Pastoral Thanatology: Healthcare and Delivering Bad News

Healthcare unfortunately sometimes sees patients as win or lose.  Was the patient saved or cured or did the patient die is the common judge of success.  Death, disease and incurable ailments though are part of life and healthcare should not see the death or survival of an individual as a grading process of competence.   While all measures and standards of care should be performed and addressed properly, sometimes patients die or cannot be cured and the end result should not be seen as defeat in healthcare.  Instead healthcare professionals must be able to extend themselves to another level of care that looks to treat the entirety of the human person who is dying.   When the person who is terminal receives the best care that reduces physical and emotional discomfort, then a healthcare professional can truly say they succeeded.  Success should be graded on giving the best that is available both physically and emotionally.

Unfortunately, not all healthcare professionals are equipped with training to give bad news to patients and family


Many physicians and nurses are not well versed or well trained to give bad news though to the terminally ill or able to communicate the death of a loved one to a family.  Instead, many times, it is handled very sterile or avoided at all costs.  Elisabeth Kubler Ross began to turn the table in the 1980s on this sterile and numb approach to communicating death.  It, however, involved an entire re-understanding of life and death, medical success vs medical failure and a better understanding of helping those in grief.   Of course, this led to Elisabeth Kubler Ross’s famous 5 stages of grieving, which mistakenly were applied to grief in general, when they were designed to retrace reactions of the terminal ill to death.  Denial, anger, sadness, bargaining and ultimately acceptance became the norms of grief reaction and they mistakenly became seen as fixed, sequential stages, instead of reactions of the terminally ill to bad news.  They still serve as foundational pieces of emotions associated with loss and can be utilized in helping those in healthcare to react to the emotional response to death and loss itself.

Since the turn of the century, the need of grief counseling, pastoral counseling and training in giving bad news to patients has increased.  While many healthcare professionals still lack bed side manner, the push to train and certify,  and prepare others through module training programs has increased.  Healthcare facilities are starting to see the need of trained professionals who can deliver the necessary news in a solemn and professional manner.

Terminal diagnosis is difficult to communicate and requires training to properly tell patients


In regards to this, those trained learn a variety of grief theories about loss, crisis intervention, and communication skills.  In many cases, the patient or family is already in a sense of anxiety due to the wait and emotions are tense.  Caregivers should be prepared for a myriad of emotions that can erupt when a bad diagnosis, or death is revealed.  Understanding the situation, being calm, and allowing the individuals to express initially is key.

While many caregivers would rather keep it simple, detail is important.  The family or person will have numerous questions.  A facility should have a quiet and private place to be able to aid the family in digesting the news.  Questions will emerge and answers should give the most up to date factual information regarding the situation.  In some cases, crisis intervention and emotional support will be required, but one should not limit information.  Information should be given as the family is able to digest it.  A later follow up meeting may be needed to allow the family to grieve until they are able to ask more logical questions.  Hence communication of diagnosis is key but also an understanding of the family system and the emotional response.  Each experience will be unique and require adjustment in how it is presented.  Silence, or avoidance however is never the answer.

The article, ‘Delivering Bad News to a Patient” by Monden, K., et. al. takes a closer look at question system employed by Rabow and McPhee.  The article states,

“Rabow and McPhee also proposed a model for delivering bad news called ABCDE: A, advance preparation; B, build a therapeutic environment/relationship; C, communicate well; D, deal with patient and family reactions; and E, encourage and validate emotions”

Monden, K.,  Gentry,  L., Cox, M. (2016). Delivering bad news to patients. Baylor University Medical Center. 29(1). 101–102.

Access here

Within the context of terminal diagnosis, the bad news could be shocking to those present but it could also be divisive.  Some family may wish to keep things a secret, or others may enter into a state of denial, while some may optimistically seek next step solutions.  It is essential to understand the state of shock the family is in and to accurately give the diagnosis, statistics and courses of option.

Giving bad news requires finding a quiet place and the patience and understanding of human reaction to loss

Within immediate death, some family may want more details, while others may fall into silence.  Others my need crisis intervention, coping advice, or the aided in relaxing from the traumatic news.  Again, training modules with case studies can help prepare healthcare providers with better methods to alleviate the pain and better aid the family in hearing the horrible news of the death.

While some healthcare professionals are naturally better at helping families emotionally, there still must be a continued emphasis on training.  Many families leave without any emotional support, confusion, and lack of full information regarding the death or the terminal diagnosis.  This only compounds the trauma and emotional stress.  Hence it is important that training be applied to all staff.  It is fine to have one particular staff member who is more emotionally able to communicate bad news, but sometimes, it is still essential for the primary care giver to be able to answer questions and help those in distress.

AIHCP offers a certification in Pastoral Thanatology that aids professionals in learning more about caring for the terminally ill as well as being better equipped to communicate difficult diagnosis or news.  The program equips professionals with knowledge on grief counseling as well as care for the terminally ill.  It also equips the professional with information on death itself and multiple cultural, pastoral and religious beliefs related to death.  The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology.  While many chaplains take the program, it is highly encouraged that nurses and other healthcare professionals also learn more about pastoral care of the dying and giving bad news.


Postavaru, G., McDermott, H., Biswas, S., Munirm, F. (2023).  Receiving and breaking bad news: A qualitative study of family carers managing a cancer diagnosis and        interactions with healthcare services. Leading Global Nursing Research,  79(6). 2211-2223.

Coyle, N. , Manna, R., Shen, M., Banerjee, S.M,  Penn, S, et. al.   (2015). Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.       Clinical Journal of Oncology Nursing 19(6). 697-702.

Monden, K.,  Gentry,  L., Cox, M. (2016). Delivering bad news to patients. Baylor University Medical Center. 29(1). 101–102.  Access here

Additional Resources

“How can doctors share bad news with patients?”. Beresford, L. (2017). Medical News Today.  Access here

“Delivering bad news: Helping your patients retain dire details”. Augnst, H. (2009). Contemporary Pediatrics. Access here

Difficult Decisions with a Terminal Illness Video

In addition to the many painful emotions associated with a terminal illness of a loved one, there are also numerous decisions that need to be made for his or her future.  Whether an aging parent, or a young child, and anything in-between, the difficulty in helping the loved one through this final phase can be difficult.

Beyond the emotional pain of dealing with a terminal diagnosis of a loved one also involves numerous medical and legal decisions. Please also review AIHCP’s Pastoral Thanatology Program


One needs to start considering possible therapies and treatments but also quality of remaining life versus quantity of days.  Should one remain in a healthcare facility with treatments unproven or accept the inevitability of death and find joy in the final days of life?  These decisions are not easy and especially made harder when the person is unable to make choices regarding their own health.

Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology



Please review the video below

Terminal Diagnosis Reactions and Grief in Pastoral Thanatology

It is terrifying to be diagnosed with a terminal illness or to discover a close family or friend discovers such a terrible diagnosis.   There are many existential reactions to such a proclamation.  Individuals respond differently to such a thought.  Finally death becomes a reality and how one deals with this reality determines one’s final chapter of life.  This video reviews the many aspects and reactions that accompany a terminal diagnosis.

A terminal diagnosis is an existential blow to many, Learning how to handle and cope is key to living one’s last chapter of life. Please also review AIHCP’s Pastoral Thanatology Program


Please also review AIHCP’s Pastoral Thanatology Certification and see if it meets your academic and professional goals.  The program is online and independent study and open to qualified professionals seeking a four year certification in Pastoral Thanatology.


Please review the video below

Grief Counseling Certification Blog on Facing a Terminal Diagnosis

Upon a worrisome visit to the doctor, eventually in one’s life, one will come to the grips of existential crisis, where one must deal with a life or death illness, or hear the terrifying words, that one is dying.  For some, these words come earlier in life, for many, later, and for some, death can come like a thief in the night.  Those who are granted the ominous warning are given a blessing and a curse.  A blessing to prepare oneself and others, to put things right and affairs in order, but also a curse in knowing the clock is fearfully clicking to a deadline that is unavoidable. Please also review AIHCP’s Grief Counseling Certification.

There is a myriad of emotions and feelings that one goes through when a terminal illness is announced.  An existential reality of one’s own finite nature is made rawly known to the intellect.  What was once considered an abstract but real concept suddenly becomes personal and intimate.  One comes to the conclusion that death will concretely and definitely happen.  It is no longer a future imaging of how but becomes a concrete concept of now and here.  Please also review AIHCP’s Grief Counseling Courses

A terminal diagnosis brings oneself to one’s final chapter in life. It is a scary time but there are ways to face death. Please also review AIHCP’s Grief Counseling Certification


How one perceives life and existence itself plays a large role in the existential dread of this bad news.  Levels of fear and anxiety are measured and varied in regards to one’s own existential beliefs.   Someone who is profoundly convinced of life after death and molded by an undying faith, may feel a sense of fear, but also a sense of hope and reward, while one who holds empiric and only observable phenomenon as a basis for existence, may feel a deeper dread of creeping into nothingness.   Some individuals are less attached to the temporal reality and are able to sense a stronger sense of purpose and peace beyond the observable world.  Those of this deeper faith, whether rightly placed or not, will react quite differently to the bad news of approaching death than one of lesser or no faith.

Fear of the unknown still exists even if in the smallest grain to the faithful.   So naturally, the evolutionary push to exist when challenged will spring forth within the soul a type of fear.   The fear of the unknown still exists for those of faith, but the levels of fear that may surround one who is terminally ill, differs greatly in intensity.   One of faith upon the announcement of bad news will definitely still feel a sense of fear and be forced to reckon with the unknowable.   This type of fear is a natural reaction.  Since one’s conception, the urge to exist is programmed within the body.  The urge remains a strong driving force.

For those facing death, a general fear may also be replaced with a more acute fear of the now.  Fear of sharing this news, or keeping it to oneself.  Fear of the disease itself and what this particular disease may do to one’s body during the final phases.  Oneself may fear the pain, the treatments, the side effects and quality of life or even the fear of leaving family and children without one’s guidance and protection.   Obviously these are grounded fears to one who has come to a firm acceptance.  While initially one may be swarmed with questions and options, one may soon find oneself consumed with collecting as much information about the disease or condition,  understanding pain management or reviewing various extraordinary measures to preserve life. Understanding the enemy can sometimes qualm some fear and even give a glimpse of hope.  One finds oneself with more power over fear when one faces the enemy across oneself.   Some individuals face the enemy, while others choose to live in fear and hide from it.  One in the end accepts how they will face death, either with a strong will, or a broken one.  Accepting death but facing it with a strong will despite fear is the true definition of courage.

Due to this natural fear of death, even among the most spiritual and religious, one when faced with this terrible thought will undoubtedly deny it.  Elisabeth Kubler Ross who worked with the terminally ill observed this natural human reaction to reject bad news initially.   Something so frightful at first refuses to be processed by the brain.  Bad news is met with an equally powerful rejection of it.   As one receives this bad news then, one will probably initially reject the sentence of death.  How long this reality takes to sink in may differ among some.  Some may seek additional medical opinions, until all options are removed.  Others will proceed with elaborate alternative therapies in hope of a cure.   For some, hope can be a evolutionary device for survival.  It definitely is not something to rejected but when hope blinds oneself to such an extent that is masquerading as denial, then it can become problematic to oneself and prevent oneself from dealing with the reality of death.

Death itself is a process that many run and flee from.  Evolution to survive engrains this feeling into oneself.  Yet, if one stops and realizes that death is a process one must face, then maybe one can allow oneself the process of dying properly.  Many cultures value a good death.  A good death is as part of life as birth.  Dying well, handling oneself well and maintaining dignity is critical to the last chapter.  Long term denial strips one the opportunity to handle affairs, repair relations, prepare the mind body and soul and live the final chapters.  So, absolutely, upon terminal diagnosis, one will feel fear and denial and this is OK.  What one does not wish to continue to entertain is a long term denial.   Hope should not be squashed, but denial should not be masked as hope either.

Oneself may think if one ignores the horrible diagnosis that it will go away.  For this reason alone many in denial, may keep a terminal diagnosis as a secret from friends and family.   One will ignore checkups and important procedures and postpone wills and other critical business at hand.   These types of secrets are part of denial at its core.  Oneself may feel as if one is sparing others grief, but this type of internalization of bad news only denies the reality and creates less time for others to express love and accept reality.

Following this diagnosis, other emotions may erupt within oneself.  As Kubler Ross points out in her famous stages of grief, one experiences far more than denial upon the initial announcement of bad news.   One will experience also a range of emotions with the first minutes or days or weeks or months.   Anger is a powerful emotion that may erupt.  One may find oneself angry at God, or others.  One may feel one’s life has been stolen or cut short.  Others may become jealous of others who were granted better health.   Again, in grief, one cannot deny these initial feelings, but understand them and see where this anger comes from.   While one may feel like they may be treated unfairly, one cannot allow anger to turn into envy and become caustic within one’s very being.  There is little time left with a terminal illness and negative emotions and negative energies while acknowledged should not be permitted to fester, unless one wishes for the soul to also suffer with the body.

With the lamenting of death, some will feel greater melancholy.  How long one grieves the impending loss of life, like fear itself, varies upon the spiritual nature and resilient nature of oneself.   One should clearly come into contact with the sadness of loss of one’s physical life, but again, like anger, it is important to evaluate the emotion within its proper degree.   Some may go into a deep depression or no longer wish to live.  Oneself may recede to the shadows well before the date of death.   When sadness of this level overtakes oneself, then one must realize that the diagnosis is now taking more life than it originally took before.  The intense grief is taking what is left.  It is stealing the final days of sunshine, family memories and expression of love.

With such deep emotions, sometimes it may be good to express these feelings.  Some may find solace in their family and friends, but others may feel a fear to cause them more pain.  While this is noble, in many ways, family and friends wish to help one carry this cross.  Oneself should not feel isolated to the point where one has none to share the fear and emotions of dying.  An additional option is finding others in support groups or other social venues where others of like diagnosis can meet and share emotional fears and acute physical symptoms.  A good balance between sharing with family and other like diagnosed individuals can play a great tool in helping one face the emotions of one’s diagnosis.

Kubler Ross pointed out that many may also bargain. As if one has a final say with the grim reaper, oneself may feel the need to negotiate with the angel of death.  This sense of powerlessness is lessened with bargaining and creates an illusion as if oneself can negotiate the final days.   Oneself may ask, if I can only have an extra year, or have only this procedure instead the other procedures.  This illusion of power and control over death is merely another way oneself may try to create one’s own ending.   Instead of focusing on “ifs”, oneself should focus on the realities and what can be done within the time given.  Less time bargaining and more time doing is a far better way to accept the angel of death.

How will you face the angel of death and one’s own existential reality when the time comes? Please also review AIHCP’s Grief Counseling Certification


Upon this terrifying news of one’s own impending death, one can react in a multitude of ways, intellectually and emotionally, but while no emotion is initially to be ignored, there is clearly a better way to face death.   It is up to you, the person facing the terminal illness, how you will face the final chapter in your life and no-one else but you can author that chapter.

If you would like to learn more about death and dying, or about AIHCP’s certification programs in Grief Counseling and Pastoral Thanatology, then please review AIHCP’s online programs.  The Grief Counseling Certification and Pastoral Thanatology Certification Programs are both online and independent study and open to qualified professionals seeking a four year certification.



Additional Reading

Elizabeth Kubler Ross Stages of Dying.  Please click here

10 Practical Tasks to Help You Deal With a Terminal Illness” by Chris Raymond

Terminal Illness : What To Expect” from Mantra Care

Terminal illness: Supporting a terminally ill loved one” from the Mayo Clinic

Dealing With Terminal Illness” from the Charity Clinic