“Mrs. Njoroge. I have terrible, terrible news. Naomi died today.” You say it out loud until you can say it clearly and loudly. How loudly? Loudly enough.
Breaking Bad News
Breaking Bad
In the room…
Sit down.
Introduce yourself and anyone you have with you (a nurse is usually best)
Establish who is in the room (just in case you’re about to break bad news to the wrong family)
Foreshadow that you have bad news, “I am afraid I have very bad news”, and then get to the point: “John is dead”. (ALWAYS USE THE PATIENT’S NAME…and don’t use fancy terms for DEAD)
How To Break Bad News (Remember SPIKES)
S = Set up for the interview
- Prepare yourself: familiarize with the patients background, medical info and anticipate some likely questions
- Environment: arrange for privacy, minimize interruptions and time-constraints…
- Establish a connection with the patient/relatives; Involve patients/relatives family, nurses etc. Ensure you are talking to the right patient/relatives
P = Assessing the patients Perceptions
- How much do they know? What happened earlier/prior to hospital arrival?
- Correct any errors or gaps in patient’s knowledge
I = Obtaining the patients/relatives Invitation
- How much does the patient/relative want to know?
- Little detail/too much detail?
K = Giving Knowledge and information to the patient/relatives
- Start with a warning shot e.g. I’m afraid to inform you or I’m sorry to inform you…
- Clear and simple information, e.g. Mr. X is dead, BUT avoid excessive bluntness e.g. You are going to die from your cancer
- Avoid medical jargon e.g. CPR, Defibrillation, Gone to a better place
- Check understanding
E = Addressing the patients/relatives Emotions
- Give time to express feelings
- Observe and acknowledge emotions
- Show empathy
- Encourage questions and allow time
S = Strategy and Summary
- Clear plans of what next
- Offer follow-up support