General Strategies

Setting
- Private room to speak to patient and / or family
- Involvement of significant others
- Have both parties seated, at eye level
- Look calm, maintain eye contact
- Listening mode: do not interrupt the patient or talk over the patient
  - Silent pauses to allow patient to talk
- Repetition as a means to acknowledge what the patient is saying
- Availability – silence phones etc.
Perception: “before you tell, ask”
- Allows patient’s expectations to be understood – gives an estimation of the “impact” of the bad news, and an opportunity to impart knowledge before breaking bad news or dealing with anger
- Ask patient what they know of the situation
  - What did you think was going on when you felt the lump?
  - What have you been told about all this so far?
  - Are you worried that this may be something serious?
- Take note of the language the patient is using, and use a similar vocabulary
- Do not confront denial head on initially
Invitation
- Check that a patient really wants to know what is going on before delivering news
  - Are you the kind of person who prefers to know all the details of what’s going on?
Knowledge or sign posting
- Give patients a warning of what is about to come, so they have more time to mentally prepare
  - Sir, unfortunately the news I have is concerning. Would you like me to proceed at this stage?
  - Ma’am, I’m so sorry, but I have troubling news.
- Avoid jargon
- Give information in small chunks
  - Check understanding at frequent intervals
  - Go over information again if news is not acknowledged
  - Always check after each “chunk” that the patient is ok to proceed with the discussion
- Tailor the rate of the discussion – slow down if the patient is having difficulty processing
Empathy: responding to patient’s emotions
- Do not downplay the severity of the information, or hold information back unless specifically asked
  - This may just serve to discredit in the future, or shake trust
- Acknowledge patient’s emotions when they arise, and address them
  - Listen for and identify the emotion. If unsure:
    - How does this make you feel?
    - What do you make of what I have just told you?
  - Identify the source of the emotion – e.g. the bad news, delayed diagnosis etc.
  - Show the patient that the connection between the above two has been made
    - I can see that this news is terribly distressing for you
    - Hearing the results of the bone scan is a major shock for you
  - Normalize the emotions
- Such responses validate a patient’s emotions, and reduce isolation
Strategy and summary
- Summarise the information given to the patient in the discussion
- Check for any concerns or questions not addressed
- Give the patient a plan of action
- Give the patient a safety net and assurance of follow-up

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General Strategies

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