1. Breaking Bad News

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

3. 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?

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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. BBN
Using the CSA score sheet write down what the doctor said or did to help achieve a successful consultation