Breaking bad news H&S

Question 1

What is bad news?

Answer 1

Any news that drastically and negatively alters the patient’s view of his or her future

Question 2

What can make breaking bad news difficult?

Answer 2

• Institutionalised beliefs
• Relatives
• Personal reasons
• Personality types
• Gender
• Culture/race

Question 3

As a clinician, what could worry you about breaking bad news?

Answer 3

1. Uncertainty about the patient’s expectations
2. Fear of destroying the patient’s hope
3. Fear of their own inadequacy in the face of uncontrollable disease
4. Not feeling prepared to manage the patients anticipated emotional response
5. Embarrassment at having previously painted too optimistic a picture for the patient

Question 4

How to break bad news

Answer 4

1. S - Setting up
2. P - Perception: how much do you know
3. I - Invitation: what do you want to know
4. K - Knowledge: how much do you want to know
5. E - Emotions: I am sorry / silence - pauses
6. S - Strategy and summary: follow up plan

Question 5

Characteristics of the grief response

Answer 5

1. Numbness for up to 2 weeks
2. Distress and acute grief for 6 months
3. Period of adjustment for 6-12 months
4. Anger
5. Denial
6. Fluctuating mood
7. Preoccupation with the situation
8. Agitated and restless
9. Vegetative signs/symptoms