1. Dr Sara Matley – Consultant Clinical Psychologist, LGI
Dr Rachel Avison – Senior Clinical Psychologist, LGI

2. Introductions Dr Sara Matley Mrs Jayne Slack
Senior Counsellor
Dr Sara Matley
Consultant Clinical Psychologist
Dr Rachel Avison
Senior Clinical Psychologist
Dr Nadia Khurram
Clinical Psychologist
Sandie Allison
Counsellor

3. On a lighter note…

4. On a more professional note…
1. Everyone here will have:
Delivered bad news
Observed someone receiving bad news
Experienced bad news first hand
2. Whether bad news is delivered or received,
it can be a difficult and emotive experience for all
3. As a result, look after yourself.
If you need to step out it’s fine to do so

5. Breaking bad news well Patient/ Carer Professional Influences…
- Emotional health & adjustment
- Physiological health
(e.g. blood pressure, pain)
Influences…
- Emotional health
(e.g. stress, burden, burn out)
- Physiological health
Patient/ Carer
Professional

6. What helps? A structure Kaye’s 10 step approach - Kaye (1999)
SPIKES model - Baile & Buckman (2000)
ABCDE mnemonic - Rabow & McPhee (2000)
Communication
Preparation
Planning
Follow up

7. Prepare the patient/ family
1. Preparation
Prepare yourself
Prepare the setting
Prepare the patient/ family

8. Prepare Yourself High anxiety normal Avoidance common
Remember, the news may be very sad but having info allows patients/ families to plan & process
Take time - review patient info & plan what to say
More contained, better experience for all
Take a colleague if possible

9. Prepare the setting Ensure protected time
Privacy – a quiet room ideal, if not, make space
‘Do not disturb’
All sit down, no barriers between you
Handover phones/ bleeps
Tissues, water nearby

10. Prepare the patient/ family
Is the patient/family ready to receive difficult news?
Child present? Their Developmental level?
Communication needs? Signer, interpreter, support worker
Any religious, cultural, ethical views?

11. Prepare the patient/ family
Before you tell, ask. What does the patient/ family know already?
Denial, wishful thinking, unrealistic expectations?
Obtain permission to have a conversation
Share that difficult news is coming
Start with the facts, minimal technical language
Give the info in small sections
Pause throughout to allow processing

12. 2. Communication
Rapport – eye contact, emotional warmth, summarise, ask questions, open, honest communication
Look for cues
Less sympathetic statements – ‘I’m sorry about this’ ‘I understand’ ‘I know this is very sad’
More empathic statements - ‘this will be very difficult news for you to hear’ ‘it’s a really tough situation’ ‘this is very sad’
Silence is important, no need to fill gaps, take time
‘Sit with’ rather than fix - hold back with advice. Reassurance can be unhelpful

13. 3. Planning End the conversation with a summary
Ask patient/ family what would help
Then make recommendations/ suggestions about support
Arrange a follow up conversation - very likely the patient/ family may not recall the details of the conversation (20%)

14. 4. Follow up Debrief and reflect Document the conversation
Work as a team in exploring support options, e.g. CNS contact, Psychology referral, Play Specialist input, Childrens Heart Surgery Fund
Summarise the discussion and support plan in writing if required
Supervision & mentoring

15. Psychological Continuum

16. Thank you for listening! Any questions, comments, thoughts?

17. References
Baile W et al. (2000) SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer, Oncologist, 5, pp
Kaye P (1996) Breaking bad news: A 10 step approach, Northampton: EPL
Rabow MW & McPhee SJ (1999) Beyond breaking bad news: How to help patients who suffer, Western Journal of Medicine, 171, pp
Royal College of Nursing Guidance document (2013) Breaking bad news: Supporting parents when they are told of their child’s diagnosis.
University Hospital of South Manchester - Sage & Thyme Training