Breaking bad newsAn essential skill to acquire

Who is it aimed

"Breaking Bad News“ It is a mandatory e learning guide for foundation trainees. It is an e learning recource for the trainees to help them prepare to deliver bad news to patients and their families.

ObjectivesTo understand-----

What is bad news.Why breaking bad news is a skill. why do we need additional training.To learn the strategy .

What is bad newsBad news can mean different things to different

people. Can be defined as any information that adversely affects an individuals view of

future carries a feeling of no hope or a threat to a

person's mental or physical well-being risks upsetting an established lifestyle conveys to an individual fewer choices in his

or her life. ref

Examples include

A patient is diagnosed HIV positive.The patient who has been diagnosed with

cancer. The couple who are told they cannot have

children.The common denominator is that bad news is

a message, which has the potential to shatter hopes leading to very different lifestyles.

Formative taskReflect on the challenges that you will face

while breaking bad news.

Why is it a skill?Breaking bad news is never a pleasant task.

Doing it in wrong way or at the wrong time can be even worse.

It is just as hard for the person breaking the bad news as it is for the person receiving it.

Why additional trainingIt is a complex communication task.

Involves using verbal and non verbal skills.

If bad news is delivered poorly, can have a long lasting impact in addition to the shock of bad news.

When staff are uncomfortable to deliver bad news, can lead to conveying unwarranted optimism.

StrategiesPreparing for the interview Go through the records and know the clinical situation

Work through your own reaction to the news

Give thought to how you would approach the delivery of bad news

Think and practice what you are going to say.

Assess your role and the level of information that you can give.

Have the necessary information you need regarding the diagnosis and treatment and support the patient needs thereafter.

Choose an appropriate place. Choose the right time allow enough time for the interviewInvite spouse, friend or relative as

appropriate

InterviewCommunicationStart off with a sentence which will suggest

the news is going to be a bad one.Get to the point and do need beat round the

bush.Use simple words, avoid jargon, be as clear

as possibleBe honestGive information in small chunksWatch the pace

Show EmpathyRead the body language for non verbal clues-

tears, silences Encourage expression of feelingsAllow time for questionsCheck understanding of information given

Dealing with situation afterwards

Planning and supportIdentify further planGive broad time frame for what may lay

aheadEmphasize quality of lifeIdentify support system

SummaryPreparing for the interviewSharing the informationShowing empathyPlanning and support

Watch a scenario:http://www.youtube.com/watch?v=QvW_g6w

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References Buckman R. (1992) Breaking Bad News: A Guide for Health Care

Professionals. Baltimore: Johns Hopkins University Press. Bor R, Miller R, Goldman E, Scher I. (1993) The Meaning of Bad News in

HIV Disease: counselling about dreaded issues revisited. Counsel Psychol Q. 6:69-80

Maguire P (1985) Barriers of Psychological Care to the Dying. British Medical Journal 291:1711-1713 Ptacek JT, Eberhardt TL. (1996) Breaking Bad News. A Review of

Literature. JAMA 276: 496-502 Baile W, Buckman R. et al. (2000) SPIKES- A Six Step Protocol for

Delivering Bad News: Application to the Patient with Cancer. The Oncologist 5:302-311