BREAKING BAD NEWSPROF. FAISAL GHANI SIDDIQUI

MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE

WHAT IS A BAD NEWS?

WHAT IS A BAD NEWS?

Any information that adversely and seriously affects an individual’s view of her/his life

WHAT CONSTITUTES BAD NEWS?

• Disclosing • diagnosis of cancer

• cancer recurrence

• Metastases

• Positive genetic test results

• Announcing death of parent/spouse/child

BREAKING BAD NEWS: WHY IS IT IMPORTANT?

Conceal truth / withhold information to Avoid discomfort

to the patient

Lying to patientObstructing autonomy

PATIENT AUTONOMY

Ethical & legal obligation on the physician to provide patients with as much information about

their illness as they desire

Truth may be disclosed without

concern for patient’s sensitivity

Discomfort

Avoid discomfort of the patient and

withhold information

Lie

Truth may be disclosed without

concern for patient’s sensitivity

Discomfort

BREAKING BAD NEWSIS DIFFICULT

5 STAGES OF GRIEF AND LOSS

5 STAGES OF GRIEF AND LOSS –KUBLER ROSS MODEL

Denial

Anger

DepressionBargaining

Acceptance

5 STAGES OF GRIEF AND LOSS –KUBLER ROSS MODEL

DENIAL Person denies the facts when he receives bad news

ANGER Develops anger, irritation, jealously and resentment

DEPRESSION Feelings of helplessness develop. May take refuge in alcohol and drugs.

BARGAINING Tries to get away from the truth in different ways

ACCEPTANCE Accepts the fact that there is no more hope

do you remember the reaction of the companions to the death of

the prophet (PBUH)?

BREAKING BAD NEWSIS DIFFICULT

… BUT IT CAN BE LEARNT

THE SIX STEPS OF SPIKES

S SETTING UP the interview

P Assessing the patient’s PERCEPTIONS

I Obtaining patient’s INVITATION

K Giving KNOWLEDGE to the patient

E Addressing patient’s EMOTIONS with empathy

S STRATEGY and SUMMARY

STEP 1: SETTING UP THE INTERVIEW

• Privacy: a private location, such as an interview room

• Involve family members for support

• Sit down

• Do not interrupt the patient when (s)he is talking

• Manage time constraints and interruptions

STEP 2: ASSESSING PATIENT’S PERCEPTION“BEFORE YOU TELL, ASK”

• Find out what patient knows about her/his illness

• Will help you understand how much patient knows

about the seriousness of her/his disease

STEP 3: OBTAINING PATIENT’S INVITATION

Although most patients want to know all the details about

their medical situation, you can't assume that this is the

case. Obtaining overt permission respects the patient's

right to know (or not to know)

STEP 4: GIVING KNOWLEDGE

• Use the same language your patient uses

• Don’t use medical jargon

• Give information in small chunks

• Clarify patient’s understanding

STEP 5: ADDRESSING PATIENT’S EMOTIONS WITH EMPATHY

• Acknowledge patients emotions

• Tell her/him that these emotions are normal

STEP 6: STRATEGY AND SUMMARY

• Summarize the information

• Give patient an opportunity to ask questions

• If you don't have time to answer tell your patient that

this issue can be discussed in detail during next

interview