This e-learning guide teaches trainees how to effectively break bad news to patients and their families. It covers why breaking bad news is an important skill that requires additional training. The guide defines bad news as information that negatively impacts a person's future, hope, or well-being. It provides examples of bad news and discusses why it is a complex communication task. The guide outlines strategies for preparing, sharing information empathetically, and planning support. These strategies include choosing an appropriate time and place, starting with a warning, keeping it simple, showing empathy, and identifying future support and care plans.

1. An essential skill to acquire

2. 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.

3. Objectives
To understand-----
 What is bad news.
 Why breaking bad news is a skill.
 why do we need additional training.
 To learn the strategy .

4. What is bad news
Bad 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

5. 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.

6. Formative task
 Reflect on the challenges that you will face while
breaking bad news.

7. 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.

8. Why additional training
 It 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.

9. Strategies
Preparing 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.

10.  Choose an appropriate place.
 Choose the right time
 allow enough time for the interview
 Invite spouse, friend or relative as appropriate

11. Interview
 Communication
 Start 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 possible
 Be honest
 Give information in small chunks
 Watch the pace

12.  Show Empathy
 Read the body language for non verbal clues- tears,
silences
 Encourage expression of feelings
 Allow time for questions
 Check understanding of information given

13. Dealing with situation afterwards
 Planning and support
 Identify further plan
 Give broad time frame for what may lay ahead
 Emphasize quality of life
 Identify support system

14. Summary
 Preparing for the interview
 Sharing the information
 Showing empathy
 Planning and support

15. Watch a scenario:
 http://www.youtube.com/watch?v=QvW_g6w8uY0

16. 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