Breaking Bad News

Question 1

What is bad news?

Answer 1

Any information likely to alter drastically a patient’s view of his or her future

Question 2

What are the key stages in breaking bad news?

Answer 2

• Establishing the patient’s current knowledge and willingness to receive bad news
• Use a warning shot
• Make a direct simple statement
• Address the patient’s agenda- feelings/concerns
• The giving of professional information

Question 3

What are the steps in the SPIKES model?

Answer 3

• Setting and listening skills
• Patient’s perception
• Invitation or Indication( warning shot)
• Knowledge(in small chunks, check understanding, avoid jargon)
• Explore emotions and empathise
• Strategy and summary – arrange the next step/follow-up.

Question 4

How should prognosis be addressed?

Answer 4

Patients generally respond more favourably to positively framed statements e.g

• 40% of patients with this condition will be alive after 5 years
• NOT 60% of patients will die from this condition within 5 years.