Is there consensus between breast cancer patients and providers on guidelines for breaking bad news?

Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. At least 70% of the three samples rated 7 of the 15 principles and 6 of the 12 steps as essential. All three groups agreed that patients have a legal and moral right to accurate and reliable information and that patients should be given the diagnosis and prognosis honestly and in simple language, though not bluntly. The groups differed on the relative importance of other items, with less variation about the steps than about the principles. Patients' perceptions of the importance of various guideline steps and principles are probably most important, given that patients receive the troubling news and that research indicates that how the news is delivered is associated with important patient outcomes. Recommendations for further research are discussed.