Breaking Bad News

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Breaking Bad News

• Dr Charlotte Clare
• Consultant in Palliative Medicine

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What is bad news?

• Any news that drastically alters a persons view
  of the future. Fallowfield 1993
• Information that drastically alters a patients
  view of their future for the worse. Kaye
  1996

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Various guises of bad news

• Illness
• Imminent death
• Sudden death
• Infertility
• Altered body image
• Loss of a job
• Loss of a relationship
• Failing exams
• Loss of possessions

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Why is it difficult?

• Feeling incompetent
• As professionals we like to make things better
• We may fear their reactions
• We feel unsure, vulnerable, what can we say to
  comfort?
• Wanting to protect or shield the patient
• Lack of time
• Feeling powerless
• The feeling that you have to do it
• Getting blamed

5
Why is it important?

• To maintain trust
• To reduce uncertainty
• To prevent inappropriate hope
• To allow appropriate adjustment
• To prevent a conspiracy of silence.

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Breaking Bad News
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10 Steps (1-3)

• Preparation
• - Know the facts
• - Who present?
• - Sit down
• - Allow time
• - Face to face
• What do they know?
• What do they want to know?

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10 Steps (4-7)

• 4. Allow denial
• - How do you feel things are going?
• 5. Warning Shot
• - Clear language
• 6. Explanations
• - Narrow gap between their information and
  reality
• 7. Elicit concerns

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10 Steps (8-10)

• 8. Ventilation of feelings
• - Therapeutic
• - Empathy
• 9. Summary and plan
• 10. Offer availability

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• Thank you