A step-by-step protocol for communicating bad news.
| Step . | Useful Phrases . |
|---|---|
| 1. Prepare for the encounter. | |
| • If possible, have advance discussion with patient about who will be present | “Is there anyone you would want to have present when we talk?” |
| • Find a location with adequate privacy | |
| • Arrange adequate time for discussion | |
| • Review the clinical information | |
| 2. Assess the patient’s understanding | “How much do you understand about what is going on medically?” |
| • Ask the patient about his or her view of the situation | “What did you take away from your talk with Dr. Lee?” |
| • Find out how much that patient wants to know | “Are you the kind of person who likes lots of detail, or would you prefer the big picture?” |
| 3. Disclose the news | |
| • Consider giving a “warning shot” | “I have some serious news that we will need to make some decisions about.” |
| • Provide information honestly and in simple language | |
| • Tailor amount of medical details and technical language in accord with patient’s wishes | “The bone marrow shows a kind of cancer of blood cells, and the medical name for this condition is acute myeloid leukemia.” |
| 4. Respond to the patient’s emotions | |
| • Encourage the patient to express his or her emotions | “I’ve given you a lot of information. What are your reactions and concerns at this point?” |
| • Acknowledge the patient’s emotions and empathize | “I can see that this information is not what you expected.” |
| • Tolerate silence | “Take your time, and tell me when you’re ready to go on.” |
| 5. Offer to discuss implications of the news, including: | “Would you like to talk more about treatment options and quality-of-life issues now, or should we schedule more time in a couple of days?” |
| • Effect on quality of life | |
| • Treatment options | |
| • Prognosis | |
| 6. Offer additional resources, including: | |
| • Assistance talking to others | |
| • Other support services | |
| 7. Summarize the discussion | “Let me summarize our discussion and next steps now.” |
| • Restate important points | |
| • Ask if there are any other questions | |
| 8. Arrange a follow-up time for patient and family questions and concerns | |
| 9. Document the discussion in the medical record |
| Step . | Useful Phrases . |
|---|---|
| 1. Prepare for the encounter. | |
| • If possible, have advance discussion with patient about who will be present | “Is there anyone you would want to have present when we talk?” |
| • Find a location with adequate privacy | |
| • Arrange adequate time for discussion | |
| • Review the clinical information | |
| 2. Assess the patient’s understanding | “How much do you understand about what is going on medically?” |
| • Ask the patient about his or her view of the situation | “What did you take away from your talk with Dr. Lee?” |
| • Find out how much that patient wants to know | “Are you the kind of person who likes lots of detail, or would you prefer the big picture?” |
| 3. Disclose the news | |
| • Consider giving a “warning shot” | “I have some serious news that we will need to make some decisions about.” |
| • Provide information honestly and in simple language | |
| • Tailor amount of medical details and technical language in accord with patient’s wishes | “The bone marrow shows a kind of cancer of blood cells, and the medical name for this condition is acute myeloid leukemia.” |
| 4. Respond to the patient’s emotions | |
| • Encourage the patient to express his or her emotions | “I’ve given you a lot of information. What are your reactions and concerns at this point?” |
| • Acknowledge the patient’s emotions and empathize | “I can see that this information is not what you expected.” |
| • Tolerate silence | “Take your time, and tell me when you’re ready to go on.” |
| 5. Offer to discuss implications of the news, including: | “Would you like to talk more about treatment options and quality-of-life issues now, or should we schedule more time in a couple of days?” |
| • Effect on quality of life | |
| • Treatment options | |
| • Prognosis | |
| 6. Offer additional resources, including: | |
| • Assistance talking to others | |
| • Other support services | |
| 7. Summarize the discussion | “Let me summarize our discussion and next steps now.” |
| • Restate important points | |
| • Ask if there are any other questions | |
| 8. Arrange a follow-up time for patient and family questions and concerns | |
| 9. Document the discussion in the medical record |