Breaking Bad News

Dr. Rahila Ali

Department of Family
Medicine

Objectives
By the end of the session students should be
able to:
Describe the concept of bad news
Discuss the steps related to breaking bad news

What is bad news?

any news that drastically and negatively
alters the patients view of her or his
future.

Buckman 1992

Reactions
Fear
Anger
Depression
Disbelief/Denial

Causes of Fear in people with a life

threatening illness
Fear of :
Separation from a loved one, jobs.
Becoming a burden to others
Losing control
Fear for dependents
Pain
Dying
Not being able to complete their role
Parkes 1998

Physicians need to individualize

their manner of breaking bad news
based on the patients desires and
needs.

Initial goals in delivering bad news

Build therapeutic relationship
Allow emotional ventilation
Achieve a common perception of the problem
Address basic information needs
Respond to immediate discomforts
Ensure a basic plan for follow -up
Anticipate what has not been talked about
Minimize aloneness and isolation

Your X-ray shows ca lung

with a very bad prognosis

ENCOURAGE HOPE

A physicians attitude and

communication skills play a crucial role
in how well patients cope when they
receive bad news.

SPIKES
(Protocol for breaking bad news)
S Setting and listening skills
P Patient perception of condition and seriousness
I Invitation from patient to give information
K Provide Knowledge in small chunks, check understanding
E Explore emotions
S Strategy and summary

Baile & Buckman 2000

Setting
Arrange a private, quiet place without interruptions
Arrange for the presence of a support person/approp.
family member
Arrange a time and place that will be undisturbed
(turn off mobiles)

Setting
Sit close enough to touch if appropriate
Prepare emotionally
Decide which words & phrases to use (write down a script)
Practice delivering the news

SPIKES
Perception
What do they Know?
How much do you understand about your illness?
How do you feel?
What is troubling you the most?

SPIKES
Invitation
From the patient to give the information
Would you like me to explain ..?
Are you the sort of person who wants to know whats
happening?

SPIKES
Knowledge
Warning shots
Be direct ( I am sorry , I have bad news)
Giving information
Do not use, jargon, acronyms
Small chunks
Check understanding

SPIKES
E-Emotions
Identify shock, anger etc
Allow for silence
Use touch appropriately

SPIKES
S-Strategy and Summary

Discuss his queries

Have a plan
Arrange additional meetings

Finding strength
Inquire about the patients resources :
When bad things have happened to you before, how have
you coped
To whom will you turn for support

Prescribe resources available to the patient:

Regular physician follow-up
Psychologist, social worker
Reading material, videos
Support group

Role play

Donts
Make assumptions about:
The patients readiness to hear the news in front
of anyone
Patients understanding

Give too much information at one time

Donts
Give inappropriate reassurances
Hurry
Use jargons i.e. ca lung, consolidation
Break bad news to relatives before telling the
patient.

Summary
Things to consider
Before environment, time, information, relatives
During using a warning shot, find out what is
understood, avoid jargon, open questions
After re-cap, instigate a plan, be positive, provide after
care

Summary
S Setting and listening skills
P Patient perception of condition and seriousness
I

Invitation from patient to give information

K Provide Knowledge in small chunks, check understanding

E Explore emotions
S Strategy and summary

References
1. Arber A, Gallagher A (2003) Breaking bad news revisited: the push for

negotiated disclosure and changing practice implications. International Journal

of Palliative Nursing Vol 9, No 4, Page 166-172
2. Baile W, Buckman R (2000) Spikes- A Six Step Protocol for Delivering Bad

News: Application to the Patient with Cancer. The Oncologist 5: Page 302-311
3. Buckman R (1992) How to Break Bad News. Papermac, London.
4. Maguire P (1985) Barriers of Psychological Care to the Dying. British Medical

Journal 291 Page 1711-1713

References
5. National Council of Hospices and Specialist Palliative Care (2003)
Breaking Bad News. Regional Guidelines. Department of Health.
6.

Parkes C M (1998) Coping with Loss: the dying adult. British

Medical Journal. April 25, 316: Page 1313-1315

7.

Schofield P E (2003) Psychological responses of patients receiving

a cancer diagnosis. Annals of oncology 14:1:Page 48-56

8.

http://www.breakingbadnews.co.uk