At some point in their careers, all physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship will have to deliver bad news to patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship and/or their families. While this is a difficult and sensitive subject, there are communication Communication The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups. Decision-making Capacity and Legal Competence techniques and protocols that can assist physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship in delivering bad news in a way that maintains and even strengthens the physician–patient relationship.
Last updated: Dec 13, 2022
Bad news is broadly defined as any information that may alter a patient’s view of their future. Bad news is typically life-changing information that should be communicated to the patient and family with empathy Empathy An individual’s objective and insightful awareness of the feelings and behavior of another person. It should be distinguished from sympathy, which is usually nonobjective and noncritical. It includes caring, which is the demonstration of an awareness of and a concern for the good of others. Psychotherapy and honesty.
No one model or method is perfect, though each protocol provides a loose structure for delivering bad news in an effective, compassionate way. Mnemonics are used for 3 of the most common protocols, though they share many of the same concepts (which are detailed in the subsequent subsections):
|Concept||SPIKES protocol terminology||ABCDE protocol terminology||BREAKS protocol terminology|
|Know the patient’s history and background.||CNI||Advanced preparation||Background|
|Quiet location, adequate time for discussion, support person present, ask for permission to deliver the news||Setting invitation||Build a therapeutic environment.||Rapport|
|Assess what the patient understands about their condition.||Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment||Advanced preparation||Explore|
|Deliver the news.||Knowledge||Communicate||Announce|
|Address emotions as they arise.||Emotions||
|Summarize and form a plan going forward.||Summary and strategy||CNI||Summarize|
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