Breaking Bad News

Question 1

What are the 6 steps to breaking bad news?

Answer 1

Setting up the interview
Assess patient perception
Obtain patient invitation
Give knowledge and information
Address patient emotions with empathy
Strategy and Summary

Question 2

What is important to consider when setting up the interview?

Answer 2

Arrange for privacy
Make sure you have all information
Decide who breaks the news
Who is there when news is broken

Question 3

How do you assess patient perception?

Answer 3

Find out how much the patient knows:
How serious illness is
How much it will affect the future

Question 4

Why is it important to assess patient perception?

Answer 4

Gauge how close patient understanding is to reality
Find out whether in denial
Articulate at patient understanding

Question 5

What clues may help with assessing patient perception?

Answer 5

Types of words used to convey emotion
Body posture
Hand movements

Question 6

Why is it important to obtain patient invitation?

Answer 6

Allow you to tell patient at the level they want to know

Can be controversial - can argue patients need to know all to make informed decision, but also must weigh up with patient autonomy

Question 7

What are the 4 crucial headings when giving information?

Answer 7

Diagnosis
Treatment plan
Prognosis
Support

Question 8

What is important when giving information?

Answer 8

Align with what patient understand
Check patient understanding - reinforce
Warning shot
Info in small chunks and understandable language
Diagrams etc. can help

ICE - listen to patient concerns

Question 9

How do you approach the strategy and summary portion?

Answer 9

Patients may look to you for help - could be confused/overwhelmed

Plan based on patient problem list

Provide sources of support for patient

Invite questions

Explain next steps