This document provides information and guidance on effectively breaking bad news to patients. It discusses why mastering this skill is important, as effective communication can improve patient outcomes. It defines bad news as any information that drastically changes a patient's view of their future. The document recommends using empathy and active listening skills when delivering bad news. It presents the SPIKES protocol as a framework, including setting, perception, invitation, knowledge, emotions, and strategy/summary. Examples of conditions requiring bad news and techniques like the "sandwich method" are provided. The overall message is the importance of compassion and ensuring patients understand their diagnosis and future options.

1. AL TABABA
TRAINING
SERIES
Communication Mastery

2. Breaking Bad News

3. NEWS!
Clinicians are the largest
professional group where breaking
bad news is an everyday exercise!

4. Breaking Bad News

7. Why should WE Master this
Skill?
Breaking Bad News Foundation, 2016:
Effective and compassionate communication between
clinicians and patients is associated with :
Medications and treatments: improved compliance
Patient coping: Less Distress
Decision making: Better Decision Making
The Breaking Bad News Foundation website also provides
educational videos and resources
(https://bbnprogram.com/).

9. Why should WE Master
this Skill?

10. The Essence of Humanity in
Medicine

11. Objectives: Viewers will:
Recognize essential principles of breaking bad
news.
Identify pitfalls in delivering breaking bad news.
Apply skills of breaking bad news in simulation .

12. The bad news about
Breaking bad news
Is that bad news is
BAD NEWS

13. Definition of Bad News

14. Bad News
Any news that drastically and
negatively alters the patient’s
view of their future.
Buckman R. BMJ 1984

15. Bad News
Any news that drastically and
negatively alters the patient’s or
their loved ones view of their
future.

16. The Good News! about Bad
News!!!Easier than you thought!
Using a PLAN for determining the
patient’s understanding of the illness
etc. and their values
PLUS
their wishes for participation in
decision making.

17. Do You Tell?
Recent studies have shown that:
Patients generally (50-90%) desire full & frank
disclosure, though a sizeable minority still may not
want the full disclosure. (Ley p. Giving information
to patients. New York: Wiley, 1982)
So the issue is not “do you?”
Issue is “how?”

19. So How Do We Do This??

20. Two Techniques for Breaking
Bad News

23. Don’ts
Ignore Patient’s
Input
Medical Jargon
Destroy Hope
Blunt Disclosure
Assumptions
Interruptions

26. Practice Little Empathy: Just Not
Sympathy
Is the ability to understand the
patient’s experiences and feelings
accurately as well as to demonstrate
that understanding to the patient.
Is an active process.
Is more than sympathy, or feeling
sorry for someone.

27. Elements of
Empathy
Verbal Non-
verbal

28. The Verbal Component: Empathy (NURSE)
Name the
emotion: I can
see that you are
upset.
Show
Understanding: it
is a very difficult
time for you.
Respect: I admire
your faith.
Support: all the
team will work
hard to help you
get better.
Explore future
needs: any other
issues you wish to
talk about?

29. Don't Forget! Non-verbal
Communication for Empathy
The Magic of Touch:
◦A pat on the shoulder.
◦A hug!
Situational Awareness:
◦A handkerchief!
◦A glass of water etc.
◦Silence-allowing the patient to talk and
express their emotions.

30. Don't Forget! Your OTHER
Team Members
The family as the
most powerful healing
source for the patient
The force of
spirituality in
achieving peace
Multiprofessional,
harmonious
patient-centered
team

31. Patientologist
Patientologists. They are empathetic; and understand what the
patient's fears and worries are, so that they can help them to
manage them.
How does a doctor become a good patientologist ? Unfortunately,
these skills are never taught formally in medical college.
Some doctors have a great bedside manner, because they have a
high EQ ( emotional quotient).
Others learn how to improve their patient skills by emulating their
teachers who are good clinicians
31

32. Do we need the SPIKES
Protocol for all Bad News?

33. Depends! Use SPIKES if any of the
following is not up to the Mark or you are
UNSURE!
Patient
sociocultural
status and
values
Coping
style
Understanding
of his/her
illness
Future
prospects

34. Examples of Conditions
Requiring Breaking of Bad
News using SPIKES???!!!!

35. Examples of Conditions Requiring
Breaking of Bad News using SPIKES
HIV
Cancer related diagnoses
Alzheimer’s Disease
Intra-uterine fetal demise
Life long illness: Diabetes, Epilepsy, Kidney Failure
etc.
Informing parents about their child’s serious
mental/physical handicap
Death

36. The Sandwich Technique: For
everyday bad news

37. The Sandwich Technique
e.g.
“Dear, you have excellent heart tests but your blood pressure is
not good but we can definitely make it better for you!”
“Umm Ahmad, your cholesterol is quite good but your sugar is
high but we can certainly get it right for you.”

38. What is NEXT?
•Practice the right way
of Breaking Bad News:
Apply them in your
everyday life!

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