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O What is bad news ?
O How should bad news be delivered ?
O Communication problems when dealing with
incurable and life threatening disease
O Costs to professionals of dealing with dying
patients and their families
O ABCDE mnemonic bad news
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O Any news that are drastically and negatively
alters the patient·s view of her or his
future.
How should bad news be delivered ?

O Physiciansneed to individualize their

manner of breaking bad news based
on the patient·s desires and needs.
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O Denial
O Collusion
O Difficult
questions
O Emotional reactions
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O 0ay be strong coping mechanism
O Relatives may encourage
O 0ay be total (rare)
O 0ay be ambivalent
O Level may change over time
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O Explore reasons for collusion
O Check cost to colluder of keeping secret
O Negotiate access to patient to check their
understanding of situation
O Promise not to give unwanted information
O Arrange to talk again and raise possibility of
seeing couple together if both are aware of
reality
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O AngerÑ ften misdirected towards health

professionals
O ÿ
Ñ
eelings that the illness is a punishment
for past sins
O |eÑBelief that current situation is fault of
others
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O -dentifying patients' concerns brings

professional close to patients' pain
O
eelings of helplessness when faced with
insoluble problems
O
eelings of failure when patient dies
O -mbalance between work and relaxation
O Risk of emotional burnout
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O
amiliarize yourself with relevant clinical
information.
O Have the pt·s data on hand during the
conversation.
O Be prepared to provide basic information about
prognosis and treatment options.
O Arrange for adequate time in a private,
comfortable location.
O -nstruct office or hospital staff that there should
be no interruptions.
O 0entally rehearse how you will deliver the news.
O Script specific words and phrases to use or
avoid.
O Prepare emotionally.
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O Determine the pt·s preferences for what and
how much they want to know.
O Have family members present, at the pt·s
discretion.
O -f bad news is anticipated, ask in advance who
they would like present and how they would like
the others to be involved.
O -ntroduce yourself to everyone present and ask
for names and relationships to the pt.
O
oreshadow the bad news.
O Use touch were appropriate.
O Be sensitive to cultural differences and personal
differences.
O Avoid inappropriate humor.
O Assure the pt you will be available.
O Schedule follow-up meetings and make
appropriate arrangements.
O Advise staff and colleagues of the situation.
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O Ask what the pt or family already knows and
understands.
O Speak frankly but compassionate.
O Avoid medical jargon, use the words cancer or
death.
O Allow silence and tears, avoid the urge to talk to
overcome your own discomfort.
O Proceed at the pt·s pace.
O Have the pt tell you his understanding of what
you have said.
O Use repetition and corrections.
O Be aware that the pt will not retain much of
what is said after the initial bad news, repeat key
information.
O At the conclusion of each visit, summarize and
make follow-up plans.
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O Assess and respond to emotional reactions.
O Be aware of cognitive coping strategies
(denial, blame, disbelief, acceptance).
O Be attenuated to body language.
O Be empathetic.
O Do not argue or criticize colleagues, avoid
defensiveness regarding your medical care.
  
  
 
O ffer realistic hope and encouragement about available
options.
O Explore what the news means to the pt.
O -nquire about pt·s emotional and spiritual needs
O ffer referral as needed.
O Use interdisciplinary services to enhance pt care, not to
disengage from the relationship.
O -ssues of transference may arise, triggering powerful
feelings.
 


O Despite thechallenges involved in

delivering bad news, physician can find
tremendous gratification in providing a
therapeutic presence during a pt·s time of
greatest need.
OA growing body of evidence demonstrates
that physicians attitude and
communication skills play a crucial role in
how well pts cope with bad news and that
pts and physicians will benefit if physicians
are better trained for this difficult task.
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