CAL MARITIMECompass
How to Cope with Loss, Grief, Death & Dying - Professionally & Personally
© 2002 Kirsti A. Dyer, MD, MS  All Rights Reserved. E-mail: griefdoc@journeyofhearts.org
The California Maritime Academy - CSUM California State University, Maritime
SOC 210. Dying: The Final Stage of Living February 7, 2002
Dealing with Bad News

ABCDE’s of Delivering Bad News

Advance Preparation

  • What the person already know/understand already?
  • Arrange for the presence of a support person and appropriate family.
  • Arrange a time and place to be undisturbed—no pagers or cell phones.
  • Prepare yourself emotionally.
  • Decide on which words and phrases to use—write a script.

    • Build a therapeutic environment/relationship

  • Arrange a private, quiet place without interruptions.
  • Provide adequate seating for all.
  • Sit close enough to touch if appropriate.
  • Reassure about pain, suffering, abandonment.

    • Communicate Well

  • Be direct - "I am sorry that I have bad news for you."
  • Do not use euphemisms, jargon, acronyms.
  • Use the words – "Cancer," "AIDS," "Death," "Died" as appropriate.
  • Allow for silence.
  • Use touch appropriately.

    • Deal with patient and family reactions

  • Assess person’s reaction: body responses, cognitive coping strategies, affective responses.
  • Listen actively, explore, have empathy.

    • Encourage and validate emotions, Evaluate the News

  • Address further needs:
    • What are the person’s immediate and near-term plans?
    • Is there any indication of the person feeling suicidal?
  • Make appropriate referrals for more support.
  • Explore what the news means to the person.
  • Express your own feelings.

    • Delivering Bad News
  • Choose a quiet setting.
  • Give the news in person, if possible.
  • Assess the person’s present physiologic and emotional state.
  • Prepare the person by saying there is a difficult topic to discuss.
  • Use clear, simple language.
  • Express sorrow for the person’s pain; be human.
  • Be realistic; avoid minimizing the problem.
  • Don’t take away all hope.
  • See how the person feels after hearing the news. Know of your resources for referral e.g. grief support groups, clergy.

    • Resources:
    Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who suffer. WJM 1999;171:260-263. Available as PDF file at: http://www.ewjm.com/cgi/reprint/171/4/260 http://www.ewjm.com/cgi/reprint/171/4/260  Leaving Site.
    Miranda J. Brody RV. Communicating bad news. WJM 1992; 156:83-85.

    © 2002 Kirsti A. Dyer, MD, MS, FAAETS. Journey of Hearts, www.journeyofhearts.org. All rights reserved.
    A single copy of this article can be made for personal or professional use.
    Contact Dr. Dyer at griefdoc@journeyofhearts.org for permission to use materials from this presentation for other ventures.