Breaking bad news

Health professionals need to use their skills to deliver bad news clearly, honestly and sensitively in such a way that patients can understand and also feel supported.

The Six-Step Protocol for Delivering Bad News

  1. STEP 1: SETTING up the interview Make sure you have all the information and test results. Talk to them in a private setting to make them comfortable. Decide who all should be in the room and start off with proper introduction.
  2. STEP2: Assessing the patient's PERCEPTION Find out how much the patient knows. Specifically how serious or severe they think the illness is and how it will affect the future. This tells how close the patient is to reality and if they are in denial or not.
  3. STEP 3: Obtaining the patient's INVITATION Figure out how much and to what extent does the patient wants to know. Some ways to ask questions are, "You don't want to be bothered with details, do you?" or else " Would you like to know the details of the diagnosis?"
  4. STEP 4: Giving KNOWLEDGE and information to the patient Give information in small bits. Warnings like " The situation appears to be more serious". Clarify if they understand or not like "Am I making sense?" Repeat important points as a patient might have not heard a few points in shock. Ask the patient their main concerns and encourage them to ask questions.
  5. STEP 5: Addressing the patient's EMOTIONS with empathic responses Respond to patient's feelings, their reaction can vary from silence to anger, distress or denial. Listen and ask them how they are feeling and then respond empathetically.
  6. STEP 6: STRATEGY and summary Identify the patient's coping strategies and implement them. Encourage them to ask questions and clear doubts. Guide and support them.