Receiving and breaking bad news: A qualitative study of family carers managing a cancer diagnosis and interactions with healthcare services.

Aims: To explore family carer experiences of managing the process of receiving and breaking bad news about cancer.

Background: Family carers' experiences of bad news are underrepresented in the literature. This study involved oncology staff with personal experience of caregiving and carers to develop broader insights into the range of needs and difficulties experienced by family members in the process of managing a cancer diagnosis. This can help facilitate subsequent interactions with healthcare professionals and improve continuity of care.

Design: This is a descriptive qualitative study informed by the theory of social constructionism. Data were analysed using template analysis.

Methods: Data were collected using semi-structured interviews and focus groups with 4 healthcare professionals and 17 family carers between January and July 2018. A purposive sampling strategy was used. Interviews were transcribed verbatim to explore participant experiences and perspectives on family carers managing a cancer diagnosis.

Findings: Three key themes were identified: (1) receiving the bad news; (2) management of bad news and (3) interaction with healthcare and support services. These and associated subthemes are discussed, with recommendations for future research and practice.

Conclusions: There was variability in the experiences and needs of carers involved in receiving and breaking the bad news.

Impact: Although family members experienced a multitude of difficult emotions when the bad news was shared, they were not often able to discern help from healthcare professionals with sharing the diagnosis with the patient and others. This impacted on access to and use of healthcare and support services. Individualized approaches to communication are needed to enable carers to seek support and provide perspectives on the patient home environment and family structure. This can help tailor breaking the bad news and care plans.

Public Contribution: Anonymised results were shared with family carers to validate the congruency of the codes with their experiences.