Avant Risk IQ factsheet

What to do when the

news is bad
It may be a normal working day for you but it might
be the most significant day in your patients life. In
fact, for most practitioners, it is always stressful to
have bad news to tell. Failing to prepare in advance
for bad news consultations may result in them not
being handled to either partys satisfaction.
Advising a patient of a serious diagnosis/poor prognosis is an
unavoidable part of a medical practitioners job. The way you
speak with a patient and provide support to them will play a
crucial role in how well the patient responds to this news.

Have a plan

Gauge how much information the patient wants to know.

Some patients want to know every detail of their diagnosis/
prognosis, while others cannot process too much information
at once. Give information in small chunks so the patient has
the opportunity to digest the information.
Answer the patients questions to the best of your ability
and admit any uncertainties. But do not offer false or
misleading hope.

Having a clear strategy for advising patients of a serious

diagnosis/poor prognosis will allow you to enter the
discussion with confidence.

Offer to speak with the patients spouse, or others, if the

patient would like this and consents to it. Identify support
systems involving relatives and friends as appropriate.

Remember, a patients or family members perspective of bad

news may be different to your own and is likely to be
affected by their individual fears, clinical understanding and
the impact of the news on their lifestyle and career.

Show empathy and understanding. Give the patient an

opportunity to express their emotions. Sometimes it can be
helpful to ask the patient what they are thinking and how
they are feeling about the news.

Prepare
Consider which other practitioners, if any, should be involved
in the discussion. Select a meeting place that is private. Allow
ample time so you do not appear rushed or impatient.
Consider if the patient should have friends, family or an
interpreter present. Be adequately prepared regarding the
patients clinical situation. Make sure you are up to date with
the facts as much as possible. Have contact details and
information about the relevant support services available.

The discussion
If you dont already know the patient, introduce yourself and
confirm that you are speaking with the correct patient.
If the relationship is already well established, you may wish to
establish a serious but supportive demeanour before
discussing the diagnosis/prognosis. A flippant or joking
familiarity is rarely appropriate.
Establish what the patient understands at this stage. This will
allow you to reinforce accurate and correct information and
also ensure you understand what the patient is expecting to
hear. It is helpful to give the patient a warning that difficult
information is coming. For example, advise the patient that
you are afraid it looks more serious than we had hoped. Speak
clearly and avoid medical jargon.

Patients often feel very alone and threatened when they are
given news that they may well have been anticipating but
hoping against hope would not occur. At this point, you have
an excellent opportunity to help mitigate their fears. This is
best done by reassuring them that you are part of a team
who will be with them as their care proceeds. Reassurance
that you will see them as required to provide support and
advice makes them feel less alone. When they are ready to
take in further information, explain the plan for treatment in
plain language.
Sometimes the patient enters a state of shock immediately
after hearing unexpected bad news. In this case, dont rush
through complex details, but provide support and empathy.
It may be best to offer another appointment at a later time,
when they are better able to process and plan.

Treatment options
Ideally, treatment options should be discussed over more
than one consultation to allow for a greater understanding
by the patient. Ensure this is a two-way conversation and the
patient considers, discusses and asks questions about each
treatment option. It is often helpful to provide written material with diagrams to facilitate the patients understanding.
It is also helpful to provide the patient with a plan of what is
to happen next and give a broad timeframe of the steps to
be taken.

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Concluding the discussion

At the end of the discussion, summarise the discussion and
encourage the patient to contact you directly with further
questions and provide appropriate contact details. Make
appropriate follow-up appointments. Ensure that the patient
is aware of other support services and provide any relevant
pamphlets/factsheets you may have. Make sure the patient is
able to make their own way home safely.
If possible, try to end on a positive note, e.g.: You do have
cancer and it is a very serious condition, but you and I will
work hard together and try and beat it. And I want you to
know I will be here for you throughout the journey.
Given the impact of psychological shock, patients often fail
to remember or mishear information given as part of a bad
news consultation. Therefore, it is especially important you
document thoroughly the details of the consultation. This
includes the names of anyone else present, and the matters
discussed with the patient, information provided and so on.
Breaking bad news can be a difficult experience for the
medical practitioner as well as for the patient; so remember
afterwards to take a short break and settle yourself before
proceeding with your next consultation.
For more advice, call Avants Medico-legal Advisory
Service on 1800 128 268.
Visit avant.org.au/risk/iq for Avant Risk IQ resources
including webinars, eLearning courses, case studies
and checklists.

This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practice
proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee
discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss
suffered in connection with the use of this information. Information is only current at the date initially published. Avant Mutual Group Limited 2015. 3381 07/15(0359)

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