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

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

3. Scenario
Dad
Doctor

4. Things done well?
Areas for improvement?

5. 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 Feb;29(1):78-82

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

7. 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

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

9. 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

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

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

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

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

14. Personal health
stressful
debrief
talk to seniors
ask for help

15. Take care of yourselves and each other

16. Questions?