:

Breaking bad news to patients is one of the most

difficult responsibilities in the practice of
medicine. Although virtually all healthcare
professional in clinical practice encounter situations
entailing bad news,medical school offers little
formal training in how to discuss bad news with
patients and their families. This article presents an
overview of issues pertaining to breaking bad news
and practical recommendations for healthcare
professional wishing to improve their clinical skills
.in this area

Breaking Bad News

:Prepared and presented by
Esraa Salah Al-ddin Ahmad
Mahasin Gamal Al-ddin Yaqoub
Hind Sayed Uthman
Huida Al-sadq Al-taieb
Wisam Fath Al-rahman Tag Al-sir

Contents
?
What is meant by bad news#
The old concept regarding disclosure of bad#
?news
?
Who breaks bad news#
Protocol for breaking bad news
#Examples#
Sonographer and breaking bad news#
Problems to solve#

What is meant by bad

?news
Bad news is any information that changes
a person's view of the future in a negative
way . It is often associated with a terminal
.illness such as cancer
However, bad news can come in many forms,
:for example
a pregnant womans ultrasound verifies a .fetal demise

The diagnosis of a chronic illness

.(e.g., liver cirrhosis)
It might be a diagnosis that comes at inappropriate time, e.g, a diagnosis of
infantile uterus for female during
.the week of her wedding

The old concepts regarding

:disclosure of bad news

In 1847, the American Medical

Associations first code of medical
ethics stated, The life of a sick
person can be shortened not only by
the acts, but also by the words or
the manner of a physician. It is,
therefore, a sacred duty to guard
himself carefully in this respect, and
to avoid all things which have a
tendency to discourage the patient
and to depress his spirits

?Who breaks bad news

He is the healthcare professional. He
needs to be both competent and
confident because it is a crucial
time for patients when they are
first told that they have a serious
.disease

Robert Buckman's Six Step

Protocol for Breaking Bad
News
Dr. Robert Buckman, A specialist in
breast cancer, has outlined a six step
protocol for breaking bad news. The
:steps are

Getting started-1
Finding out how much the patient -2
.knows
Finding out how much the patient- 3
. wants to know
Sharing the information- 4
Responding to the patients - 5
feelings
Planning and follow-through- 6

Getting started
?"How are you feeling right now

Finding out how much

the patient knows
what the patient has already been told
? about his illness
I have Splenomegally, and I need )"
"( surgery

Finding out how much the

patient wants to know
Some patients want me to cover every"
medical detail, but other patients
want only the big picture--what would
?" you prefer now

Sharing the information

I'm going to stop for a minute to see)"
"(.if you have questions

Responding to the
patients feelings
Could you tell me a bit about what you)"
"(. ?are feeling


...

Planning and followthrough

or the"( I'll see you in clinic in 2 weeks)"
fact that you won't see the patient )"I'm
going to be rotating off service, so you
.will see Dr. Back in clinic"(

SPIKES
S etting up
P erception
I nvitation
K nowledge
E motions
S trategy and summary

What if the patient starts

?to cry while I am talking

In general, it is better simply to wait for

the person to stop crying. If it seems
appropriate, you can acknowledge it ("Let's
just take a break now until you're ready to
start again") but do not assume you know
the reason for the tears (you may want to
explore the reasons now or later). Most
patients are somewhat embarrassed if
they begin to cry and will not continue for
long. It is nice to offer kleenex if they are
available; but try not to act as if tears are
an emergency that must be stopped, and
don't run out of the room--you want to
show that you're willing to deal with
. anything that comes up

Examples
: Helpful phrases and questions are
I wish I had better news" (as opposed to "
, "I'm sorry, I have bad news")
," I admire your courage "
," I will be here for you "
?" What gives you hope and strength"

:Unhelpful statements include

,"It could be worse "
," We all die"
,"I understand how you feel "
." Nothing more can be done"

Thinking Point
Individuals remember different things
.following bad news interviews
:For example
The doctor was very kind to me when she
,told me I had cancer
but I dont remember any thing of what she
,said to me on that day
.I just remember she was very kind
When I was told that I had cancer, I felt
my whole world collapse
.around me

Sonographer and
breaking the bad news
Until recently sonographers have been
constrained by the medical
profession when they are first told
.that they have a serious diagnosis

but today reporting on scans and

communicating information
regarding fetal abnormalities by
sonographers has become
.common practice
Sonographers are now the mostly
likelly health professionals to tell
women the news that a fetal
anomaly has been detected

Bad news during these ultrasound

examinations is an uncontrollable,
unexpected event. It is associated
with a wide range of psychological
disorders; e.g, acute stress
disorder. Whilst these psychological
effects will subside over time in
.most women

The inept handling of women by

sonographers when breaking this
bad news can increase the womans
.long-term psychological morbidity
So,sonographers must undertake the
responsibility of breaking bad news in
. the best way possible

Problems to
solve with
Hind and
Wisam

Finally
it is obvious that acquiring the skill of
breaking bad news greatly required
because 'How a physician delivers bad
news may affect patients' understanding
of and adjustment to the news as well as
their satisfaction with their physician
The limits of medicine assure that patients
cannot always be cured. These are
precisely the times that professionalism
most acutely calls the physician to provide,
hope and healing for the patient