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Home GuidelinesSharing
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Give the information clearly, in manageable chunks and in response to the patient's questions. Give a warning of the seriousness of the information, and observe their reactions, both verbal and non-verbal. Stop if the patient indicates that they have heard enough.
No one likes breaking bad news, so there is a temptation to give the whole message, usually too quickly. Although you cannot give the news gently, you can be sensitive and show your awareness of the likely impact on the patient. Use simple language, but avoid euphemisms, such as "little wart" when you mean cancer. Silence is a powerful tool to encourage the patient to respond.
You might choose to begin breaking bad news by using language like:
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We have your test results back, and I'm afraid that it is
more serious than I hoped.
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I'm afraid the news is not good. Are you ready for me to discuss
it with you.
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The patient may respond in one of several ways:-
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So it's cancer then?
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What did you find?
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I'm not sure that I want to know
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How will you treat it?
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You will then be able to respond to the patient with appropriate information,
or check out what they mean if there is any ambiguity in their response:-
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You say you are not sure that you want to know, What is your
biggest worry?
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I'll come on to treatment, but can I tell you some more about
what we found?
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By progressing at the patient's pace, there is a greater chance that
they will absorb the message and only be required to deal with what
they can manage at any one time.
Sometimes it is difficult to gauge a patient's reactions. Their words might indicate acceptance of a situation, but their body language suggests something quite different. To check the situation, it is useful to "say what you see" eg. "You say that understand, but you look very puzzled to me.". This allows the patient to respond with any worries or concerns eg. " I do understand that you have found cancer cells in my breast, but you also mentioned lymph nodes and I don't know what they are"
Remember, the more information you give at any one time, the less will be remembered. Start with the salient facts and only move on when the patient shows a readiness for more, and relevant, information
A patient has been diagnosed with cancer of the bowel. In addition to learning of their diagnosis, you will need to discuss future plans. These will include surgery, effect on lifestyle, potential problems and future support.
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How will you decide on the priorities for this patient in
terms of keeping him informed enough to make decisions on his
care? |
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