Skip to Main Content

Bad News (Breaking Bad News)—Guidelines

A. FOR UNEXPECTED DEATH, E.G. MOTOR ACCIDENT

DOs

  • Personal contact of relative/s, preferably by doctor.

  • Be well-prepared: check facts, plan approach.

  • Use suitable quiet private room (not to be disturbed).

  • Provide empathy, support, understanding, sensitivity.

  • Be honest, direct.

  • Allow time, opportunities to react and question.

  • Allow silence, touching and free expression of emotions.

  • Allow viewing of a dead or injured body.

  • Provide appropriate follow-up and ongoing support.

DON’Ts

  • Delay contact.

  • Rush the interview.

  • Avoid fudging.

  • Be blunt.

  • Withhold the truth or get facts wrong.

  • Give platitudes and euphemisms.

  • Give false reassurance.

B. FOR SHARING BAD PERSONAL NEWS (TABLE B2)

|Download (.pdf)|Print
Table B2 Seven-step protocol for breaking bad news

Assess the patient’s interest in and capacity for detailed information.

Establish the patient’s beliefs about the illness and what he or she wants to know.

Provide accurate information in small doses, checking regularly what has been understood.

Monitor how the patient feels about the problem and what has been said.

Repeat the messages as the illness progresses, especially after each new step of management and/or deterioration.

Involve family members as much as the patient wants.

Plan for continued involvement. An assurance of continuing contact between doctor and patient is important.

  • Plan the consultation, check facts, set aside ample time.

  • Meet in an appropriate room with privacy and no interruption.

  • Ask the patient if they would like company (e.g. a relative or friend).

  • Make good eye contact and be alert for non-verbal responses.

  • Use simple, understandable language.

  • Be honest and diplomatically to the point (don’t cover up the issue).

  • Allow time, silence, tears or anger.

  • Avoid inappropriate methods (refer to ‘Don’ts’ above) and don’t give precise predictions about life expectancy.

BEREAVEMENT AND COPING WITH LOSS

Bereavement or grief is the emotional response to loss, with a complex amalgam of anger, sadness, helplessness, guilt, yearning and despair.

Stages

The usual normal stages are:

  1. Shock or disbelief: hrs to days

  2. Grief and yearning: 6 wks +

  3. Despair—social withdrawal, sadness, hopelessness: ~6 mths 2–3 include anger, guilt and self-blame

  4. Adaptation and acceptance, includes: apathy, depression, physical ailments: 1 or more yrs

Role of GP

  • Provide basic counselling and ongoing support.

  • Provide patient hand-outs.

  • Refer to grief counsellor, religious groups, support groups, e.g. SIDS.

  • Watch for morbid or pathological grief.

Rules

The bereaved may:

  • feel very guilty

  • be angry towards you or others

  • need a clear, gentle explanation about cause and manner of death

  • need to sense you are genuinely interested

  • need to work through stages of grief

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close