Communicating bad news

Question 1

21. Psychotherapeutic steps in the communication of bad news

Answer 1

1. The concealment of the nature of the illness, of bad news
2. The immediate and comprehensive information of the patient (the model of prompt, full disclosure)
3. Information tailored to the needs of the patient, which is disclosed gradually, and in several steps (the model of gradual disclosure)

Question 2

1. circumstances of communicating bad news

Answer 2

a. face to face
b. bad news has to be disclosed to the patient himself
c. informing a relative may be done only with the permission of the patient
d. we have to provide a convenient place (consultant room) and time for the conversation

Question 3

2. the process of communicating of bad news

Answer 3

a. we explain what the examination is specifically aimed at
b. we tell the patient about our suspicious regarding the disease
c. we tell the patient why is it specifically necessary to perform this examination

Question 4

3. preparation (setting up the interview)

Answer 4

a. suitable place
b. enough time
c. water, glass, tissue paper
d. ask the patient whether he would like one of his relatives to present during the conversation

Question 5

4. opening questions (assessing the patient’s perception)

Answer 5

a. ex. How do you feel?

b. On the basis of his knowledge and experiences so far what does he currently think of his illness?

Question 6

Giving the news

Answer 6

• Ask for consent
• information about the illness
• supportive behaviour (address emotions with empathic responses)

8. handling of difficult questions
   a. Am I going to die?
   i. Be honest and supoortive
   ii. We should admit what we don’t know