Breaking Bad News

What is Bad News? "any information which adversely and seriously effects an individual's view of his or her future"

Preparation for the consultation What can I glean form the medical record. What do my colleagues know about the patient and their situation What do I need to look up? Are there any resources that may help the consultation?

Flannagan’s Model 2 common situations They are very worried about possible bad news They are not expecting bad news

Not expecting bad news Welcome the patient Start with the usual open question Find out why the test was organised What was said at the time of the test What has happened since Find out about them as a person

Not expecting bad news The warning shot PAUSE – do not talk until after they do Succinctly deliver the bad news Allow time for emotion Show empathy

Not expecting bad news Allow time for the bad news ‘to sink in’ Answer any questions they may have, as best you can Explore SPICE and what happens next Agree what you and the patient may need to do before review Arrange review (soon) Summarise before they go

Patient very anxious about BN Patient anxiety around an anticipated result can paralyse the consultation You need a different approach You cannot draw out the consultation asking all the background questions

Patient very anxious about BN I can see you are very anxious about the result. Normally I would find out about what lead up to the test and what happened next and find out about you. But I can see you are really worried. Let me give you the result and we can sort that out afterwards.

Patient very anxious about BN The warning shot PAUSE – do not talk until after they do Succinctly deliver the bad news Allow time for emotion Show empathy

Patient very anxious about BN Ask any background questions (SPICE) Agree what you and the patient may need to do before review Arrange review (soon) Summarise before they go

BBN Using the CSA score sheet write down what the doctor said or did to help achieve a successful consultation https://www.youtube.com/watch?v=JSrXT2TMUtM&t=121s