Tips on breaking bad news
Breaking bad news requires good communication skills, sensitivity and empathy, as well as experience and knowledge.
Who should do it?
Ideally the most senior member of the team related in a patient’s care, or the most experienced, the one responsible for the patient’s care.
Where?
Make every attempt possible to tell the patient/relatives in person. Ensure privacy and freedom from disturbance of any kind.
When?
Ideally ASAP after the diagnosis is certain and all essential information is available.
How much?
That depends on the patient; some are keen to know as much as possible (monitors*); others only wish to know the essential information (blunters*). Proceed gradually and gauge from their responses how much they want to know; respect their wishes.
How?
· Avoid medical jargon
· Ensure you have all the essential information to hand
· Encourage the patient/relatives to express their feelings freely
· Allow enough uninterrupted time to clarify their doubts
· Answer questions about treatment and prognosis honestly
· Use appropriate body language to convey empathy, warmth and reassurance to the patient
· If the patient prefers, involve the family/significant others in the consultation
· Avoid being too pessimistic, or saying “we cannot do anything more”; hope is very important to people at such times, even if it is just a faint glimmer of it.
· Assess the patient’s understanding of the situation; offer assistance to tell others
· Provide information about support services for patients and carers
· Arrange a time for review within a few days
Finally:
Document the information given; let other professionals know what has been communicated to the patient.
Bibliography:
Suresh K: “Tips on…breaking bad
news”, BMJ Careers,