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ABCDE’s of Delivering
Bad News
Advance Preparation
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What the patient already know/understand already?
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Arrange for the presence of a support person and
appropriate family
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Arrange a time and place to be undisturbed (Hand
off beeper!)
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Prepare yourself emotionally
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Decide on which words and phrases to use—write a
script
Build a therapeutic environment/relationship
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Arrange a private, quiet place without interruptions
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Provide adequate seating for all
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Sit close enough to touch if appropriate
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Reassure about pain, suffering, abandonment
Communicate Well
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Be direct - "I am sorry that I have bad news for
you."
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Do not use euphemisms, jargon, acronyms
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Use the words – "Cancer," "AIDS," "Death" as appropriate
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Allow for silence
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Use touch appropriately
Deal with patient and family reactions
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Assess patient reaction: physiologic responses, cognitive
coping strategies, affective responses
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Listen actively, explore, have empathy
Encourage and validate emotions,
Evaluate the News
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Address further needs: What are the patient’s immediate
and near-term plans, suicidality?
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Make appropriate referrals for more support
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Explore what the news means to the patient
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Express your own feelings
Source
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 |
