Bad news relates to situations where there is either a feeling of no hope, a threat to a person's mental or physical well-being, a risk of upsetting an established lifestyle, or where a message is given that conveys to an individual fewer choices in his or her life.
Examples: cancer diagnosis, recurrence or relapse of cancer, ending of anticancer treatment, transition to palliative care.
Storey P and Knight CF. Unipac five: communication and the physician´s role on the interdisciplinary team. Reston, Virginia. American Academy of Hospice and Palliative Medicine. 1998. p. 36.
Breaking bad news is an important task for physicians, as it enables patients and family members to choose their preferred medical care and improves patients’ sense of control.
But there is reluctance among medical professionals to give bad news, probably because of the difficulty that they experience while conveying this kind of information.
Breaking bad news too abruptly may disorganize the patient psychologically; structured training can improve physicians’ skills in breaking bad news.
A step-wise approach is the best way to test the pace at which the individual wishes to know what is happening.
Robert Buckman has outlined a six-step protocol for breaking bad news. The steps are:
1. Getting started
2. Finding out how much the patient knows
3. Finding out how much the patient wants to know
4. Sharing the information
5. Responding to the patient’s feelings
6. Planning and follow-through