RD09 (2016) Breaking bad news

 

Why do it well?

·        Because we should

·        More organ donation

·        Less litigation

 

1.Preparation:

Plan

·     Arrange meeting without delay

·     Rehearse your lines

People

·     Patient/relatives ± support person

·     Anaesthetist ± support person

·     Proceduralist

·     Junior doctor (for documentation + learning)

Place

·     Private room

·     Chairs

·     All on the same level

 

2.Discussion:

Introduction

·     Introduce your team

·     Confirm identity of those attending

Assessment

·     Ask what they know already

·     Consider level of understanding

Tell

·     Fire a warning shot

·     Small pieces of information

·     Frequent pauses

·     Facts only

·     No jargon

·     Sympathy but not blame

Listen

·     Allow time to process

·     Acknowledge emotional response

·     Allow questions

Summarise

·     Say it again in 20 words

·     Offer further contact

·     Offer referral serves

 

Alternative: SPIKES

·        Setting

·        Patient perception

·        Invite information

·        Knowledge transmission

·        Emotions and empathy

·        Summary and strategy