## 4 Discussion
### Intervenient Factors in Communication and Management of Bad News  
The identified dimensions related to the structure of communicating bad news in nursing were the characteristics of the person in a palliative care situation and their caregivers/family members, the characteristics of the nurse, and the institutional and organizational culture. The absence of prior information regarding diagnosis or prognosis significantly influences the reception of bad news and diminishes the individual's inclination to engage in meaningful discussions, respecting their preferences and end-of-life wishes [15; 31]. Difficulties in acknowledging a poor prognosis and in comprehending the limitations and complexities of supportive treatments, conflicting care objectives between family members or the multidisciplinary team, and the reluctance to accept bad news due to the desire to maintain hope for a cure pose barriers to the effective communication of bad news that are directly linked to the patient, family, and caregivers [28; 37]. Regarding the characteristics of nurses, it was found that those who are more experienced, with a greater number of years of professional experience in a given context, generally experience fewer difficulties in communicating and managing bad news with the person in a palliative care situation/family members/ caregivers [15; 33]. However, not only does the number of years of clinical practice contribute to the acquisition of skills, as training in the area of end-of-life communication significantly increases the confidence of health professionals in their ability to have difficult conversations, it also increases their ability to communicate with families in crises, manage emotional needs arising from bad news, manage family and professional conflicts, and manage the communication of bad news at the end of life in general [15; 19; 29; 33]. Organizational and institutional factors also often impede nurses' abilities to have meaningful conversations with the person in palliative care situations and their caregivers/family members. The high workload and inadequate professional/patient ratio often cause a lack of time for nurses to get to know the participants in-depth, building therapeutic relationships so that they can discuss clinical situations as a team, as well as conveniently and adequately inform people [32; 36; 37]. The lack of materials such as brochures or other informative documents and treatment protocols, the lack of home support structures, the insufficient amount of hospitalization spaces when there is a need for symptomatic control or caregiver overload, and the lack of a private place for communication also negatively affect the quality of communication and the deliverance of bad news [37]. Teamwork is mentioned as a factor that facilitates the quality of communicating bad news, promoting reflection on positive and negative interactions and occurrences; facilitating the management of feelings, emotions, and complex situations; facilitating the management of time spent on communication; and allowing caregivers and family members to prepare for the death of the patient [32; 35]. To facilitate the communication of bad news, it is important that the team shares relevant information, such as prognosis andtreatment and care objectives. The possibility for the reference nurse to be present when bad news is communicated, becoming aware of the information shared and the way in which it was shared, facilitates the subsequent management of communication by the remaining members of the multidisciplinary team. This sharing makes it possible to improve the quality of care provided, contributes to improving communication skills within the team itself, increases the satisfaction of the person/caregivers/family regarding the care received, and allows for better management of the emotions of everyone involved [33; 35; 37; 38]. However, there are documented situations in which the multidisciplinary team could become a barrier to communicating bad news.