Breaking Bad News

Source: raw/nsg210_wk09_BREAKINGBADNEWS.pdf (2 pages). Titled “Sharing Bad News.”

Learning Objectives

• Identify common challenges in breaking bad news
• Identify the key elements of the discussion
• Observe and practice it
• Improve self-observation of provider-patient interactions and skill in giving feedback
• Reflect on general principles

Ten Steps

1. Setting and time: comfort, privacy, quiet, no interruptions
2. Prepare yourself: rehearse key points and monitor your own reactions
3. Involve family (especially key decision-makers) and other professionals; ask the patient who should be there
4. Align first (unless you already know them well): what do they know, what do they want to know; let them set the pace
5. Be brief and simple: key message in a few sentences, plain language, no jargon or euphemisms, realistic goals for the first talk, repeat and write down key points
6. Honesty: avoid false reassurance and false optimism, but also avoid excess bluntness; respect cultural and personal preferences; give needed prognosis without false precision
7. Listen: attending to the patient matters more than what you say; respond to emotions, tolerate silence, invite questions, clarify, ask what “hope” means for this patient
8. Support: show caring, respond to emotion, empathize, acknowledge difficulty, identify supports and offer resources
9. Next steps: plan follow-up and guarantee continued availability; bad news is a process, not an event
10. Document what was shared and communicate it to the team

Nursing Takeaways

• Telling a diagnosis is usually the provider’s role; the nurse is often there, prepares the setting, assesses understanding afterward, clarifies, supports, and documents
• Use silence and open-ended questions; avoid “I know how you feel” and false reassurance

References in the Handout

Buckman (1992), How To Break Bad News; Girgis and Sanson-Fisher (1995); Quill (1991, 2000); Lo, Quill, and Tulsky (1999); Fallowfield et al. (1995); The et al. (2000).