Breaking Bad News

1. Breaking Bad News

2. Breaking Bad News • What do they know already? • An understanding of their medical condition. • The possible outcome of the assessment. • Their prognosis. • Other options. • Future strategies.

3. Breaking Bad News • Waiting • Shock • Uncertainty • Fear • Anxiety • Hope • Depression

4. Breaking Bad News • Everyone is different • Emotions • Reactions • Self esteem • Responses • Personal identity/control/virility • Perceptions of what is bad news

5. Breaking Bad News • Prolonged or chronic illness • Succession of bad news. • Continuing fear/anxiety. • It is not just the patient who suffers. • Waiting for news can be the most difficult part. • Relationship with the professionals is crucial.

6. Breaking Bad News • What does one say? • Identify the key person(s) and make eye contact. • GET TO THE POINT. • Give them time to absorb information. • Use silence. LISTEN and watch. • Use touch if appropriate. • Enable them to feel that they have met someone who cares.

7. Breaking Bad News Giving support requires • A caring, listening ear • Availability and time • Unquestioning acceptance • Confidentiality • Self awareness • Strategies for dealing with your own feelings

8. Breaking Bad News Giving Support • Build rapport • Use non-verbal empathy • Pace feelings – allow emotions to be expressed • Pace and lead • Pace beliefs and opinions • Pace emotions • Break rapport – non-verbally first

9. Breaking Bad News Listening skills • Focus on the other person • Keep still • Use appropriate body language • Give non-verbal response • Use questions • Summarise what you have heard. • USE SILENCE

10. Breaking Bad News Gathering and Using the Information • Remaining objective • Questioning • Summarising • Agreeing objectives • Agreeing strategies / solutions

11. Breaking Bad News Helping to set realistic goals • Identify short term goals first • Discuss first steps and how they might be achieved • Try to start with what is most important to the other person • Build on any success already made • Identify successful strategies from the past • Hold out long term goals as encouragement for the future • Celebrate success

12. Breaking Bad News Particular Challenges • Supporting people you know very well • Supporting people over a long period of time • Supporting in situations with which you are very familiar • Supporting couples • Supporting when your own beliefs are challenged • Dealing with other people’s anger • Letting go

13. Breaking Bad News • Vital elements • Be yourself. • Be clear and honest. • Watch and listen. • Don’t be afraid of silence. • Have your own support strategies

14. Breaking Bad News • Afterwards • Try to leave them with someone to give support. • If possible be prepared to come back if they want to speak to you again. • Try to send them away with something tangible for later reference. • Have a debrief for yourself if necessary.