Lecture 4.1: Breaking Bad News

Question 1

What is Bad News?

Answer 1

Any information that drastically alters a patient’s view of their future for the worse

Question 2

Why is it important to tell patients when there is Bad News? (5)

Answer 2

• To maintain trust
• To reduce uncertainty
• To prevent unrealistic expectations
• To allow appropriate adjustment
• To promote open communication

Question 3

Why is it difficult to break Bad News? (8)

Answer 3

• Fear of unleashing a reaction i.e. anxiety, crying or anger
• Not being able to adequately deal with patients’ emotions
• Feeling incompetent in communicating the facts empathetically/professionally
• Afraid of not knowing all the answers
• Not knowing how to behave or what to say
• Not having enough time for questions and discussion
• Fear of being blamed
• Fear of making things worse

Question 4

What is SPIKES?

Answer 4

S: Setting and Listening Skills
P: Patient’s Perception
I: Invitation from Patient
K: Knowledge
E: Empathy
S: Strategy & Summary

Question 5

What to not do when breaking bad news?

Answer 5

• Use jargon and numbers
• Don’t talk to relatives first if avoidable
• Don’t ask multiple questions
• Say you know how they feel
• Give information without clarifying the patients knowledge first
• Normalise / jolly along
• Switch focus

Question 6

What is the ABCDE approach?

Answer 6

A: Advance preparation
B: Build a therapeutic environment/relationship
C: Communicate well
D: Deal with patient and family reactions
E: Encourage and validate emotions