First ask:
You have to determine what the patient knows about their current situation before starting a discussion about the next phase.
“What is your understanding of your illness?”
Warning shot:
Warn them about the bad news to come ” I am afraid I have some bad news for you”
Pause: Give them a moment to compose themselves and get ready to hear the news
Deliver the news:
- Use short sentences.
- Make it non technical to the extent possible.
” As you may recall, we did a CT scan of your lungs. The results show that the cancer has come back”
Sympathetic silence:
- Give them time to process the bad news. Don’t rush into the next steps
- Allow them to assimilate the information
Answering questions:
- Be prepared to repeat the information: sometimes the impact of the information is so great that patients may want to hear it a second time
- Answer questions kindly and honestly
- If you do not know the answers please state so
- If the next step is uncertain state so.
Assure nonabandonment:
- Assure the patient that you will be willing and available to support them on an ongoing basis.
” I am here to support you. I will still be your doctor no matter what happens”
Follow up:
- Make clear plans for follow up.
- Please write our instructions briefly and clearly and hand it to them
- Give them guideline how about how best to get in touch with you/designee
De-brief and self-reflection:
- Be aware that your colleagues (trainees, multi disciplinary clinicians) often have strong reactions to these situations. Be sure to check in with them.
- Be aware of your own responses. Be kind to yourself.
More information about delivering bad news:
- Delivering bad news: part one: http://www.eperc.mcw.edu/fastFact/ff_006.htm
- Delivering bad news: part two : Talking to Patients and Precepting Traineeshttp://www.eperc.mcw.edu/fastFact/ff_011.htm
