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 which conveys to an individual fewer choices in his or her life.
Examples: the cancer diagnosis, recurrence or relapse of cancer, ending of anticancer treatment and 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. Page 36.
Breaking bad news is an important task for physicians to enable patients and family members to receive their preferred medical care and improve 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