Table 1.
A step-by-step protocol for communicating badnews*
| Step | Description |
|---|---|
| Prepare for the encounter | If possible, have advance discussion with patient about who will be present |
| Find a location with adequate privacy | |
| Arrange adequate time for discussion | |
| Review the clinical information | |
| Assess the patient's understanding | Introduce everyone present |
| Assess the patient's understanding of the situation | |
| Find out how much patient wants to know | |
| Discuss the news | Provide information honestly and in simple language |
| Tailor amount of medical details and technical language to patient wishes | |
| Respond to the patient's emotions | Encourage patients to express their emotions |
| Acknowledge the patient's emotions and empathize | |
| Tolerate silence | |
| Offer to discuss implications of the news, including | Prognosis |
| Treatment options | |
| Effect on quality of life | |
| Assistance talking to others | |
| Identify support services | |
| Summarize the discussion | Restate important points |
| Ask if there are any other questions | |
| Arrange a follow-up time for patient and family questions and concerns | |
| Document the discussion in the medical record |
*
From Girgis and Sanson-Fisher,2 Baile et al,16Buckman and Baile,17 and von Gunten et al.18