1 When giving bad news, ensure that the setting is appropriate, and ensure patient’s confidentiality.
2 Give bad news:
– in an empathic, compassionate manner
– allowing enough time.
– providing translation, as necessary.
3 Obtain patient consent before involving the family.
4 After giving bad news, arrange definitive follow-up opportunities to assess impact and understanding.
6-step protocol for communicating bad news (see SKDIFF below)
- Getting started
- Confirm the medical facts of the case. Ensure that all the needed information is available. If this is an unfamiliar task, rehearse what you will say. Don’t delegate the task.
- Create an environment conducive to effective communication.
- A box of facial tissues should be handy.
- Allot adequate time for the discussion
- Ensure that the right people are present.
- What does the patient know?
- Start by establishing what the patient and family know about the patient’s health
- What do you understand about your illness?
- How much does the patient want to know?
- Each person has the right to voluntarily decline to receive any information and may designate someone else to communicate on his or her behalf. Find out how the patient would like to receive information.
- If this condition turns out to be something serious, do you want to know?
- Rather than confronting family members’ request not to tell with “I have to tell the patient,” explore why they do not want you to tell the patient. Suggest going to the bedside together to find out what the patient wants to know.
- People handle information differently
- Sharing the information – deliver the news
- break bad news by using language like: · I’m afraid the news is not good. The biopsy showed that you have.…
- Deliver the information in a sensitive but straightforward manner.
- Responding to patient and family feelings – make empathetic statements
- I imagine this is difficult news…
- Outbursts of strong emotion are an expected component of information sharing. Learn how to cope with this.
- Planning constructively and follow-up
- Setting: quiet, private, ensure confidentiality, ask if anyone should be present
- Knowledge: how much pt knows, note level of understanding
- Detail: how much or little the pt wants to know
- Information: use language that is easy to understand
- Feelings: empathy
- Follow-up: summarize, ask if questions/concerns, plan a f/u
Where Language is a barrier:
Avoid using family members as primary translators. It confuses their role, frequently compromises the therapeutic quality of the interview, and may compromise some patients’ desires for confidentiality.
- Inquire why the patient and family are asking in order to have a sense of their context for the question.
- Give an accurate estimate of prognosis when requested.
- How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman