Breaking Bad News

Question 1

Goals of breaking bad news?

Answer 1

1. Gather information from the patient
2. Provide information to the patient
3. Support the patient in their emotional response
4. Involve patient in the planning of treatment

Question 2

Structure of breaking bad news?

Answer 2

Ask (yourself)
Ask (the patient)
Tell (the patient and guardian)
Ask (the patient)
Ask (the patient)
Plan (the future!)

Question 3

First Ask?

Answer 3

Ask yourself
…is this the right place?
…am I the right person?
…do I have time?
…is my phone switched off?
…do I have any urgent engagements to attend to?

Question 4

Second Ask?

Answer 4

Ask the patient
…what do they understand about what is wrong with them?
…would they like to know more?
…would they like someone else to be with them?

Question 5

Tell?

Answer 5

First fire a warning shot
And then
…in simple language, slowly and clearly what is wrong with them
…avoid euphemisms
then wait…
* observe any response…
* allow time for silence…

Question 6

How do you fire a warning shot?

Answer 6

1. I’m sorry I have some difficult news’…would you like to hear more now?
2. Are you the sort of person who likes to know what is going on …even when
   it’s not so good?

Question 7

Third Ask?

Answer 7

Ask the patient…
…do they understand what ‘cancer’ means? (or any other ‘technical words’
which may be unfamiliar)

Question 8

Fourth Ask?

Answer 8

Ask the patient…
* …do they have any questions?
* …what are their main concerns?

Question 9

Plan?

Answer 9

Plan with the patient…
1. who will see them and when?
2. how can we address their main concerns?
3. what treatment will they be receiving and why?

Question 10

What are the pitfalls of effective communication in BBN?

Answer 10

1. Giving a pathophysiology lecture
2. Not finding out the patient’s information needs
3. Launching into your agenda first without negotiating the focus of the
   interview
4. Offering reassurance prematurely