Breaking Bad News

Question 1

Step 1

Answer 1

Preparations: setting the room for privacy and confidentiality. Having water and tissues available. Making sure you have all the information. Check if the patient wants anyone there to support

Question 2

Step 2

Answer 2

1. Setting the scene:

• Establish Rapport with the patient, reassures confidentiality
• Elicits patient’s understanding or suspicions-
• Summarises the chain of events and ensures that the patient has an understanding of the purpose of the consultation.
• Enquire what has happened since last visit. Gauge how patient is feeling.

Question 3

Step 3

Answer 3

1. Sharing the information/ process of breaking bad news:

• Gives a warning shot.
• Shares the basic information simply and honestly, without overwhelming patient.
• Check that the patient understands what has been said.

Question 4

Step 4

Answer 4

1. Being sensitive to the patient:

• Allows patient time to process the news. Encourage patient to express her feelings.
• Validates/normalizes the patient’s reaction
• Shows empathy and checks if patient has any questions or needs further explanation.

Question 5

Step 5

Answer 5

1. Planning and supporting:
   • Checks patient’s support structures at home, family or friends. Asks if she needs assistance in telling the news to anyone.
   • Where will she be going after this visit?

Question 6

Step 6

Answer 6

1. Follow up and Closing:
   • Does not rush the patient to make a decision.
   • Sets up an early follow up appointment.
   • Offers availability/ willing to see spouse or relatives as well.