How to communicate bad news to your patients

An aging population means family physicians are increasingly responsible for giving patients and their families devastating news. Taking an individualized yet systematic approach can help you feel more confident and reduce your patients’ suffering:

1. Assess the patient’s understanding. Ask “What is your understanding of your condition?” This helps you determine a starting point for the conversation by building on what the patient already knows.

2. Give a “warning shot.” Prepare the patient and family for the news by saying, “I’m sorry. I have bad news.” Wait for them to give you their full attention.

3. Present the bad news using words the patient will understand. Avoid medical jargon. Use plain words such as “terminal” or “cancer” to reduce the potential for misunderstanding.

4. Be quiet and listen. Allow the patient or family to make the next move. If the silence is prolonged, ask how they are feeling. Validate emotional responses by saying, “You must feel terrible,” but avoid saying you know how they feel unless you really do.

5. Provide additional information, if asked. Use a “peel the onion” strategy, presenting additional information at the patient’s pace, one layer at a time. Do not convey more optimism than is realistic.

6. Develop a plan for follow-up care. Schedule a time to get together again to answer any questions the patient or family come up with after the initial shock wears off. Avoid making statements that sound distancing, such as “There is nothing more we can do.” You may not be able to cure the patient’s disease, but there is always something you can do for the patient.

Adapted from “Communicating Bad News to Your Patients.”