Table 1.

The essential elements of delivering bad news for emergency physicians

Steps	Examples	Why Important?
Set up	Sit down, private settings, avoid interruptions, involve loved ones	Small steps can maximize the delivery of the bad news in the most patient-centered approach.
Perception	Ask what they heard already: “What have you heard about todays’ test?”	Understanding patient’s perceptions and expectations can allow emergency physicians to anticipate the prognostic awareness.
Invitation	Obtain permission to talk about the news: “Would it be ok if I share bad news?”	When patients are asked for permission, they perceive a sense of control in uncontrollable situations in the ED.
Knowledge	Disclose the news clearly: “The CT scan showed blood clots and a new cancer in the liver – I am worried that the cancer is getting worse.”	Avoid jargon like pulmonary embolism, metastatic disease, etc. Clear headlines: short messages and their overall implications for the patient
Emotion	Respond to patient’s emotional response: “This is disappointing and overwhelming.”	Without acknowledging and empathizing with patients’ emotions, patients cannot process the information being communicated.
Summary	Summarize and discuss next steps: “The key things that I want you to know are”	Next steps after

Data from Kei Ouchi, MD.