Communicating Bad News to Older Patients from the Physician's Point of View: Focus on the Influence of Gender and Length of Work Experience

Background: Communicating bad news is of great interest in the geriatric field, but few works have considered the physician's point of view in this regard. Objectives: The aim of this study was to explore possible differences related to physicians' gender and work experience in how a terminal diagnosis is disclosed to older patients. Methods: Study participants were 420 Italian physicians (277 M, 143 F) working in clinical medicine (58.2%), surgery (33.3%), or other medical departments (8.5%). They completed an anonymous multiple-choice questionnaire that investigated various issues associated with communicating bad news to terminally ill older patients. Results: Men had more work experience than women (55.6% vs. 44.8% had worked for ≥23 years) and were more likely to work in surgery departments, while more women worked in clinical medicine. Most physicians declared that terminally ill older patients, if mentally competent, should always (14.4%) or generally (64.3%) be directly and openly informed of their condition. With no difference in gender, length of work experience, or specialty area, 36.9% of physicians thought that this was a human right and 18% that it would improve the patient's quality of life. Where older patients were alone, male physicians were more likely than female (30.2% vs. 8.9%) to always communicate bad news directly to them. More than 70% of physicians, especially those with longer work experience, declared that they always or often took enough time to inform the patient. Female physicians and those working in clinical medicine were more likely to need psychological help when deciding to break bad news, but only a smaller proportion declared to have received it. Conclusions: Gender and work experience may influence how physicians communicate with patients and how often they seek psychological support.