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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 NewsBreaking Bad NewsPrepared and presented by:Esraa Salah Al-ddin Ahmad

Mahasin Gamal Al-ddin YaqoubHind Sayed Uthman

Huida Al-sadq Al-taiebWisam 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 woman’s 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 Association’s 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:

1-Getting started2-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 patients feelings

6 -Planning and follow-through

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? .)"

فكرهفكرهتشم أن تعلم

لك... البد أي الدخانتشعر أن

وهم بمشاعراالخريناليك يتحدثون

Planning and follow-through

"(I'll see you in clinic in 2 weeks )"or the 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 don’t 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 thisbad news can increase the woman’s 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

Finallyit 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

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