Breaking Bad News

Breaking Bad NewsDr. Rahila Ali

Department of Family Medicine

Objectives By the end of the session students should be

able to:

Describe the concept of bad news

Discuss the steps related to breaking bad news

What is bad news?

“any news that drastically and negatively alters the patient’s view of her or his future.”

Buckman 1992

Reactions

FearAngerDepressionDisbelief/Denial

Causes of Fear in people with a life threatening illness

Fear of :Separation from a loved one, jobs.Becoming a burden to othersLosing controlFear for dependentsPainDyingNot being able to complete their role

Parkes 1998

Physicians need to individualize

their manner of breaking bad news

based on the patient’s desires and

needs.

Initial goals in delivering bad newsBuild therapeutic relationshipAllow emotional ventilation Achieve a common perception of the problem Address basic information needs Respond to immediate discomforts Ensure a basic plan for follow -up Anticipate what has not been talked about Minimize aloneness and isolation

Your X-ray shows ca lung with a very bad prognosis

ENCOURAGE HOPE

A physician’s attitude and communication skills play a crucial role in how well patients cope when they receive bad news.

SPIKES(Protocol for breaking bad news)

S Setting and listening skills

P Patient perception of condition and seriousness

I Invitation from patient to give information

K Provide Knowledge in small chunks, check understanding

E Explore emotions

S Strategy and summary

Baile & Buckman 2000

Arrange a private, quiet place without interruptions

Arrange for the presence of a support person/approp.

family member

Arrange a time and place that will be undisturbed (turn

off mobiles)

Setting

Sit close enough to touch if appropriate

Prepare emotionally

Decide which words & phrases to use (write down a script)

Practice delivering the news

Setting

SPIKES

Perception

What do they Know?

How much do you understand about your illness?

How do you feel?

What is troubling you the most?

SPIKESInvitation

From the patient to give the information

Would you like me to explain ……..?

Are you the sort of person who wants to know what’s

happening?

SPIKESKnowledge

Warning shots

Be direct ( I am sorry , I have bad news)

Giving informationDo not use, jargon, acronyms

Small chunks

Check understanding

SPIKESE-Emotions

Identify shock, anger etc

Allow for silence

Use touch appropriately

SPIKESS-Strategy and Summary

Discuss his queries

Have a plan

Arrange additional meetings

Inquire about the patients resources :

When bad things have happened to you before, how have you coped To whom will you turn for support

Prescribe resources available to the patient: Regular physician follow-up Psychologist, social workerReading material, videos Support group

Finding strength

Role play

Don’tsMake assumptions about:

The patients readiness to hear the news in front of anyonePatient’s understanding

Give too much information at one time

Don’ts

Give inappropriate reassurances

Hurry

Use jargons i.e. ca lung, consolidation

Break bad news to relatives before telling the

patient.

Summary Things to consider

Before environment, time, information, relatives

During using a warning shot, find out what is understood, avoid jargon, open questions

After re-cap, instigate a plan, be positive, provide after care

SummaryS Setting and listening skills

P Patient perception of condition and seriousness

I Invitation from patient to give information

K Provide Knowledge in small chunks, check understanding

E Explore emotions

S Strategy and summary

References

1. Arber A, Gallagher A (2003) Breaking bad news revisited: the push for

negotiated disclosure and changing practice implications. International Journal

of Palliative Nursing Vol 9, No 4, Page 166-172

2. Baile W, Buckman R (2000) Spikes- A Six Step Protocol for Delivering Bad

News: Application to the Patient with Cancer. The Oncologist 5: Page 302-311

3. Buckman R (1992) How to Break Bad News. Papermac, London.

4. Maguire P (1985) Barriers of Psychological Care to the Dying. British Medical

Journal 291 Page 1711-1713

References

5. National Council of Hospices and Specialist Palliative Care (2003)

Breaking Bad News…. Regional Guidelines. Department of Health.

6. Parkes C M (1998) Coping with Loss: the dying adult. British Medical

Journal. April 25, 316: Page 1313-1315

7. Schofield P E (2003) Psychological responses of patients receiving a

cancer diagnosis. Annals of oncology 14:1:Page 48-56

8. http://www.breakingbadnews.co.uk