1. 1 Breaking Bad News

2. 2 What do they know already? An understanding of their medical condition. The possible outcome of the assessment. Their prognosis. Other options. Future strategies.

3. 3 Breaking Bad News Waiting Shock Uncertainty Fear Anxiety Hope Depression

4. 4 Breaking Bad News Everyone is different Emotions Reactions Self esteem Responses Personal identity/control/virility Perceptions of what is bad news

5. 5 Breaking Bad News Prolonged or chronic illness Succession of bad news. Continuing fear/anxiety. It is not just the patient who suffers. Waiting for news can be the most difficult part. Relationship with the professionals is crucial.

6. 6 Breaking Bad News What does one say? Identify the key person(s) and make eye contact. GET TO THE POINT. Give them time to absorb information. Use silence. LISTEN and watch. Use touch if appropriate. Enable them to feel that they have met someone who cares.

7. 7 Breaking Bad News Giving support requires A caring, listening ear Availability and time Unquestioning acceptance Confidentiality Self awareness Strategies for dealing with your own feelings

8. 8 Breaking Bad News Giving Support Build rapport Use non-verbal empathy Pace feelings – allow emotions to be expressed Pace and lead Pace beliefs and opinions Pace emotions Break rapport – non-verbally first

9. 9 Breaking Bad News Listening skills Focus on the other person Keep still Use appropriate body language Give non-verbal response Use questions Summarise what you have heard. USE SILENCE

10. 10 Breaking Bad News Gathering and Using the Information Remaining objective Questioning Summarising Agreeing objectives Agreeing strategies / solutions

11. 11 Breaking Bad News Helping to set realistic goals Identify short term goals first Discuss first steps and how they might be achieved Try to start with what is most important to the other person Build on any success already made Identify successful strategies from the past Hold out long term goals as encouragement for the future Celebrate success

12. 12 Breaking Bad News Particular Challenges Supporting people you know very well Supporting people over a long period of time Supporting in situations with which you are very familiar Supporting couples Supporting when your own beliefs are challenged Dealing with other peoples anger Letting go

13. 13 Breaking Bad News Vital elements Be yourself. Be clear and honest. Watch and listen. Dont be afraid of silence. Have your own support strategies

14. 14 Breaking Bad News Afterwards Try to leave them with someone to give support. If possible be prepared to come back if they want to speak to you again. Try to send them away with something tangible for later reference. Have a debrief for yourself if necessary.