delivered may be more important than the medium itself. Empathy, clarity, and sensitivity remain central to how patients experience such difficult conversations, regardless of whether they take place face-to-face or over the phone.
Journal of General Internal Medicine
The Disclosure of Bad News Over the Phone vs. in Person and its Association with Psychological Distress: a Systematic Review and Meta-Analysis
Jonas Mueller et al.
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