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Bridging the gap – removing communication barriers. Breaking bad news to patients and relatives INTRODUCTION Communicating bad news is an essential skill for physicians. Challenging to convey bad information, especially when this involves a life-threatening illness. Some feel inadequately prepared or inexperienced. Others fear the news will be distressing and adversely affect the patient, family, or the therapeutic relationship. Cultural variations are important, breaking bad news in a direct and compassionate way can improve the patient’s and family’s ability to plan and cope, encourage realistic 	goals and autonomy, support the patient emotionally, strengthen The physician-patient relationship 6-step protocol for communicating bad news

The recommended 6-step protocol has been adapted from How to Break Bad News: A Guide for Health Care Professionals by Robert Buckman: · Getting started · What does the patient know? · How much does the patient want to know? · Sharing the information · Responding to patient and family feelings · Planning and follow-up Step 1: Getting started

Before starting to communicate any news, plan what will be discussed. Confirm the medical facts of the case Ensure that all the needed information is available. If this is an unfamiliar task, rehearse what you will say Create an environment conducive to effective communication Ensure privacy and adequate seating Allot adequate time for the discussion. Determine who else the patient would like to have present for the discussion.

Step 2: What does the patient know?

Start the discussion by establishing what the patient and family know about the patient’s health. What do you understand about your illness? How would you describe your medical situation? Have you been worried about your illness or symptoms? What did other doctors tell you about your condition or any procedures that you have had? When you first had symptom X, what did you think it might be? What did Doctor X tell you when he sent you here? Did you think something serious was going on when…?

Step 3: How much does the patient want to know? People handle information differently, depending on their race, ethnicity and culture, religion, and socioeconomic class Phrasing the question:  “I have the results of your genetic testing, but I just want to make sure that this is still information you want to know.”

 “Are you the kind of person who likes the full details of the diagnosis, or would you prefer just to hear about the options available to you?” ADVANCE PREPARATION use

 “I’m sorry to have to tell you this”  “I know this is not good news for you”  “I was hoping for a better result”

Avoid  “You knew….We talked about…this was a possibility”  “I see this all of the time”  “There’s always next time”

Step 4: Sharing the information

Deliver the information in a sensitive but straight forward manner. Use simple language that is easy to understand

You might choose to break bad news by using language like:

“Unfortunately, I have some (unexpected) (bad) news to tell you.”  “I’m sorry, but the test results are not what you were hoping for…”  “I’m sorry to tell you…”

Step 5: Responding to feelings

Identify and acknowledge the clients reaction  Inquire about the patient’s emotional and spiritual needs, and support systems  Identify patient’s coping strategies and reinforce them  Offer realistic hope  Avoid trying to be overly reassuring  “The success or failure of the breaking bad news interview ultimately depends on how the patient reacts and how you respond to those reactions and feelings.”

Step 6. Planning and follow-through

Establish a plan for the next steps. This may include gathering additional information or performing further tests. Treat current symptoms. It may include helping parents to tell their child about their illness and what treatment will be like for them. Arrange for appropriate referrals Explain plans for additional treatment. Discuss potential sources of emotional and practical support

“Sometimes all person needs is a hand to hold and a heart to understand”