There is an evident deficiency on how best to break bad news in medicine. This is an essential communication skill that our patients expect of us. It is an essential requisite of Good Medical Practice. This presentation is part of a course held at Al Hammadi Hospital, Suwaidi, Riyadh, KSA on Breaking Bad News. 2017

1. BREAKING BAD NEWSA N E S S E N T I A L C O M M U N I C A T I O N S S K I L L
D R M O H A M A D A L - G A I L A N I
C O N S U LTA N T S U R G E O N
B R E A K I N G B A D N E W S C O U R S E
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2. BAD NEWS
•Any news that drastically and
negatively alters the patient’s view
of his or her future
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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3. EXAMPLES OF BAD NEWS
•Cancer diagnosis
•Intra uterine foetal death
•Life long illness e.g. Diabetes, epilepsy
•Poor prognosis related to chronic diseases e.g.
heart failure
•Informing parents about their child’s serious
mental/physical handicap
•Non clinical situations like giving feedback to
poorly performing trainees or colleagues
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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4. PATIENT’S AND FAMILY
EXPECTATIONS
Privacy
Empathy
Dignity
Clarity of message
Competency
Time for questions
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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5. PATIENTS HAVE A RIGHT TO:
• Accurate and true information
• Receive or not receive bad news!
• Decide how much information they want or do not
want
• Decide who should be present during the
consultation, e.g. Family members
• Decide who should be informed about their diagnosis
and what information that person(s) should receive
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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6. RESPONSES TO BAD NEWS
• Denial
• Shock
• Anger
• Guilt
• Blame
• Agitation
• Helplessness
• Sense of unreality
• Misinterpreting
information
• Regret/anxiety
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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7. DO…
• Ensure privacy and
confidentiality
• Respect
• Honest
• Simple language
• Listen
• Sensitive to the non-
verbal language
• Allow for silence, tears
and other patient
reactions
• Document and liaise
with the
multidisciplinary team
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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8. DO NOT…
•Overload with
information
•Distort the truth
•Give false
reassurance
•Feel obliged to keep
talking all the time
•Withhold information
•Assume that you
know what is
concerning the
patient
•Criticize
•Make judgements
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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9. AVOID
1. Meeting in public
2. Being alone
3. Hurrying!
4. Not being prepared!
5. Interrupted by your mobile phone!
6. Patronizing e.g. It is all your fault you smoked!
7. Give prognosis e.g. You have 6 months to live!
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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10. BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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11. 1. S: SETTING
Arrange for some privacy
Sit down
Make connection and establish rapport with
the patient
Manage time constraints and interruptions
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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12. 2. P: PERCEPTION
Determine what the patient knows?
Listen to the patient!
Accept denial but do not confront at this
stage.
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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13. 3. I: INVITATION
Ask patient if they wish to know?
Accept patient’s right not to know!
Offer to answer questions later if they wish
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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14. 4. K: KNOWLEDGE
Use language appropriate to patient
Give information in small chunks
Give diagnosis e.g. Cancer
Give any positive aspects e.g. Cancer has not
spread
Check whether the patient understood what
you said!
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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15. 5. E: EXPLORE
Prepare to give an empathetic response
Give the patient time to express their
feelings then respond
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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16. 6. S: STRATEGY (SUMMARY)
Ask whether they want to clarify
something else?
Offer agenda for the next meeting e.g. I
will speak to you again when we have the
opinion of cancer specialist.
Close the interview
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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17. V I D E O
H O W N O T T O
B R E A K B A D N E W S
B R E A K I N G B A D N E W S C O U R S E 3 R D F E B R U A R Y
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18. HOW NOT TO
BREAK BAD NEWS
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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Scenario: Relative informed (in public) by a junior doctor of the
passing away of his father admitted to ER with a heart attack!

19. VIDEO SCENARIO
•What went Wrong in this scenario?
1.Conducted in Public
2.Not given by the appropriate person
3.No Privacy
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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20. S C E N A R I O
NEW
BREAST CANCER
DIAGNOSIS
( T h e c a s e o f M r s . A m a l )
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI
2017

21. SCENARIO: (The case of Mrs. Amal)
•10 minutes (Scenario): The Consultation
between Mrs. Amal and her surgeon Dr.
Lee.
•10 minutes: Observer remarks.
•10 minutes: Course Participants’ remarks
•General Discussion & Questions.
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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22. SCENARIO: (The case of Mrs. Amal)
• Mrs. Amal is a 38-year-old housewife who presented
with a 3-week history of feeling a lump in her right
breast.
• She has last week seen her surgeon Dr. Lee who after
examining her ordered investigations.
• The investigations included a mammogram,
ultrasound and a needle core biopsy from the lump
her right breast.
• She has come today for the Results of herBREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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23. SCENARIO:
1. S: “Good afternoon Mrs. Amal”
2. P: “What do you know so far Mrs. Amal”?
3. I: “Would you like me to discuss your results”?
4. K: “I’m afraid I have some bad news for you”, K “The test
results regrettably confirmed my fears…of breast cancer”
5. E: Checks the patient has understood the bad news E Let
patient ask questions and to discuss their concerns E Gives
room to the patient’s feelings and silence.
6. S: “Can I summarize what we have discussed”, S “I will
arrange for us to meet again next week”, S “Goodbye Mrs.
Amal, see you next Monday with your husband”
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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24. OBSERVER COMMENTS:
CASE OF MRS. AMAL
• What went well? Privacy, Eye Contact, No
Interruptions.
• Was it according to “SPIKES”? Yes
• Did Dr. Lee show Empathy, Knowledge,
Summate? Yes
• What could have been done better? Presence of
a Chaperon (Nurse), More Listening, Time for
Silence!
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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25. BREAKING BAD NEWS
SUMMARY
•A Difficult But Fundamentally Important Task
for All Health Care Professionals.
•Focused Training in Communication Skills &
Techniques Improves Performance.
•Enhances Patients’ Satisfaction & Physicians’
Comfort.
•An Essential Skill of Good Medical Practice.
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
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26. D R . M O H A M A D A L - G A I L A N I F R C S
‫ي‬ ‫ن‬ ‫ال‬ ‫ي‬ ‫ك‬ ‫ل‬ ‫ا‬ ‫د‬ ‫م‬ ‫ح‬ ‫م‬ ‫ر‬ ‫و‬ ‫ت‬ ‫ك‬ ‫د‬ ‫ل‬ ‫ا‬
C o n s u l t a n t S u r g e o n
‫ي‬ ‫ر‬ ‫ا‬ ‫ش‬ ‫ت‬ ‫س‬ ‫ا‬ ‫ح‬ ‫ا‬ ‫ر‬ ‫ج‬
M e d i c a l E d u c a t i o n & T r a i n i n g D i r e c t o r
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A l H a m m a d i H o s p i t a l , S u w a i d i
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R i y a d h , K S A
‫ض‬ ‫ا‬ ‫ي‬ ‫ر‬ ‫ل‬ ‫ا‬,‫ة‬ ‫ي‬ ‫د‬ ‫و‬ ‫ع‬ ‫س‬ ‫ل‬ ‫ا‬ ‫ة‬ ‫ي‬ ‫ب‬ ‫ر‬ ‫ع‬ ‫ل‬ ‫ا‬ ‫ة‬ ‫ك‬ ‫ل‬ ‫م‬ ‫م‬ ‫ل‬ ‫ا‬
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