1. Advance Care Planning
2. Communicating Bad News
3. Whole Patient Assessment
4. Pain Management
5. Assisted Suicide Debate
6. Anxiety, Delirium
7. Goals of Care
8. Sudden Illness
9. Medical Futility
10. Common Symptoms
11. Withholding Treatment
12. Last Hours of Living
13. Cultural Issues
14. Religion, Spirituality
15. Legal Issues
16. Social and Psychological
Clergy and Faith Communities
Step 4. Sharing the Information
Step 5. Responding to Feelings
Step 4: Sharing the Information
General Guidelines for Breaking Bad News
Deliver the information in a sensitive but straightforward manner
Avoid delivering all of the information in a single, steady monologue
Use simple language that is easy to understand
Avoid technical jargon or euphemisms
Use silence and body language as tools to facilitate the discussion.
Do not minimize the severity of the situation
- Well-intentioned efforts to "soften the blow" may lead to vagueness and confusion
Examples of How to Break Bad News
You might choose to break bad news by using language like:
"Mr Lopez, I feel badly to have to tell you this, but the growth turned out to be cancer."
"I’m afraid the news is not good. The biopsy showed that you have colon cancer."
"Unfortunately, there’s no question about the test results: it’s cancer."
"The report is back, and it’s not as we had hoped. It showed that there is cancer in your colon."
"I’m afraid I have bad news. The bone marrow biopsy shows your daughter has leukemia."
When and How to Say "I'm Sorry"
Be aware that the phase "I’m sorry" may be easily misinterpreted...
- To imply that the physician is responsible for the situation
If you use the phrase, adjust it to show empathy
For example, "I’m sorry to have to tell you this."