{
  "abstract": "Background Caring for dying patients and their distressed families can be traumatic. For physicians, these encounters shape the way they see, act and feel as professionals, influencing the inculcation and display of their professional expectations and values—otherwise known as professional identity formation (PIF). When inadequately supported, such changes in PIF can impact patient care, family support and teamwork. With recurrent, brief yet emotionally charged interactions with patients and families especially likely to predispose to moral distress, compassion fatigue and burnout, we propose a review into how breaking bad news (BBN) to patients and families impacts PIF and this personal cost of caring.Methods Framed by the modified-Systematic Evidence-Based Approach, we conducted a systematic scoping review of studies on BBN published between 2000 and 2024 in PubMed, Embase, Scopus, CINAHL and PsycINFO. To chart changes in PIF, we employed the Ring Theory of Personhood (RToP). Thematic and RToP-guided content analyses were concurrently performed, supplemented by ChatGPT-5 to the triangulate human-led analysis.Results 15 786 titles and abstracts were identified, 346 full-text articles were reviewed and 31 were analysed. BBN demands physicians balance familial goals while preserving patient interests. This predisposes to the personal cost of caring and impacts PIF. These effects are aggravated by ineffective organisational support.Conclusion BBN impacts PIF and triggers the personal cost of caring. Greater use of team-based approaches in BBN to families should be adopted in practice while training and longitudinal assessment in these approaches should be integrated within purpose-designed, holistic programmes.",
  "authors": [
    {
      "affiliations": [
        "Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"
      ],
      "name": "Cheng Yat Tan"
    },
    {
      "affiliations": [
        "Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"
      ],
      "name": "Nicholas Wei Hong Thum"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore"
      ],
      "name": "Trivikram Mohan"
    },
    {
      "affiliations": [
        "Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"
      ],
      "name": "Aidan Kay Jan Cheng"
    },
    {
      "affiliations": [
        "Yong Loo Lin School of Medicine, National University of Singapore, Singapore",
        "Centre for Biomedical Ethics, National University of Singapore, Singapore"
      ],
      "name": "Ranitha Govindasamy"
    },
    {
      "affiliations": [
        "Division of Cancer Education, National Cancer Centre Singapore, Singapore"
      ],
      "name": "Nur Amira Binte Abdul Hamid"
    },
    {
      "affiliations": [
        "Division of Cancer Education, National Cancer Centre Singapore, Singapore",
        "Duke-NUS Medical School, Singapore",
        "Division of Medical Oncology, National Cancer Centre Singapore, Singapore"
      ],
      "name": "Simon Yew Kuang Ong"
    },
    {
      "affiliations": [
        "Division of Cancer Education, National Cancer Centre Singapore, Singapore",
        "Duke-NUS Medical School, Singapore",
        "Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore",
        "Medical Affairs, National Cancer Centre Singapore, Singapore",
        "SingHealth Duke-NUS Medical Humanities Institute, Singapore",
        "School of Health Sciences, University of Dundee, Dundee, UK",
        "Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK",
        "Health Data Science, University of Liverpool, Liverpool, UK",
        "PalC, The Palliative Care Centre for Excellence in Research and Education, Dover Park Hospice, Singapore"
      ],
      "name": "Lalit Kumar Radha Krishna"
    }
  ],
  "title": "Breaking bad news and the cost of caring on physicians: a systematic scoping review",
  "uid": "a7729f23-acf0-58a2-b2d2-f4f6fc80470f"
}