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Bad News Communication:
A 6 Step Approach to Use & Teach
Gary Winzelberg, MD MPH FACP
Division of Geriatric Medicine
Palliative Care Program
The University of North Carolina at Chapel Hill
With Support from The Donald W. Reynolds Foundation
Copyright © 2012 The University of North Carolina School of Medicine at Chapel Hill
Objectives
• Recognize bad news communication as a
core physician skill
• Understand the six basic steps used to
initially deliver bad news
• Practice giving feedback to a resident whom
delivered bad news
• Identify & discuss challenges of providing
feedback about a sensitive topic
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Today’s workshop
• Folder with group lists, physician information
sheets and resident evaluation forms
• 2 cases with SPs – Jennifer Hawkins (breast
cancer) and Pat Smith (colon cancer)
• Choose 1 group member to share bad news
(maximum 10 minutes)
• Other group members observe, give
feedback (maximum 5 minutes)
» Use evaluation form to help structure
feedback
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SPs will switch rooms after 15 minutes
Share bad news with 2nd SP, give feedback
Large group discussion
Lunch
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Delivering Bad News -- Procedure
• Interpersonal & communication skills –
ACGME core competency & common
program requirement
• “Residents must demonstrate interpersonal
and communication skills that result in the
effective exchange of information and
collaboration with patients, their families, and
health professionals.”
• Bad news communication = skill to teach,
evaluate, improve
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Difficulties in Communicating Bad
News
• Many physicians feel unprepared
• Discomfort with strong emotion
• Desire to protect the patient
• Desire to soften the bad news
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Bad News
• Any information threatening to a patient’s
health, sense of wellbeing
• Examples: cancer, chronic diseases,
pregnancy, developmental delay
• Six step communication approach
» Evidence-based
» Expert opinion
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1. Set up the interview
• Preparation
» Review history & data – know the facts
» Decide with learner how news will be
communicated
• What will happen if encounter doesn’t go well?
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Setting
Involve significant others
Sit down
Manage time constraints and interruptions
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2. What does the patient know?
• Before you tell, ask.
• Assess the patient’s ability to comprehend
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3. Obtain the patient’s invitation
• Some patients don’t desire full information
• May address prior to test ordering
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4. Share the information
• Give a warning shot
» Unfortunately I have some bad news to share
» I wish I didn’t but I have bad news about your
test result
• Stop, wait, and listen
• Minimize jargon
• Give information in small chunks
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5. Address emotions
• Observe
• Name the emotion
• Legitimate
» Many people would feel…
• Explore
• Make empathic statements
» I can see how upsetting this is to you
» I realize that this is a shock
» I was also wishing for a different result
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6. Planning and follow-up
• Next steps
• Timing of future communication
• Contact information
• Patient support
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Evaluation Form
• Includes feedback on each of six steps
• This session: Focus feedback on #4 and #5.
• Identify strengths and areas for improvement
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Acknowledgements and
Disclaimer
This project was supported by funds from The Donald
W. Reynolds Foundation. This information or content
and conclusions are those of the author and should not
be construed as the official position or policy of, nor
should any endorsements be inferred by The Donald
W. Reynolds Foundation.
The UNC Center for Aging and Health, the UNC
Division of Geriatric Medicine also provided support for
this activity.
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Copyright © 2012 The University of North
Carolina School of Medicine at Chapel Hill
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