A Clinician’s Guide To Delivering Bad News
Conveying bad news can be one of the most difficult duties healthcare providers encounter. Studies have shown that without proper training, the discomfort of disclosing bad news can lead to a healthcare provider emotionally disengaging with their patient.

So the question is, How to deliver bad news to my patients?

Step 1: SETTING UP the interview

This step involves preparing for the discussion with your patient. Here, you choose the location at which you will disclose your patient’s results. Plan to modify factors that could interrupt the meeting. Involve family members and make the room as comfortable as possible, such as having seats for everyone and providing tissues.

Step 2: Assessing the patient’s PERCEPTION

Ask the patient an open-ended question such as “What do you know about why we did a breast biopsy?” prior to disclosing the test results. Based on this information you can correct misinformation and tailor the bad news to what the patient understands.

Step 3: Obtaining the patient’s INVITATION

Obtain permission to discuss the diagnosis or test results. Many patients would like full disclosure of their condition and all information possible regarding treatment, prognosis, and follow-up. Some patients, however, feel less is more.

Step 4: Giving KNOWLEDGE and information to the patient

A strategy called forecasting can be used here, warning the patient that bad news is coming may lessen the shock that can follow the disclosure of bad news and may facilitate information processing. Give medical facts while avoiding overt bluntness. Try to use common words and synonyms for a medical language. Give information in small chunks.

Step 5: Address the patient’s emotions with EMPATHIC responses

Showing empathy can allow patients to feel justified in the feelings they are experiencing. In an empathic response, the clinician can ask “What are you thinking?” Once the clinician has connected to the patient’s emotion, per the protocol, the provider can use a “connecting statement” such as “I’m sorry the biopsy is showing cancer, I know this is not what you wanted to hear today.”


In my experience, starting to plan with patients helps them to feel a sense of relief and purpose, if the patient is ready for such a discussion. The clinician can further explore the patient’s wishes and incorporate his or her values into the plan.

With proper training, clinicians can disclose bad news to their patients with confidence. A process such as this one helps the provider to create a positive experience out of an otherwise heartbreaking time in their patient’s lives.

Source: https://www.mdedge.com/obgyn/article/166655/obstetrics/delivering-bad-news-obstetric-practice
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