Breaking Bad News

Question 1

What is bad news?

Answer 1

Any news that drastically and negatively alters the pt view of the future

Question 2

Why is it difficult to give bad news?

Answer 2

Fear upsetting pt/life
Not knowing the pt - resources/limitations
Fear of implications for pt - pain, social
Fear of pt emotional reaction

Question 3

What are the 3 steps to giving bad news?

Answer 3

1. Preparation
2. Discussing the news
3. Reviewing the situation

Question 4

How should you prepare to give news?

Answer 4

Consider

1. Information to be given
2. Setting of interaction
3. Time considerations

Ask Self

1. Is pt expecting bad news - what do they know?
2. Should anyone else be present
3. Can you prepare self for any questions

Question 5

What is process of giving bad news?

Answer 5

Give information
Check pt understanding 
Identify main concerns
Elicit pt personal response 
Decide management

Question 6

What are the 3 main skills in Calgary-Cambridge framework when giving bad news?

Answer 6

1. Find out what they know
2. Find out what they want to know -active listening/ understand perspective
3. Give information - minimal jargon

Question 7

What is empathy?

Answer 7

Experience of understanding another persons condition from their perspective

Question 8

What is an empathetic response?

Answer 8

Identify the emotion, the cause and show connection made

Avoid platitudes and false sympathy

Question 9

How should decision making happen?

Answer 9

Shared process

1. Share own thinking - ideas/ dilemmas
2. Involve pt - suggestions > directives
3. Explore management
4. Ascertain level of involvement pt wishes to have
5. Negotiate mutually acceptable plan
6. Check w/ pt