Actual delivery of bad news

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:

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