Breaking bad news in palliative care
The way bad news is broken to patients and their families may enhance or hinder their understanding of the prognosis and treatment options, and their adjustment to their situation.
When giving bad news, prepare to communicate the reality of the situation, while being empathic and maintaining a sense of hope. This involves telling the patient about the situation, what can be done for them, who will be able to help and support them, and reminding them of their own strengths and personal resources. For guidance, see Guidance for breaking bad news and Discussing prognosis.
Emotional responses are common following diagnosis, and can include shock, disbelief, anger, sadness, fear, numbness, and feeling dazed or disconnected. For more information, see Overview of emotional, psychological and behavioural symptoms in palliative care.
Suggested steps for breaking bad news to a patient are as follows; these may vary depending on the context.
Preparation
Encourage the patient to have a family member or friend with them for support; consider cultural factors (eg whether particular people should be present).
Consider having another member of the healthcare team present (eg nurse, social worker); they can often provide ongoing support to the patient and family.
Use a quiet private place and ensure everyone is comfortably seated; allow enough uninterrupted time.
Communicate the information
Assess the patient’s understanding of the situation and how much and what type of information they want.
Provide information honestly and directly; be clear, concise and avoid medical jargon. Repeat information if necessary.
Give the patient time to process the information; allow silence and resist filling it with information.
Encourage the patient to express their feelings; acknowledge their emotions and respond with empathy.
Check the patient’s understanding along the way; encourage them to ask questions and seek clarification.
Avoid giving early or false reassurance as this may block the patient from expressing fears or concerns.
Discuss any treatment options and give reassurance of ongoing support and symptom management. Avoid saying ‘nothing more can be done’.
Conclude and follow up
Discuss next steps.
Arrange for ongoing support and follow-up—make an appointment for a few days’ time to check what the patient has understood, and to answer any questions and clarify issues.
Write down the key points discussed, date of follow-up visit and relevant contact details, and give them to the patient.
Offer assistance in telling others or explaining to others what is happening.
Document the information given and decisions made in the medical notes.