1. An essential skill to acquire

2. Who is it aimed
"Breaking Bad News“ It is a mandatory e learning guide
for foundation trainees. It is an e learning recource for
the trainees to help them prepare to deliver bad news
to patients and their families.

3. Objectives
To understand-----
 What is bad news.
 Why breaking bad news is a skill.
 why do we need additional training.
 To learn the strategy .

4. What is bad news
Bad news can mean different things to different people.
Can be defined as any information that
 adversely affects an individuals view of future
 carries a feeling of no hope or a threat to a person's
mental or physical well-being
 risks upsetting an established lifestyle
 conveys to an individual fewer choices in his or her
life. ref

5. Examples include
 A patient is diagnosed HIV positive.
 The patient who has been diagnosed with cancer.
 The couple who are told they cannot have children.
 The common denominator is that bad news is a
message, which has the potential to shatter hopes
leading to very different lifestyles.

6. Formative task
 Reflect on the challenges that you will face while
breaking bad news.

7. Why is it a skill?
 Breaking bad news is never a pleasant task.
 Doing it in wrong way or at the wrong time can be
even worse.
 It is just as hard for the person breaking the bad news
as it is for the person receiving it.

8. Why additional training
 It is a complex communication task.
 Involves using verbal and non verbal skills.
 If bad news is delivered poorly, can have a long lasting
impact in addition to the shock of bad news.
 When staff are uncomfortable to deliver bad news, can
lead to conveying unwarranted optimism.

9. Strategies
Preparing for the interview
 Go through the records and know the clinical situation
 Work through your own reaction to the news
 Give thought to how you would approach the delivery of bad news
 Think and practice what you are going to say.
 Assess your role and the level of information that you can give.
 Have the necessary information you need regarding the diagnosis and
treatment and support the patient needs thereafter.

10.  Choose an appropriate place.
 Choose the right time
 allow enough time for the interview
 Invite spouse, friend or relative as appropriate

11. Interview
 Communication
 Start off with a sentence which will suggest the news is
going to be a bad one.
 Get to the point and do need beat round the bush.
 Use simple words, avoid jargon, be as clear as possible
 Be honest
 Give information in small chunks
 Watch the pace

12.  Show Empathy
 Read the body language for non verbal clues- tears,
silences
 Encourage expression of feelings
 Allow time for questions
 Check understanding of information given

13. Dealing with situation afterwards
 Planning and support
 Identify further plan
 Give broad time frame for what may lay ahead
 Emphasize quality of life
 Identify support system

14. Summary
 Preparing for the interview
 Sharing the information
 Showing empathy
 Planning and support

15. Watch a scenario:
 http://www.youtube.com/watch?v=QvW_g6w8uY0

16. References
 Buckman R. (1992) Breaking Bad News: A Guide for Health Care Professionals.
Baltimore: Johns Hopkins University Press.
 Bor R, Miller R, Goldman E, Scher I. (1993) The Meaning of Bad News in HIV Disease:
counselling about dreaded issues revisited. Counsel Psychol Q. 6:69-80
 Maguire P (1985) Barriers of Psychological Care to the Dying.
 British Medical Journal 291:1711-1713
 Ptacek JT, Eberhardt TL. (1996) Breaking Bad News. A Review of Literature. JAMA 276:
496-502
 Baile W, Buckman R. et al. (2000) SPIKES- A Six Step Protocol for Delivering Bad News:
Application to the Patient with Cancer. The Oncologist 5:302-311