With great interest we have read the scientific letter by Abellán Lucas and Vallve-Bernal entitled “Communication with patients and their families: how to deliver bad news” published in your journal.1 We are We are deeply grateful that these issues, traditionally relegated to the ‘hidden curriculum’; what is implicit or learned by imitation, such as the surgeon's communication skills, have been addressed openly here.
Recently we experienced a situation that has led us to reflect on the limits of these skills in real environments and how their absence or deficient application can directly affect the emotional well-being of our patients' relatives.
After emergency surgery on an 87-year-old female patient with multiple pathologies, she developed a respiratory complication and was transferred to the Resuscitation Unit. There, given the lack of response to intensive treatment, the family was informed of the decision (not openly agreed with them) to adapt the treatment effort and implement palliative measures, adding that the patient would be transferred to the ward "where she would be better, accompanied by her relatives".
There was no mention of the extreme seriousness, the irreversible nature of her situation or the imminence of death. No words were used that would suggest near death, quite the opposite: “… she’d be better back in the ward”. Hours later, when the patient's situation worsened even further, the relatives found themselves bewildered, overwhelmed and, above all, uninformed. They were not aware that the situation was irreversible nor did they expect the outcome, since the intervention had gone well. “Delivering the bad news” had been carefully avoided.
As the article rightly points out, ‘bad news is defined as any information that negatively affects a person's outlook for the future’. and its delivery requires planning, clarity and honesty, especially in urgent contexts.1,2 In this case, the absence of words such as “death”, “passing” or “end of life” deprived the family of an essential resource: emotional preparation for the impending loss..3–6
The article rightly points out the risk of reducing this human process to a merely informative and protocolised event. However, it also highlights the usefulness of structured frameworks such as SPIKES 7,8 or SUNBURN, 9 which can help us not to shy away from uncomfortable words and to conduct difficult but necessary conversations with sensitivity. Various adaptations in Spanish, such as the EPICEE model or the ABCDE protocol, have also been shown to be useful in improving communication in critical situations.
We must accept that death is a reality, not the failure of medicine. As surgeons, we are not only responsible for operating but also for accompanying, guiding and supporting patients and families at the most vulnerable times. Learning to communicate death is part of that care.
FundingNo specific support from public sector agenciescommercial sector, or not-for-profit organisations was received for this research study.
Conflict of interestsThe authors have no conflict of interests to declare.
