OSCE Breaking Bad News

A Advance Preparation
- Have patients chart or pertinent laboratory data on hand
during the conversation
- Be prepared to provide at least basic information about
prognosis and treatment options
- Arrange for adequate time in private, comfortable location
with no interruptions
- Review relevant clinical information
- Mentally rehearse
o Script specific words and phrases to use or avoid
- Prepare yourself emotionally
B- Build A Therapeutic Environment/Relationship
- Determine patients preferences for what and how much they
want to know
- If possible, have other family members or other supportive
persons present
- Introduce yourself to everyone present and the relationship to
the patient
- Foreshadow the bad news Im sorry, but I have bad news
Warn the patient that bad new is coming
- Use touch when appropriate, avoid inappropriate humor, be
sensitive to cultural differences
- Assure patient you will be available
- Schedule Follow-up appointments
C- Communicate Well
- Ask patient or family what they already know and
understands
o Ask what the patient or family already knows
- Before you tell, askFind out the patients expectations
before you give the information
- Be frank but compassionate; avoid euphemisms and medical
jargon
o Use the words cancer or death
- Allow for silence and tears; proceed at the patients pace
- Have the patient describe his or her understanding of the
news; repeat this information at subsequent visits
- Allow time to answer; write down and provide written
information
o Be aware that the patient will not retain much of what is
said after the initial bad news
o Repeat key information
- Conclude each visit with a summary and follow-up plan

D- Deal with patient and family reactions

- Assess and respond to the patient and the familys emotional
reaction; repeat at each visit
o Be aware of cognitive coping strategies (e.g. denial,
blame, intellectualization, disbelief, acceptance)
o Be attuned to body language
- Be empathetic
o It is appropriate to say Im sorry and I dont know
- Do not argue with or criticize colleagues
o Avoid defensiveness regarding your or a colleagues
medical care
E- Encourage and validate emotions
- Explore what the news means to the patient
o Inquire about patients emotional and spiritual needs
and what support systems they have in place
- Offer realistic hope according to the patients goals
o Offer hope and encouragement about what options are
available
o Discuss treatment options
- Use interdisciplinary resources to enhance patient care (e.g.
Hospice) avoid using these means as disengaging from the
relationship
- Take care of your own needs; be attuned to the needs of
involved house staff and office or hospital personnel