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Taking The Sting Out Of Bad News

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While the news may be bad, the manner in which it is delivered can make it either traumatic or bearable, says Dr Elly Hann, an expert on end-of-life care programme.  And what is interesting is that the technique applies not just to patients detected to have cancers, but to any bad news like loss of a job, failure in an examination, or a failed relationship,
It is being increasingly realized that bad news, no matter how bad, needs to be told rather than concealed, as getting to know it helps the patient or victim to cope better and set realistic goals. Recent research contradicts traditional belief that it takes away hope plunging people in irretrievable despair. That is of course if the news is communicated properly.
The currently accepted technique of delivering bad news that we might all find universally useful in our own lives, has 6 steps.
Step1: Getting started. A little thoughtful preparation needs to go into ascertaining and reconfirming the unpleasant facts before telling them and in creating the right environment, ensuring adequate time and deciding who else needs to be in the room. Breaking bad news, such as the test report showing cancer, cannot be done with frequent interruptions by cell-phone calls, or in a crowded room,  or in haste as while rushing to work on the corridor. You would realize that similar factors would apply while you tell your son about his poor results in an examination or discuss a breakup with your romantic partner.
Step 2: In this step one explores what is already known. The patient may be aware of the diagnosis and may be seeking a validation.
Step 3: is finding out how much the patient wants to know. In Asian cultures, an elderly woman may not want to know the diagnosis, and may delegate the responsibility to her eldest son to find out and decide further. Her wish needs to be respected.
Step 4: is the actual sharing of the information. It should be straight-forward but delivered with sensitivity. It is useful to give a few warning shots such as “The results have come. I am afraid the news is not good” or “I have something serious to discuss with you, unfortunately it is not good news” . Then the news needs to be stated, briefly, clearly and unemotionally. Then WAIT. Let it sink in and let the patient emotionally process the information. Non-verbal communication, such as putting your hand on his shoulder, is of more value at this stage than a long flow of words which the patient may have stopped listening to. Start speaking only when he has responded.
Step 5: is to respond to the feelings that the bad news generates; it can range from depression, anger, and guilt. One needs to be a good listener at this stage, allowing the patients verbal emotions to flow.
Step 6: is to offer follow up and to reassure non-abandonmnent. Break up of a relationship can be hurting, but to decide to part on pleasant terms without animosity or hostility, and remain in touch as friends, will ensure a smoother life ahead for both.
Let us try to take the sting out of bad news in our clinics, homes and offices.
 As published in HT City (Hindustan Times) dated 21 november , 2010.

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