how to convey breaking bad news.

1. Bad news
Bad news: “ Any information which adversely and seriously affects an
individual’s view of his or her future” Eg: Terminal diagnosis, death of
patient, IUFD, lifelong illness etc.
An uncomfortable experience for both giver and receiver.
So, it’s a relative concept and should depend on the circumstances,
interpretation and reaction

2. Importance
• Better psychological adjustment by receiver
• Reduces stress in doctors
• Facilitates open discussion among patient, relatives and doctors.
• Empowers patient by allowing them a greater say in treatment

3. Challenges in delivering:
1. Challenges of individualizing , according to patients needs or desires.
2. Hectic pace and other circumstances during clinical practice
3. Emphasis on biomedical model in medical training than on communication skills.
“ Clinicians focus often on relieving patients’ bodily pain , less often on their
emotional distress and seldom on their suffering.”

4. General Guide- ABCDE/SPIKES approach
• A – Advance preparation
• B- Building a therapeutic environment
• C- Communicate well
• D- Deal with patient and family reactions
• E- Encourage and validate emotions

5. Advance Preparation
• Familiarize yourself with the relevant clinical information, know details well.
• Arrange for adequate time without interruption in a private, comfortable
location.
• Mentally rehearse and be emotionally prepared

6. Building a therapeutic environment/relationship
• Finding out who to provide information, what information to be provided and
how much?
• Introducing oneself with role. Ask family or other people to introduce themselves
with relation to patient. Its better if any support person is present there to
provide support.

7. Communicate well
• Ask patient what they already know and find out patients expectations.
• Allow silence and avoid urge to talk to overcome discomfort.
• Warn about bad news before bad news is broken “ I am sorry but I have bad
news….”
• Deliver information in small bites: Tell a story what has happened till now from
beginning and then get to the point with news
• Avoid jargon: eg : say “he died” at some point. Don’t say vague statements like “
he is no longer with us”.
• Speak frankly but compassionately.
• At the conclusion summarize and make follow up plans.

8. Deal with Patient and family reactions
• Assess emotional reaction and respond accordingly and be aware of cognitive
coping strategies (denial, blame, intellectualization, disbelief, acceptance)
• Don’t: lose control, criticize or defend your colleague or yourself
• Stay cool and keep your safety first( always maintain easy access to door and be
prepared to just leave)

9. Encourage and validate emotions
• Offer realistic hope and encouragement
• Explore what the news means to the receiver and inquire about their needs and
explain what support system can be provided.
• It can be a traumatic situation for you as well. So attend to your own needs and
emotions during and following the delivery of bad news and don’t hesitate to
seek help if required.

10. Dos’
• Ensure privacy and confidentiality
• Simple language
• Listen
• Sensitive to non verbal language
• Allow for silence tears and other
reactions
• Document and liaise with
multidisciplinary team
Don’ts’
• Overload with Information
• Distort truth and give false assurance
• Assume that you know what is
concerning them
• Criticize or make judgements
• Meeting in public
• Not being prepared
• Hurrying
• Interrupted
• Patronizing: eg: it is all your fault you
smoke

11. “ If we do it badly, the patients or family members
may never forgive us; if we do it well they may
never forget us”