Tips for breaking bad news status tests

Breaking bad news for patients and relatives is an important skill that you will need to learn but in general practice it can be done by the chief nurse at a scheduled meeting, in the right place with the patient and his relatives. However, in the case of trials, you will not be given such comfort, and it will be your job to pass on bad news alone, for example, the situation you may be given on the phone and you must explain the death of a person to endure visiting relatives at night.

We have taken the following points from the Oxford Handbook for Medical School to help you prepare for this test in your exams:

Preparation in advance

This is important for both you and the patient / relatives. Read patient notes in advance including all recent results (e.g. blood test and scan). Mentally rehearse the questions you are asked. Be prepared to discuss the importance of the results of the investigation, with comments from other specialists and your elders.

Permission

This should be sought from the patient, where possible, in order to disclose information in front of anyone else, including family members. Patients still have the right to their own independence and should respect their wishes, even if they choose not to know about their availability.

Introductions

This is necessary so that you know who you are talking to. Also write down all present in patient notes.

Establish pre-existing information

This should be asked at the beginning of the meeting to find out what is already known, and what the patient / family would like to know.

Signposting and warnings

This applies to psychologically preparing patients to receive bad news; secret and confusing language will not help. Admittedly, 'Unfortunately, I have some bad news to share with you'.

Time

This is a powerful part of such discussions. After telling the patient the bad news logically, allow enough time for the details to sink in and anticipate emotional reactions such as denial, crying, anger, and panic.

Number of details

This should be given at the patient's speed, and will require individual judgment. Everyone can process bad news better if they are provided with controllable links. Keep track of their responses to the information provided, and proceed with consultation while confirming their understanding.

Empathy

This will prevent the patient from feeling isolated. You may not fully understand what they are feeling but you have shown that you can relate to them by assuming that you are in their place. Give hope but not with dishonesty and honesty about treatment and prediction. Do not commit to a time frame or make false promises.

The tongue

It should be easy, understandable, and without a jar.

ICE

Remember this mnemonic (Ideas, Concerns, and Expectations). You have to deal with the patient's opinions and concerns about the bad news they have been given and the expectations of your team.

Summarize

Do this in the end because the patient may still be dealing with bad news unlike all the other issues discussed including management and counseling options. Make sure the patient is able to understand and repeat the information provided at the end of the consultation.

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