Listening mode: do not interrupt the patient or talk over the patient
Silent pauses to allow patient to talk
Repetition as a means to acknowledge what the patient is saying
Availability – silence phones etc.
Perception: “before you tell, ask”
Allows patient’s expectations to be understood – gives an estimation of the “impact” of the bad news, and an opportunity to impart knowledge before breaking bad news or dealing with anger
Ask patient what they know of the situation
What did you think was going on when you felt the lump?
What have you been told about all this so far?
Are you worried that this may be something serious?
Take note of the language the patient is using, and use a similar vocabulary
Do not confront denial head on initially
Invitation
Check that a patient really wants to know what is going on before delivering news
Are you the kind of person who prefers to know all the details of what’s going on?
Knowledge or sign posting
Give patients a warning of what is about to come, so they have more time to mentally prepare
Sir, unfortunately the news I have is concerning. Would you like me to proceed at this stage?
Ma’am, I’m so sorry, but I have troubling news.
Avoid jargon
Give information in small chunks
Check understanding at frequent intervals
Go over information again if news is not acknowledged
Always check after each “chunk” that the patient is ok to proceed with the discussion
Tailor the rate of the discussion – slow down if the patient is having difficulty processing
Empathy: responding to patient’s emotions
Do not downplay the severity of the information, or hold information back unless specifically asked
This may just serve to discredit in the future, or shake trust
Acknowledge patient’s emotions when they arise, and address them
Listen for and identify the emotion. If unsure:
How does this make you feel?
What do you make of what I have just told you?
Identify the source of the emotion – e.g. the bad news, delayed diagnosis etc.
Show the patient that the connection between the above two has been made
I can see that this news is terribly distressing for you
Hearing the results of the bone scan is a major shock for you
Normalize the emotions
Such responses validate a patient’s emotions, and reduce isolation
Strategy and summary
Summarise the information given to the patient in the discussion
Check for any concerns or questions not addressed
Give the patient a plan of action
Give the patient a safety net and assurance of follow-up
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