2. INTRODUCTION (general)
◦ This would also involve sufficient background
reading to ensure you are up to date with the
patient’s past medical history and recent events.
◦ Check you have the correct patient
◦ Introduce your full name and purpose
◦ Gain consent
◦ Mention confidentiality if relevant
3. INTRODUCTION (rapport)
◦ Ask about them
◦ Offer them a seat, a glass of water
◦ Empathise with any emotion they
display/verbalise an acknowledge the
difficulty/stress they could be experiencing
◦ Listen and respond to the things they say
4. INTRODUCTION (active listening skills)
◦ Maintain an appropriate level of eye
contact
◦ Open, relaxed, yet professional. (Uncrossed
legs and arms, leaning slightly forwards)
◦ Nodding, acknowledging
◦ Avoid interrupting the patient
5. SETTING
◦ COMFORTABLE, QUIET AND PRIVATE
ROOM
◦ Must or try to have some privacy.
◦ Tissues
◦ Ensure both you and the patient are sitting
down
◦ Ensure you have uninterrupted time
◦ Ask them if they want anyone to be or not to
be with them
6. PERCEPTION
◦ Discuss the events leading up to
now…
◦ Discuss any symptoms the patient
may have been experiencing up to
this point
◦ Establish what the patient already
knows or is expecting
◦ Establish the patient’s current
emotional state and if there is
anything particular on the
patient’s mind (any ideas, concerns
or expectations the patient might
have)
◦ “Could you tell me what’s happened
so far?”
7. PERCEPTION
◦ Here you could agree with the
patient and say something like
◦ ‘Yes, the reason we wanted to do the
tests were so we could find out why
you have been experiencing the
symptoms you just described to me.
Were you aware of what sort of
things the investigations might
show?
◦ If they don’t know of the possible
diagnoses – you could say
something like this ‘ Symptoms like
the ones you’ve been describing can
sometimes be as a result of an
infection, but sometimes they can be
as a result of more serious
underlying conditions’ This can also
act as a warning shot.
◦ Check if the patient wants the
result immediately
8. KNOWLEDGE
◦ Ensure you deliver the information in understandable language, and
regularly check for understanding.
◦ Use a warning shot to indicate that you have unfortunate news
◦ “As you know we took a biopsy/did a scan, and unfortunately the results
were not as we hoped”
◦ Allow a large pause if necessary, so the patient is able to digest what
you have told them.
9. KNOWLEDGE
◦ Provide the diagnosis.
◦ Use simple language
◦ I’m afraid/sorry to tell you this but
the results from the investigations
show you have cancer
◦ After giving the diagnosis, it’s wise to
wait for the patient to reinitiate.
◦ Example
◦ “I’m afraid it’s not the news we were
hoping for Mrs Brown”
◦ PAUSE
◦ ”Unfortunately, the lump is due to a
more serious underlying cause”
◦ PAUSE
◦ “I’m so sorry to tell you, but you have
breast cancer”
◦ PAUSE until the patient speaks, or
after they seem to be ready to talk
again. This may be a few minutes.
10. EMOTIONS AND EMPATHY
◦ Recognize and respond to emotions
with acceptance, empathy and
concern
◦ Reflect their body language
◦ Do not lie (when asked about
prognosis)
◦ Be frank if you don’t know the
informations
11. STRATEGY AND SUMMARY
◦ Make a plan together to meet the
patient again/inform them of what the
next step is
◦ Reassure patient their referral will be
managed by appropriate team of
specialists
◦ Try not to rush the patient to make
decisions about treatment.
◦ Check the patient’s understanding
◦ Summarise
◦ Ensure to answer all questions
◦ Offer assistance to tell other family
12. When it’s over?
◦ Be aware that breaking bad news can be emotionally
challenging for us healthcare professionals also – particularly if
you have built a rapport with the patient.Think through your own
thoughts, and reflect on how you’re feeling. Take time out if
needed.
13.
14. THANK YOU
◦ REFERENCES
◦ Baile, W., Buckman, R., Lenzi, E., Glober, G., Beale, E., & Kudelka, A. SPIKES – a six step
protocol for delivering bad news: Application to the Patient with Cancer. Oncologist 2000;
5(4):302-311.
◦ Geeky medic - Breaking bad news
