Breaking Bad News

Maman Abdurahman, dr., SpB(K)Onk

Nano Isdiyanto, dr.

 Definition
Bad news in oncology contex has
been defined in many different ways

One common definition any news

that seriously and adversely affect
the patient view of the future

In other word the badness of news is

the gap between the patient’s
expectation and the medical reality
I’m glad this tumor Oh my God…I just
can definitely be can’t handle
removed another surgery
Breaking bad news is a complex communication task
and involves a verbal component (giving the news)

Responding to Involving the Finding ways to

patients patients in frame hope and
emotion decision-making provide support

How the What concern

information has the patient may
been received have
Why skills breaking bad news are
important ?

Breaking bad news is a key aspect of

communication with cancer patient
Cancer events warranting bad news discussions
and key communication challenges at these
points on the cancer trajectory

Prescription
The Cancer Prognosis of
of harsh
diagnosis the illness
treatment

Unexpected
Disease
or severe
recurrence
side-effects
 End of anti Discussion of
Treatment
cancer discontinuation
failure
treatment / DNR of ventilation

Sudden
Genetic test
unexpected
result
death
 SPIKES Protocol
Strategies using the SPIKES Key skills and taks Example of the clinician’s
anagram comment
1. Set up the interview Use a private space with We’re today to discuss the
uninterrupted time, results of your pathology
seated, tissues available,
consider who should be
there.
2. Review the patient’s Check understanding. I’d like to make sure you
Perception of the ilness Determine information gap understand the tests.
and expectations. Do you remember that we
Correct misunderstanding sent the tissue from your
and define your current operation to the patologist
role and goal. for examination?
3. Get an Invitation from Determine what type and Are you the type of person
the patient to deliver the how much information the who wants every bit of
news. patient want. detail, or do you prefer an
Acknowledge that overview of what we
information needs change found?
over time.
 SPIKES Protocol
4. Give the patient
Knowledge and
information.
5. Respond to the patient’s
Emotions.
6. Summarize the
treatment plan and review
all that has been
communicated
Forecast what will come. I’m afraid I’ve got some
Share the information in bad news for you.
chunk, avoiding jargon.
Draw diagrams and write The pathology show that
down details. the cancer has spread
Check understanding. through the wall of bowel
into a nearby lymph gland.
Explore emotions. I can see how upsetting
Acknowledge empathically. this is for you.
Validate the emotions Can you tell me what you
Promote a sense of are feeling right now?
support. It is very common for
patients to feel this way.
Discuss future treatment We have good treatment
options. using chemotherapy and
Check understanding and radiation for your situation.
future needs.
Review next steps.
 Conclusion

Most recommendations about the delivery of

bad news are based on ‘ best practice’ and
derive from patient preferences for receiving
information.