Breaking Bad News

One of the toughest and most important jobs we have as hematologists is to break bad news to patients. Though this responsibility never gets easier, we can improve our delivery through practice and technique. The skills can be learned so do not be disheartened by one or two family meetings that do not go well. One valuable method, identified in Baile WF et al., is SPIKES (Setting up the interview; assessing the patient’s Perception; obtaining the patient’s Invitation; giving Knowledge to the patient; addressing the patient’s Emotions with empathic responses; Strategy and summary).¹

Here are a few more pointers from a fellow almost done with clinical training.

1. Be honest and upfront. Not all patients want to hear nitty-gritty statistics, but they all want to know that you are giving them a knowledgeable opinion.
2. Identify the stakeholders. In many families, decision-making may primarily be done by parents or children of patients, not the patients themselves.
3. Talk at the patient’s level (and use a translator if necessary). Some patients want to hear an update from the most recent SWOG trial, but others lack medical literacy even if they are fluent in English.
4. Allow for silence. It is important to leave time for the patient and their companions to process the information you are providing, so do not keep speaking just to help ease the tension.
5. Don’t take away hope. Even when you are presenting a terminal diagnosis without good treatment options, you can offer your support and symptomatic relief as you guide a patient through enrollment in the hospice process.
6. Enlist help if you need it. You are still in training; ask your attending for help, discuss techniques with the palliative care team, and debrief with your co-fellows.