Bad news, bad behavior: The communication of bad news and aggressive behavior in healthcare. A multicenter retrospective italian study

Background: The communication of bad news in healthcare is a critical factor in patient care and workplace safety. Ineffective communication can contribute to emotional distress and aggression toward healthcare professionals. Despite its importance, many professionals lack the necessary training to manage these conversations effectively, increasing the risk of conflict. This study investigates the relationship between communication breakdowns and workplace violence in healthcare settings. Methods: This retrospective observational study analyzed incident reporting data from two major Local Healthcare Authorities in Southern Italy (2019–2023). Reports of aggression toward healthcare professionals were categorized by type (verbal or physical), triggering event, location, severity, and aggressor identity. Chi-square tests and linear regression models were used to identify trends and associations. Results: A total of 248 reported incidents were analyzed, with 85.1% classified as verbal aggression and 14.9% as physical aggression. The primary trigger was disagreement over clinical management (57.4%), followed by perceived delays in care (25.5%) and denial of assistance by family members (11.7%). Most incidents occurred in community-based healthcare services (42.6%) and emergency departments (25.5%). Family members were the primary perpetrators of physical assaults (64.3%), while patients were responsible for most verbal aggression (55.3%). Conclusions: Poor communication strategies contribute to workplace violence. Improving healthcare professionals’ communication skills through structured training, implementing conflict management strategies, and strengthening security measures in high-risk areas are crucial for reducing aggression. Future research should explore additional risk factors and assess the effectiveness of targeted interventions