You have to determine what the patient knows about their current situation before starting a discussion about the next phase.
"What is your understanding of your illness?"
Warning shot:
Warn them about the bad news to come " I am afraid I have some bad news for you"
Pause: Give them a moment to compose themselves and get ready to hear the news
Deliver the news:
Use short sentences.
Make it non technical to the extent possible.
" As you may recall, we did a CT scan of your lungs. The results show that the cancer has come back"
Sympathetic silence:
Give them time to process the bad news. Don't rush into the next steps
Allow them to assimilate the information
Answering questions:
Be prepared to repeat the information: sometimes the impact of the information is so great that patients may want to hear it a second time
Answer questions kindly and honestly
If you do not know the answers please state so
If the next step is uncertain state so.
Assure nonabandonment:
Assure the patient that you will be willing and available to support them on an ongoing basis.
" I am here to support you. I will still be your doctor no matter what happens"
Follow up:
Make clear plans for follow up.
Please write our instructions briefly and clearly and hand it to them
Give them guideline how about how best to get in touch with you/designee
De-brief and self-reflection:
Be aware that your colleagues (trainees, multi disciplinary clinicians) often have strong reactions to these situations. Be sure to check in with them.
Be aware of your own responses. Be kind to yourself.
