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Breaking bad news

Bad news can be defined as any news that drastically and negatively alters the patients view of his or her future.

The principles of breaking bad news are applicable to all such situations and include information given to carers or relatives. Information should only be given to relatives or carers with the patient’s consent; if the patient does not have the capacity, information should be shared in the patient's best interests.

Breaking bad news is always hard and professionals often feel that they could have done it better. No-one can make it easy but use of a system, such as described here, can provide a structure which is helpful for the bad news breaker and aims to ensure that bad news is broken sensitively to patient and carer.

Breaking bad news is especially hard when:

  • The news is very bad
  • The person has no idea about the news
  • There are several people to break the news to, together
  • The bad news breaker is stressed or fatigued

Breaking bad news is important because:

  • Withholding bad news diminishes patient autonomy
  • Understanding of the situation allows adjustment and preparation
  • Patients who discover that bad news has been withheld may cease to trust their professional carer

Breaking Bad News — The Process

Preparation

Ensure a comfortable, private space.

Time: it is important to set aside some time for the patient or relative, and avoid being interrupted if possible.

Knowing the facts: it is essential to be fully aware of all the relevant facts about the patient and their illness before the consultation. Ask whether the person would like somebody with them (a relative, carer or professional carer).

Understanding of what is known

Gaining an understanding of what the patient or relative knows so that you know how to build on their understanding. e.g. ‘What’s your understanding of what the doctors have been looking for?’

Gauging how much the person wants to know

 e.g. ‘Are you the sort of person who likes to know everything about your health?’ (if the person does not want to know what is happening, make it clear that they can ask again in the future. Check if they are happy for you to speak to their family about the issue).

Warning shot (if appropriate)

e.g. ‘I’m afraid the news isn’t good’ or ‘there seem to be some unusual cells in the biopsy we took’ Pause (allow silence) Allows time to think and prepare the person to formulate a question so that they have some control over the way the news is broken (and if it is broken).

Break the news

(if the person wishes this) clearly but sensitively, pausing to acknowledge the response. Be empathetic— “I’m really sorry”.

Share a plan and offer support

Explain what will be happening next as far as you can. Make sure that they know when they will be seen again and who they can contact with any questions. Give written information where possible.

Finally— Breaking bad news is draining. This is NORMAL. Make sure that you are able to debrief to colleagues or a supervisor wherever possible.

Acknowledgement

(Adapted from North of England Cancer Network Breaking Bad News leaflet).

Hospiscare provides a 2 day specialist communications course called communicating effectively when it matters most. Led by practising clinicians with practical experience of dealing with these issues, this workshop will develop your communication skills focusing specifically on strategies for effective communication with patients – a key aspect of high quality care.