The document discusses how to effectively deliver bad news. It defines bad news as information that will disappoint or upset the recipient. It recommends using the SPIKES model, which involves setting up a private meeting, assessing the recipient's perspective, inviting their questions, providing knowledge of the situation, addressing emotions, and creating a care plan and summary. The direct approach states the bad news outright while the indirect approach uses a positive buffer first. Proper delivery of bad news is important to support patients and prevent lasting negative impacts, while maintaining goodwill and allowing discussion. Training in communication skills helps providers effectively address this challenging task.

1. What is bad news?
A bad news message is a letter, memo, or email that
conveys negative or unpleasant information that is likely to
disappoint, upset or even anger a reader. Also called n
indirect message or a negative message.

2. Example:
 Life threatening illness. eg: Cancer, HIV
 conditions.eg: Alzheimer/ dementia
 Chronic illness.eg: Rheumatoid arthritis /
Systemic lupus erythematosus
 Mental retardation in children. eg: Downs
syndrome / cerebral palsy

3. The Task of Breaking Bad
News
“If we do it badly, the patients or family members may
never forgive us; if we do it well, they may never forget
us (Buckman,1992)

4. Supporting patient and provider
Patient and family are supporting by:
• Being included in conversations and planning
• Being treated as care partners
Provider is supported by:
• Training and practicing good communication skills
• Learning ways to effectively cope with emotionally charged
issue
• Having another person available who knows the patient

5. SPIKES MODEL
There are six SPIKES model:
1.Setting
2.Perception
3.Invitation
4.Knowledge
5.Emotions
6.Strategy & summary

6. Setting
• Provide privacy
• Introduce self
• Determine who else should be present
• Ensure no interruptions
• Provide comfortable space
• Create welcoming environment

7. perception
• Prepare before speaking
• Ask about patient’s perception of what is going on.
Invitation
• Ask questions to invite the patient into conversation.
• Ask how much information the patient want to hear.

8. Deliver the massage
• Use plan language
• Be mindful of body language
• Get to the point give information in small chunks
• Pause
• Wait for reaction

9. Emotions and Empathy
• Be prepared for patient’s and family’s emotional
response
• Anticipate fear , anger, sadness, denial, guilt
• Be mindful of your own response comfort the patient

10. Strategy and Summary
• Assess patient’s readiness for planning
• Negotiate next steps
• Verify support structure
• Acknowledge and answer questions
• Summarize plan

11. Two approaches for writing a
bad news letter
There is a small difference between two approaches.
Direct approach:
This approach works best when the audience will be accepting of the
main point of bad news and not apposed to it. It is commonly used in
situations where the bad news is being presented orally. This is called a
deductive argument (stated as facts).
Indirect approach:
For all other situations, indirect approach is usually most effective. This
approach occurs when you open bad news with a positive point and
end it positively such as “Positive-Negative-Positive’’ format. This is
called an inductive argument (based on observation of specific
cases).

12. The Direct Pattern:
It consists of three rules:
 Bad news
 Reasons
 Positive closing
When using the direct approach:
1. State the bad news first:
Open with bad news and be sure to give a
clear and specific statement of bad news.

13. 2. Give reasons:
Provide reasons of bad news for the decision. Apologies can fit
in this section. However, they must be used carefully.
Apologies can express sympathy but they can also admit
liability (responsibility).
3. End it positively:
End with a positive statement; attempt to maintain
goodwill. Don’t fluff (something of little value) the ending
too much. You need to be truthful to the situation and have
respect for the reader.

14. The Indirect Pattern:
It consist of four rules:
 Buffer
 Reasons
 Bad news
 Positive closing
When using the indirect approach:
1. Begin with a buffer:
It means a positive opening that doesn't reveal the bad news.
A buffer creates a common ground (reason) between you and
reader and softens the impact. It needs to be sincere. It leads into
reasoning and explanation.

15. 2. Give reasons:
In this portion, you will provide the reader with
your explanation for the bad news. In the indirect
approach, it is best to start with a positive points first
and then move into negative points. It encourages the
reader to hear you out and understand the reasons.
3. Clearly state the bad news:
The buffer and explanation has prepared the
reader to receive the bad news. So, in this section,
Be careful to make sure the message is clearly
conveyed.

16. 4. Close it
positively:
In the end, avoid a negative conclusion. Next, try to
limit implications (inferences) of future correspondence
(communication by the exchange of letters) and lastly, be
sincere and close with positive conclusion in a confident
manner.

17. Advantages of bad news
messages:
Direct approach makes a shorter message possible.
In direct approach, the audience needs less time to
reach the main idea of the message.
In direct approach, a tactful tone and focus on
reasons will help make any bad news message easier
to accept.
Indirect approach identifies the subject of the matter,
presents the reason before the refusal and avoids
negative reactions.

18. Contd..
The practice of breaking bad news is better as
psychological adjustment by patient and depressed
people.
This practice reduces stress in doctors and news
agencies.
Facilitate open discussion among the patients,
relatives and doctors.
Maintain as much goodwill as possible with your
audience.

19. Disadvantage:
May hinder effective delivery, interpretation, and
discussion of bad news due to strong emotions.
It requires more time.
Unable to immediately respond to concerns
less able to control long term impact on working
relationships.
Negative experience can have lasting effect on
depression.

20. Things to Employ:
The indirect approach is usually
the best approach for a Bad news.
Keep in mind that a tactful and
courteous words can build goodwill.
 Demonstrate that you understand and
have considered the complaint.
The claim is unreasonable use
possible alternative.

21. Things to Avoid
Never accept or blame any customer for any wrong
happening.
Use of bad language destroys one’s image and
can bring defamation or bad name for his own self
and for the other as well.
Never start with “NO” or “BUT” it will create negative
image.

22. Situation
Consists of all those circumstances in which bad news is
being delivered.
Transfer bad news daily
routine of physician’s.
Delivery of message have long
lasting effect.
Training and experience
will facilitate.
A teacher have to deliver bad news on PTM but with the
help of proper training and guidance, he can make better
changes in a student life(here PTM is situation)

23. Summaries
“No one loves the
messenger who brings
bad news.”
Sophocles, Antigone

24. Thank you