Dr Karen Arnold October 2014 Breaking Bad News Dr Karen Arnold October 2014

Objectives Structured approach to breaking bad news Show patience and sensitivity when communicating with families Examples of breaking bad news

Scenario Dad Doctor

Things done well? Areas for improvement?

The majority of patients find the attitude of the news giver, combined with the clarity of the message and the news giver's knowledge to answer questions the most important aspects of giving bad news. Jan M, Girvin JP, Can J Neurol Sci. 2002 Feb;29(1):78-82

Structured Approach A Advance preparation B Building therapeutic relationship C Communicating well D Dealing with patient and family reactions E Encouraging and validating emotions

Advance Preparation arrange adequate time and privacy undivided attention involve significant others face-to-face with baby/child present confirm medical facts review relevant clinical data emotionally prepare for the encounter

Build a therapeutic relationship introduction body language empathise identify patient preferences regarding the disclosure of bad news warning shot

Communicating well determine the patient's knowledge and understanding proceed at the patient's pace avoid medical jargon or euphemisms be direct and truthful answer questions small chunks of information check understanding

Dealing with reactions allow for silence and tears assess and respond to emotional reactions empathize with the patient.

Encourage and validate emotions most difficult part identify and name the emotion understand the reason for the emotion allow time to express feelings

and Finally summarise important information offer break present treatment options clear plan arrange further meeting written literature

Structured Approach A Advance preparation B Building therapeutic relationship C Communicating well D Dealing with patient and family reactions E Encouraging and validating emotions

Personal health stressful debrief talk to seniors ask for help

Take care of yourselves and each other

Questions?