BREAKING BAD NEWS

Nguyen Thi Khanh Linh

Đối tượng: Sinh viên khối khoa học sức khỏe

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LEARNING OBJECTIVES

After this lesson, students will be able to:

1.Define bad news
2.Describe SPIKE method for breaking bad news
3.Respond to patient’s reaction
4.Apply these concepts to clinical practice.
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LEARNING CONTENT
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What is Bad News?
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1. Definition of Bad News
o “ …any information which adversely and seriously effects
an individual’s view of his or her future”
Buckman, 1992
o “ …any information that is not welcome”
Arber and Gallagher, 2003
o “ …an uncomfortable experience for both the giver and
the receiver”.
Aitini and Aleotti, 2006
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1. Definition of Bad News
Examples:
oLife threatening illness
oDegenerative conditions
oChronic illness
oMental retardation in children
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2. Facts of Bad News
Is Delivering Bad News Difficult? Why?
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2. Facts of Bad News
Why is Breaking Bad News Difficult?
-Upsetting of patient’s family
-Negative experiences
-Fear of being blamed
-Patient’s emotional reaction
-Skills and methods
-Time/ health system
-Cultural issues
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2. Facts of Bad News
Why should it be done?
- Part of clinical practice.
-Doctor’s skill
-Ethic
-Patient’s health
-Patient-doctor relationship.
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2. Facts of Bad News

“An expert in breaking bad news is not someone who gets it right
every time—he or she is merely someone who gets it wrong less
often, and who is less flustered when things do not go smoothly.“
The aims:
+ Deliver bad news clearly, honestly and sensitively
+ In order that patients can both understand and feel supported.
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3. Breaking Bad News Approach
SPIKES—A Six‐Step method for Delivering Bad News
SETTING UP the Interview
S
Assessing the Patient’s PERCEPTION
P
Obtaining the Patient’s INVITATION
I
Giving KNOWLEDGE and Information to Patient
K
Addressing the Patient’s EMOTIONS with empathic
E responses
Strategy and Summary
S
Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP (1992) SPIKES – A SixStep
Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist 5:302-
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3. Breaking Bad News Approach
Advance Preparation
oClinical information
oLab reports
oThink about specific words or phrases to use and to avoid.
oTime, space, with no interruptions
oPatient’s reaction

https://www.youtube.com/watch?v=_uOS7hfKkVI
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STEP 1: SETTING UP the Interview

Setting the Environment

oProvide privacy
oIntroduce self
oDetermine who else should be present
oEnsure no interruptions
oProvide comfortable space
oCreate welcoming environment
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STEP 2: Assessing the Patient’s PERCEPTION

Perception
oAsk what he/she already knows about the medical condition or what he
suspects.
oListen to level of comprehensions.
oAccept denial but do not confront at this stage.
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STEP 3: Obtaining the Patient’s INVITATION

Invitation 
oFinding out how much the patient wants to know
oAccept patient’s right not to know.
oOffer to answer questions later if s/he wishes.
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STEP 3: Obtaining the Patient’s INVITATION

You want to get a clear invitation from the patient to share information.
If the patient deny to discuss the information, leave the option open for later
discussion.
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STEP 4: Giving KNOWLEDGE and Information

Deliver the message

oUse plain language
oBe mindful of body language
oGet to the point
oGive information in small chunks
oPause
oWait for reaction
oUse “teach back” to verify that message was received
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STEP 5: Emotions and Empathy

Emotion and Empathy

oBe prepared for patient’s and family’s emotional response
oAnticipate fear, anger, sadness, denial, guilt
oBe mindful of your own response
oComfort the patient
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STEP 6: Strategy and Summary

Strategy and Summary

oAssess patient’s readiness for planning
oNegotiate next steps
oVerify support structure
oAcknowledge & answer questions
oSummarize plan
oUse “teach back” technique
oFollow-up
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Key points
Delivering bad news is an important part of a physician's job.
The manner in which the news is delivered to family
members will have a long lasting effect.
Proper training and experience will facilitate the process.
Remember to treat your patients as you would like to be
treated.

Q&A
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Reference

1. Behavioral medicine: A guide for Clinical Practice;

Mitchell D. Feldman, John F. Christensen; 2008.

2. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP

(2000) SPIKES – A SixStep Protocol for Delivering Bad News:
Application to the Patient with Cancer. Oncologist 5:302-311
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