10 Tips for Breaking Bad News
Part 2 in a series on Breaking Bad News to Patients”
- Consider the environment: Select a suitable place for privacy and effective interchange of information. If there’s going to be family members present, ensure that everyone has adequate seating. Have tissues. Bottled water is a plus.
- If there are language barriers, ensure that your designated practice translators are comfortable and skilled in translating the information you are about to communicate. Avoid using family members as primary translators because they are there as family members, not as translators. This confuses their roles in the communication process, and potentially creates an awkward, uncomfortable interchange of sensitive information.
- Turn off your pager; cell phone ringer. Try & avoid all interruptions.
- Use sensitivity and simple language. But always be honest and frank.
- Your first preparatory statement can be: “I don’t have good news.”
- After making that first statement, pause briefly, allowing patients and family members time to process the information.
- Show compassion by listening, acknowledging their feelings, as well as coping and expecting emotional outbursts. Reassure them that their responses are okay; and consider touching the patient if appropriate, in a reassuring way. Offer water and allow time for the patient and family to express and process their feelings.
- Always provide an accurate and realistic estimate of the prognosis.
- Communicate your plans to the patient for next steps. Provide sources of social services, home health, hospice, counseling, support groups, and other options for next steps.
- Ensure that the patient and family know that you are actively engaged to help in the patient’s healthcare team. Provide access for the patient and family to reach you for asking additional information. This may include scheduling a follow up for further questions and treatment considerations.