Royal College of Surgeons in Ireland
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Breaking bad news: tackling cultural dilemmas

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journal contribution
posted on 2021-10-08, 09:01 authored by Sophie Nilusha Holmes, Jan IllingJan Illing
Requesting that serious diagnoses be concealed from patients, a widespread phenomenon in many cultures, presents a professional dilemma. Practical and sensitive communication strategies are needed.
Methodology: In this paper, we use analysis of the existing literature to develop a communication tool for practitioners facing requests for diagnostic non-disclosure. Our approach builds on existing strategies, in providing a mnemonic communication tool, permitting more than one outcome, and focusing on the need for mutual understanding and cooperation.
Results: Existing work on this dilemma highlights the need to appreciate the family's standpoint, affirm their benevolent intentions and correct misperceptions. To this end, we have developed a mnemonic tool, 'ARCHES', to be used in situations where the family has requested diagnostic non-disclosure. The model has six stages: acknowledge the request for non-disclosure, build the relationship, find common ground, honour the patient's preferences and outline the harm of non-disclosure, provide emotional support and devise a supportive solution.
Conclusion: Facing requests for diagnostic non-disclosure is a challenge of communication. The dilemma is particularly marked when practising across cultures. Our model gives a structure for building rapport with the family and realigning their misperceptions while upholding the patient's right to knowledge.



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Published Citation

Holmes SN, Illing J. Breaking bad news: tackling cultural dilemmas. BMJ Support Palliat Care. 2021;11(2):128-132.

Publication Date

19 May 2021

PubMed ID



  • Health Professions Education Centre

Research Area

  • Health Professions Education




  • Published Version (Version of Record)