Six-step Approach in Giving Bad News

One of the hardest task in medicine is to give bad news to patients or relatives. This can range from diagnosing a chronic illness to giving news about a death or disability. However, any news that brings with it some restriction or potential loss can be sad or bad news.

Reviews of research in this area have identified three important factors.

1. People appreciate it if the clinician is kind, confident, sensitive, and caring. People also prefer clinicians to show concern and distress rather than being aloof and detached.
2. People appreciate it more if the news is given clearly, using simple terms, and if they have time to talk about it with the clinician and ask questions.
3. People appreciate a quiet and private setting.

Here are the six-step approach whose principle guidelines overlap a good deal

1.	Setting up	Prepare thoroughly for the interview. Make sure you have all the relevant information. Locate the interview somewhere private, where you will not be interrupted. Allow yourself the time to give the news and then deal with people’s responses and questions.
2.	Patient’s perception	Start by checking how much the person already knows and understands so you can tailor the bad news appropriately. Use an open questions here such as ‘What have you been told so far?’
3.	Information needed	Ask the person how much they want to know about the diagnosis, prognosis, and treatment. This helps tailor the type and amount of information you give in this session to what the person wants and is able to cope with.
4.	Knowledge given	Impart knowledge of the bad news. It can help to pre-warn the person by saying something like, ‘It’s not the good news we hoped for’ and then pausing. This allows the person short time to prepare for the bad news. Give the bad news clearly and in simple language. Ambiguous statement should be avoided Give the information in small, manageable chunks.
5.	Emotional response	A range of emotional response may arise when giving bad news including shock, disbelief, fear, anxiety, distress, grief, and anger. The best way to deal with emotional responses is to recognize them and empathize. With very bad news there is little you can do but offer empathy and support. Evidence suggests that people will appreciate this.
6.	Summarizing and strategy	Towards the end of the interview the clinician should summarize the main points or outcomes of the interview and consider or agree a future strategy such as curative or palliative treatment. This helps focus the person on the next steps, gives some certainty, provides a known support structure, and where possible may provide hope.