Bad news can vary (e.g. cancer, STIs, type 1 diabetes, miscarriage etc.) 😢

 You must always pre-empt the patient’s emotions and feelings 

 Do not be ambiguous when giving bad news (e.g. be sure to say cancer/death etc. rather than using euphemisms or medical terminology) 

Introduction

1. Wash hands ✋ 
2. Put PPE on if appropriate 
3. Confirm patient details, including preferred name ✍  
4. Explain the purpose of the discussion 
5. If you are not their usual doctor, apologise for this  
6. Get patient consent ✅ 

Listen actively 

 Eye contact: maintain, as appropriate 👁

 Body language: Professional and relaxed (e.g. sit with arms and legs uncrossed, and lean in towards the patient slightly) 

 Nodding: to acknowledge what they are saying or asking 

 Avoid interrupting 

Build a rapport 

 Ask: check how they are, and offer them whatever they may need, such as water or a seat❓ 

 Empathise: observe the patients and/or relatives to assess their emotions 

How to structure the consultation 

The best way to do this is to adopt the SPIKE method❗ 

 Setting: choose an appropriate setting (Sitting down in a private and quiet room where you will not be interrupted, if possible! Provide tissues and ask if they would like anyone else with them. You may also find it useful to have a healthcare worker present for support) 

 Perception: discuss the events so far (scans, biopsies etc.), asses their emotional state, ask about symptoms currently present, establish what they already know or are expecting 

 Invitation: ask the patient if they want to receive the results now❓ 

 Knowledge: break the information down into smaller pieces to help them to comprehend it Say something to indicate the bad news you are about to give (e.g. “unfortunately the results were not what we were hoping for”). Pause to allow the patient and/or relatives to take this in, then deliver the diagnosis using simple language, then allow the patient to initiate subsequent conversation 

 Emotions: recognise the patient and/or relative’s emotions and respond empathetically, but do not lie when responding to questions about their prognosis 😢

Next Steps: 

 Plan to meet the patient again

 Inform them about what happens next  

 Do not rush any decision making ⏰  

 Ensure the patient understands what you have told them ✔  

 Summarise what you have told them to reiterate the most important parts❗ 

 Answer all questions❓ 

 Offer assistance going forward (e.g. details of a clinical nurse specialist who can answer any questions at a later date) ➡  

 Tell them where to find more information 

 Give any written information that may be of benefit 

 Where appropriate, ask about the patient’s religious preferences (e.g. chaplain visits) 

Post-consultation: 

1. Dispose of all PPE 
2. Wash hands ✋ 
3. Reflect on your own thoughts and feelings 
4. Take time out if you need to ⏱ 

Summary:

1. Listen actively, utilising your body language
2. Be empathetic and ask questions to build a rapport
3. Use the SPIKE method: choose appropriate Setting, be Perceptive, Invite them to receive the results, break your Knowledge and information down into smaller chunks, and be aware of their Emotions
4. Answer any questions they have, and arrange a follow up meeting