🗒 Breaking bad news

Communication

The medical profession’s service delivery, communication and explanation practices are linked to patient complaints and claims. Particularly important when breaking bad news.

MIPS emphasises the need for appropriate communication to enable appropriate patient decision making and understanding, including:

  • provision of all treatment options
  • warnings and risks

Breaking bad news

Your communication can affect the patients’ and/or family members’:

  • comprehension of the news
  • perception of your attitude and quality of care you provide
  • level of confidence they have in the prognosis and treatment
  • mental wellbeing.

You should strive to communicate the Diagnosis/Prognosis/Purpose of care and involve patients in planning treatment.

When communicating accurately the options and reasonable expectations to the patient, the manner in which bad news is delivered can be just as important and influential as the prognosis itself. It is essential you:

  • communicate the diagnosis clearly and how you reached this
  • give details of your prognosis and the reasons you believe this is most accurate
  • do not mislead, be honest
  • explain the purpose of care you now propose and why this is the option most suitable above others
  • involve the patient in planning treatment wherever possible.

Strategies to employ. These will vary but in general terms:

  • Give warning that bad news is coming
  • Keep it simple, slow and summarise
  • Avoid clichés and jargon
  • Opportunity for questions
  • Check understanding
  • Answer questions openly and truthfully
  • Avoid bluntness
  • Instil optimism but realistic hope
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