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" In Denmark, we’ve developed communication thus far for almost all IT systems in the health sector. We have implemented all prescription and medication information, and all discharge letters and summaries from hospitals. This also includes outpatient notes, injury reports, x-ray reports, lab reports and lab orders. Reimbursements from health insurance have been made electronic, along with referrals to hospitals and private specialists, and referrals to psychologists. All private physicians have electronic health records today so they can communicate and transfer documents electronically, as well.

From the beginning it was a grassroots effort; we thought it was a good idea to exchange information electronically. And now it has become mandatory that you must communicate electronically. There was a state-wide agreement that this was a good idea."

A new set of interactive guidelines have been created to help clinicians more effectively communicate when they deliver bad news to patients.

COMFORT is an acronym that stands for Communication, Orientation, Mindfulness, Family, Ongoing, Reiterative, and Team.

Communication- Clinicians need to learn to how to use clear and familiar language
when breaking bad news. Patients are people and have the basic right of receiving information in a manner that makes sense to them. Communication between doctors and patients should strive to be person-centered and nonverbally direct.

Orientation- Low health literacy leaves most patients and their families with little choice
about their care. A patient receiving bad news will be overwhelmed, and will often respond to any clinician recommendations, even if they are ineffective. Treatment outcomes should be clearly articulated in language that is appropriate for both the age and education level of the patient.

Mindfulness- Doctors need to learn to treat each patient interaction separately. When
delivering bad news, the patient should be at the center of the doctor’s attention.
Focusing on a patient’s individual experience requires doctors to avoid basic scripts and protocols.

Family- Families should be included in conversations when doctors break bad news
to patients, since families provide support to the patient. Families are also affected by illnesses, and clinicians need to address both the patient and their family.

Ongoing- Clinicians must emphasize that the patient will not be abandoned after a
diagnosis, or while they receive ongoing treatments. By continually communicating with patients, clinicians can provide more clarification about the diagnosis, especially if the recovery will not be quick.

Reiterative- When interacting with a patient, clinicians need to keep the meaning behind
their messages the same, even if the message delivery takes different forms over time. The message must always adapt to fit the needs of the patient.

Team-Patients receive care from a team of medical professionals, including physicians,
nurses, chaplains, psychologists, and social workers. Communicating as a team will help reassure patients and their families that they will be receiving proper care.

This study appears in Volume 59 of Communication Education, a publication of the National Communication Association. For more information about NCA or its journals, please visit www.natcom.org.